Arianna D'Angelo

Effect of inner myometrium fibroid on reproductive outcome after IVF

To evaluate the influence of inner myometrium fibroids (myomas) on the outcome of IVF cycles, a retrospective agematched controlled study was performed at SISMeR Reproductive Medicine Unit. The study group included 129 IVF/intracytoplasmic sperm injection cycles in 75 patients with one or more intramural and/or submucosal fibroids, while the control group consisted of 129 cycles in 127 patients without fibroids. The two groups were similar for mean oestradiol concentration at human chorionic gonadotrophin administration (1205.16 +/- 874 versus 1395 +/- 821 pg/ml), mean number of transferred embryos (2.02 +/- 0.4 versus 2.14 +/- 0.6) and clinical pregnancy rate (34.9 versus 41.1%). Conversely, the implantation rate was significantly lower in the study group (18.0%) than in the control group (26.5%; chi(2) = 4.81, P < 0.05), whereas the rate of spontaneous abortion demonstrated an opposite trend (40 versus 18.9%; chi(2) = 4.34, P < 0.05). Further research should be aimed at classifying fibroids on the basis of their location, especially when they are positioned in the junctional zone of the myometrium. Whether this classification will be superior in predicting the impact of fibroids on the reproductive outcome should be elaborated in a large multicentric study.

Uterine leiomyosarcoma discovered after uterine artery embolisation

in some cases (O’Mara et al., 1979; Neil et al., 1987). Although the diagnosis is rarely made on clinical grounds alone, the plain abdominal radiograph shows diagnostic features in the majority of cases (Young, 1980). Caecal volvulus is associated with an increased mortality that can vary from 2% for simple postoperative intestinal obstruction to 40% in caecal volvulus with vascular compromise (Quatromoni et al., 1980; Ballantyne et al., 1985). Therapy for caecal volvulus is based on the condition at diagnosis (Konvolinka et al., 2001). As a rule, caecal volvulus cannot be reduced using sigmoidoscopy and requires immediate operation (Welton et al., 2000), although Anderson et al. (1978) reported detorsion in three cases. Corrective surgery is determined by the viability of the involved bowel. When the bowel is infarcted, resection with or without proximal diversion is required. For those in whom the bowel is still viable, the treatment options include detorsion, resection, cecopexy and cecostomy (Welton et al., 2000). ‘Goodrisk’ patients should undergo resection with primary anastomosis (O’Mara et al., 1979). There is no room for delay in the diagnosis and surgical correction of this postoperative complication. Prompt intervention has an obvious impact on survival. The presence of viable bowel results in mortality that is only 7 – 14% (O’Mara et al., 1979; Singh and Wexner, 1991) whereas gangrenous tissue increases the mortality to 33 – 40% (O’Mara et al., 1979; Ballantyne et al., 1985). To avoid the high mortality associated with vascular compromise, a high index of suspicion in any post-operative patient with ‘wind pain’ is important. References Anderson M.J. Sr, Okike N. and Spencer R.J. (1978) The colonoscope in cecal volvulus: report of three cases. Diseases of the Colon and Rectum, 21, 71 – 74. Anderson J.R., Lee D., Taylor T.V. and Ross A.H. (1981) Volvulus of the transverse colon. British Journal of Surgery, 68, 179 – 181. Ballantyne S.H., Brander M.D., Beart R.B. and Ilstrup D.M. (1985) Volvulus of the colon: incidence and mortality. Annals of Surgery, 202, 83 – 92. Keighley M.R.B. and Williams N.S. (1999) Large bowel obstruction. In: Surgery of the Anus, Rectum and Colon, edited by Keighley M.R.B. 2nd edn, pp. 2177 – 2225. London, W.B. Saunders. Konvolinka C.W., Moore R.A. and Bajwe K. (2001) Caecal volvulus causing postoperative intestinal obstruction: report of a case. Diseases of the Colon and Rectum, 44, 893 – 895. Neil D.A.H., Reasbeck, P.G., Reasbeck J.C. and Effeney, D.J. (1987) Caecal volvulus: ten year experience in an Australian teaching hospital. Annals of the Royal College of Surgeons of England, 69, 283 – 285. O’Mara C.S., Wilson T.H., Stonesifer G.L. and Cameron J.L. (1979) Caecal volvulus: analysis of 50 patients with long-term follow-up. Annals of Surgery, 189, 725 – 731. Quatromoni J.C., Rosoff, L., Halls J.M. and Yellin A.E. (1980) Early postoperative small bowel obstruction. Annals of Surgery, 191, 72 – 74. Singh J.J. and Wexner S.D. (1999) Colonic volvulus: a treatment algorithm. Seminars in Colon and Rectal Surgery, 10, 158 – 163. Welton M.L., Madhulika G.V. and Amerhauser A. (2000) Colon rectum and anus. In: Surgery: Basic Science and Clinical Evidence, edited by Norton J.A., Bollinger R.R. and Chang A.E., 1st edn, pp. 700. New York: Springer-Verlag. Young W.S. (1980) Further radiological observations in caecal volvulus. Clinical Radiology, 31, 479 – 483.

Spontaneous multiple pregnancy after uterine artery embolization for uterine fibroid: case report

Uterine artery embolization (UAE) is an effective non-surgical treatment for uterine myomas. Effects on fertility preservation are still under investigation. Various complications have been reported as well as few pregnancies. We report a case of spontaneous twins pregnancy following UAE in a woman who desired to preserve fertility.

Morphological changes in conservatively managed benign ovarian cyst characterised by simple ultrasonography rules in asymptomatic postmenopausal women: A retrospective cohort study based on the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) data

Introduction Approximately 20% of pregnancies end in miscarriage. NICE (2012) stated that vaginal misoprostol can be used for outpatient management of missed or incomplete miscarriage. No guidance is available on suitable ultrasound parameters. Methods Retrospective audit from June 2013 to January 2014 at Medway Maritime Hospital. Cases included all women who underwent outpatient medical management of miscarriage with 800 mcg misoprostol per vagina. Initial ultrasound findings were then compared with final outcomes following treatment. Primary outcome measure was the absence of retained products of conception on ultrasound scan, ie. a complete miscarriage. Results A total of 68 cases were identified. For women with missed miscarriages, gestational sac ranged 4.5–37.7 mm (mean 18.7 mm), and the crown-rump length (CRL) ranged 2–18.1 mm (mean 6.7 mm). For women with incomplete miscarriages, products of conception (POC) ranged 10–30 mm. After administration of misoprostol, all women were rescanned at an average of 10 days later (range 7–21 days). 79% (n = 54) women had complete miscarriages. 15% (n = 10) women required subsequent surgical management of miscarriage, and 6% (n = 4) required a second dose of misoprostol. Of the women requiring further management, 79% had an intact gestational < 12 mm and 57% had a gestational sac < 15 mm. 100% incomplete miscarriages were successfully managed with single dose misoprostol. Conclusion Misoprostol has a very high success rate for outpatient medical management of miscarriage, especially with regards to incomplete miscarriage. Its success rate appears to be reduced with larger, intact gestational sacs that are < 12 mm. This may lead to medical management only being offered to women with smaller gestational sacs and retained POC. However due to the small number of cases, more national data comparing ultrasound scan findings with success rates is required in order to come to a more formal conclusion. FC.02 Imaging in molar pregnancy – a multi-modal approach Chisholme, B; Treharne, A Bonduelle, M