The current study highlights the natural history of antenatally detected hydronephrosis. Mild fetal hydronephrosis appears to be associated with an excellent prognosis and probably represents the group with physiological renal pelvic dilatation. Moderate/severe fetal hydronephrosis is associated with poorer outcome and is perhaps the group that will need more intense follow up both antenatally and postnatally.

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think that the requirement of additional oxytocin limited the comparison of ST changes between groups.Oxytocin was diluted with normal saline to a total volume of 10 ml and then given as an i.v. bolus dose in 1 minute. ST changes occurred within 120 seconds of the bolus, and as electrocardiograms (ECGs) were recorded by continuous ambulatory ECG monitoring, these observations are accurate and could not have occurred earlier. In the study by Svanstrom et al.,3 oxytocin was undiluted, and was given as a quick bolus over a few seconds, which could explain the difference in time of occurrence.We agree to the fact that atropine use was relatively high in this study, and it cannot be excluded that the effects of atropine may have had an influence on outcome variables. However, there was no difference in the number or quantity of doses between groups. The timing of atropine administration was 11 ± 4 versus 16 ± 7 minutes (mean ± SD) prior to delivery in the 5-and 10-iu groups, respectively (P = 0.1).We did not find a reason to stop the study after the interim analysis, despite the high prevalence of ST depressions, as the calculation was uncertain, there were only a few cases with an elevation of troponin I, and, as pointed out previously, the use of 10 iu oxytocin was common practice in Sweden at that time. The procedure used for the sample size calculation could possibly have biased the results in favour of a type-I error, which was addressed as a limitation to the study.The aim of our study was to investigate whether there was a difference in the rate of ECG changes indicating myocardial ischemia between two different doses of oxytocin, and not to investigate the optimal dose of oxytocin for maintenance of uterine tone. Valuable studies on these issues have shown that oxytocin bolus doses can be reduced or omitted in the non-labouring women, although the requirement of additional uterotonics is not uncommon in these low-dose regimens. Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse Sir,We read with interest the study by Price et al. 1 It was reported that this technique is a uterus-sparing surgical procedure for correction of uterine prolapse. Many women are now increasingly requesting uterine conservation, for a variety of reasons, including preservation of their fertility. It was mentioned that these women should subsequently be delivered by elective caesarean section because the mesh could potentially prevent cervical dilatation. Of the 51 women in their study it was stated that none have so far become pregnant. We would like draw attention to our report of a woman who underwent a laparoscopic sacrohysteropexy and went on to have a successful pregnancy. This 31-yearold lady became pregnant a year after the procedure. She experienced a normal pregnancy and was delivered by elective caesarean section at term. Follow up postpartum revealed a well-supported uterus, the sacrohysteropexy repair remaining intact. This emphasises the strength of the operation, w...

Radical Vaginal Trachelectomy (RVT) is a fertility sparing technique first described by D’Argent in 1994.1 This involves removal of the cervix and parametrial tissue, laparoscopic bilateral pelvic lymph node dissection (LND), and insertion of isthmic cerclage suture. Subsequent or continuing pregnancy management is challenging.2,3 We describe the case of a 27 year old woman, Para1, with a smear noting severe dyskaryosis. Large loop excision of the transformation zone (LLETZ) noted cervical intra-epithelial neoplasia (CIN) 3 and multiple foci of early invasive Squamous Cell Carcinoma. Magnetic Resonance Imaging (MRI) noted no lymphadenopathy, giving FIGO Stage 1b1. Pre-operative bloods noted a positive BHCG, and a 5-week gestational sac was detected on subsequent ultrasound scan (USS). Options were discussed and she chose modified RVT and pelvic LND at 10 weeks. Histology returned clear. She had regular USS for cervical length and fetal growth, which remained normal. A low vaginal swab was taken, and prophylactic antibiotics given every 4 weeks, with steroids at 32 weeks. She underwent elective caesarean section at 35+5 weeks via Pfannenstiel and high transverse incisions. She delivered a healthy male infant, weighing 3230g, with normal apgars. A subsequent 3 day admission to Special Care Baby Unit (SCBU) occurred due to grunting and rash. She required cervical dilation and removal of cerclage on Day 3 postpartum, due to stenosis and endometrial collection. She was discharged on Day 6 and proceeded to laparoscopic hysterectomy and bilateral salpingo-oophorectomy 1 month later. Histology was negative and follow-up to date is clear. References D’Argent D, et al. Pregnancies following radical trachelectomy for invasive cervical cancer. Gynaecologic Oncology 1994;52:105 Shepherd JH, et al. Radical vaginal trachelectomy as a fertility-sparing procedure in women with early stage cervical cancer-cumulative pregnancy rate in a series of 123 women. British Journal of Obstet and Gyn 2006;113:719–724 Ungar L, et al. Abdominal radical trachelectomy during pregnancy to preserve pregnancy and fertility. Ostet Gynecol. 2006;Sep;108(3pt2):811–4

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