Objective Intra‐amniotic injection of digoxin is a well‐known method for feticide before inducing a termination of pregnancy (TOP) at 17–24 weeks of gestation. Information on its effectiveness when administered after 24 weeks of gestation is limited. This study evaluated the efficacy of intra‐amniotic digoxin injection for inducing fetal demise within 18–24 hours, at 21–30 weeks of gestation, and its safety. Design Prospective cohort study. Setting Tertiary university medical centre. Population Women at 21–30 weeks of gestation with a singleton pregnancy, admitted for TOP. Methods Intra‐amniotic injection of 2 mg of digoxin was performed 1 day before medical TOP. Fetal heart activity was evaluated by ultrasound for 18–24 hours after the injection. Serum digoxin level and maternal electrocardiogram (ECG) were evaluated 6, 10, and 20 hours after injection. Main outcome measure Frequency of successful fetal demise. Results Fifty‐nine women participated in the study. The mean gestational age was 24+2 weeks (range 21+0–30+0), with 29 (49.2%) beyond 24+0 weeks of gestation. Fetal cardiac activity arrest was achieved in 55/59 cases (93.2%). Normal maternal ECG recordings were noted in all cases. Mean serum digoxin levels 6 and 10 hours after injection were in the therapeutic range (1.3 ± 0.7 ng/l and 1.24 ± 0.49 ng/l, respectively) and below the toxic level (2 ng/l). Extramural delivery following digoxin did not occur. There were no cases of chorioamnionitis. Conclusion Intra‐amniotic digoxin for feticide at 21–30 weeks of gestation in a singleton pregnancy appears effective and safe before TOP at advanced gestational ages. Tweetable abstract This study shows that feticide by intra‐amniotic digoxin injection at 21–30 weeks of gestation appears effective and safe.

Study Objective: The study aimed to evaluate whether there is an association between the ovarian ligament length and ovarian torsion. Design: This is a prospective cohort study. Design Classification: II.2. Setting: The study was conducted in the gynecology department of a university affiliated hospital. Intervention: We measured the length of the ovarian ligaments during laparoscopy. Patients: A total of 56 women were recruited, of which 28 women were operated for ovarian torsion (torsion group) and 28 others for other gynecologic conditions (control group). Measurement and Main Results: The study found correlations between ovarian ligament length and ovarian torsion. The length of the right (2.2 ± 0.6 cm) and left ovarian ligament (2.3 ± 0.8 cm) in the control patients were similar. Ovarian torsions occurred mainly on the right side (67.9 %). The right ovarian ligament was significantly longer in the torsion group (3.2 ± 0.9 cm) than in the control group (2.2 ± 0.6 cm; p < 0.001). Even after exclusion of patients with ovarian cyst, the ovarian ligament was still significantly longer in the torsion group as compared to the control group (3.2 ± 1.1 vs. 2.2 ± 0.6 cm respectively, p = 0.01). Conclusion: Our results suggest that increased length of ovarian ligament might be correlated with the development of ovarian torsion. This could be a basis for ovarian ligament fixation or oophoropexy at the time of conservative surgery for ovarian torsion.

Background Postcoital bleeding (PCB) is a common gynecological symptom that may cause concern among both patients and physicians. Current literature is inconclusive regarding management recommendations. Objective To identify risk-factors for dysplasia/cancer among patients presenting post-coital bleeding (PCB). Methods Using large health maintenance organization (HMO) database, all women reporting PCB in 2012–2015 were identified. PCB patient records in a single colposcopy center were reviewed. Age, marital status, ethnicity, gravidity, parity, BMI, smoking, PAP smear result (within 1 year of PCB presentation), colposcopy and biopsy results were recorded. Cases were matched by age and socio-economic enumeration area to controls accessing primary care clinics for routine care. Results Yearly incidence of PCB ranged from 400 to 900 per 100,000 women; highest among patients aged 26–30 years. Among the sample of 411 PCB cases with colposcopy, 201 (48.9%) had directed biopsy. Biopsy results included 68 cervicitis (33.8%), 61 koilocytosis/CIN 1/condyloma (30.3%), 44 normal tissue (21.9%), 25 cervical polyp (12.4%), 2 CIN 2/3 (1%) and 1 carcinoma (0.5%). Positive predictive value for koilocytosis/CIN 1 or higher pathology was 15.6% (64/411) and 0.7% for CIN 2 or higher grade pathology (3/411). In conditional logistic regression, multiparty was a protective factor: OR 0.39 (95% CI 0.22–0.88, P = 0.02), while pathological PAP smear was a related risk-factor: OR 3.3 (95% CI 1.31–8.35, P = 0.01). When compared to controls, PCB patients were significantly (P = 0.04) more likely to present CIN 1 or higher grade pathology (OR 1.82, 95% CI 1.02–3.33). Conclusions Study results indicate that PCB may require colposcopy, especially for nulliparous women with an abnormal PAP smear.