Christopher J. Verco

Monoamniotic Twin Pregnancy Complicated by Massive Fetal‐Maternal Haemorrhage

Summary: An unusual case is presented in which a term monoamniotic monochorionie twin pregnancy was complicated by a massive fetal‐maternal haemorrhage resulting in the simultaneous death of both twins. Monoamniotic monochorionie twins and massive fetal‐maternal haemorrhage are reviewed and discussed.

Vascular perfusability and capillary macromolecular permeability in the mechanically induced rabbit hydrosalpinx.

The mechanically induced rabbit hydrosalpinx, a frequently studied animal model of human hydrosalpinges, was examined to determine the variations, in vascular perfusion and capillary albumin permeability, which occur in hydrosalpinges. At laparotomy, 4 adult female virgin rabbits underwent isthmic and ampullary occlusion with small tantalum clips. 4 weeks later, fluorescein isothiocyanate-labelled bovine serum albumin (FITC BSA: molecular weight 67,000) was injected intravenously 5 min before oviduct excision. Examination of tubal sections by incident light fluorescent microscopy demonstrated poor interplical vascular perfusability and markedly reduced interplical capillary permeability to FITC BSA in both isthmic and ampullary segments of hydrosalpinx. These observations imply that, in the experimental rabbit hydrosalpinx, interplical deciliation is probably vascular in origin; furthermore the marked decrease in capillary macromolecule permeability may explain the serous fluid collection within the hydrosalpinx. Poor fecundity following microsurgical restoration of tubal patency in hydrosalpinges is possibly due to the failure of this decrease in submucosal capillary perfusability and macromolecular permeability to resolve.

Acute haemothorax after ruptured ectopic pregnancy

2007). However, additional treatment modalities seem to be necessary in a large proportion of women with cervical pregnancies, due to the primary MTX treatment failure. Surgical or combined medical-surgical treatments are (1) angiographic embolisation of the cervical, uterine or internal iliac arteries followed by curettage or MTX; (2) laparoscopyassisted ligation of uterine or internal iliac arteries followed by curettage or MTX; (3) intra-amniotical MTX followed by subsequent curettage (Adabi et al. 2013); (4) combination of MTX and mifepristone followed by subsequent curettage (Heikinheimo et al. 2004) and (5) complete resection by operative hysteroscopy or laparoscopy-assisted uterine artery ligation combined with hysteroscopic local endocervical resection. Advanced gestational age, high serum BHCG levels and the presence of a viable embryo are associated with higher rates of treatment failures. In patients with cervical pregnancy without embryonic cardiac activity, there is no reason to use to ultrasound-guided injection; therefore, systemic treatment with MTX should be the best choice. Verma et al. report the largest study about cervical ectopic pregnancies (25 cases) and indicate that non-surgical management by systemic MTX, combined with foetal intra-cardiac KCl injection in case of viable embryo, is a successful option in the vast majority of patients, in order to avoid haemorrhage, other complications and to preserve fertility (Verma and Goharkhay 2009). Very few cases of successful term pregnancy obtained after a cervical pregnancy are reported in literature, due to the condition of subfertility of many patients who developed cervical pregnancy after ART and the few studies describing the incidence of following pregnancies. This case supports the hypothesis that the use of MTX does not have negative effects on their subsequent fertility treatment (Ohannessian et al. 2014).

The Quality of Consent – What is the Evidence?

The documentation of consent is an important component of the clinical encounter. This study assesses the quality of documentation of that consent for a common surgical procedure, caesarean section, in an obstetric unit at a major teaching hospital and compares this quality between elective and emergency cases. There was a significant difference in the quality of documentation between the elective and emergency groups in some, but not all, categories assessed. Overall, the standard of consent documentation in the obstetric unit was less than desired. A proforma was designed to be included in the case notes of women undergoing caesarean section to improve the efficient and thorough documentation of consent.

Uterine Tube Microvascular Architecture after Oophorectomy in the Rabbit

4 adult female virgin rabbits underwent bilateral oophorectomy. 4 weeks later methylmethacrylate corrosion vascular casts of their uterine tubes were prepared. Scanning electron microscopy of the acrylic casts revealed a decrease in the size and number of the large ampullary plical and fimbrial veins which are normally characteristic of these regions. This observation suggests that the reported tubal dysfunction which follows oophorectomy may have a vascular component.

Rabbit oviduct microvascular architecture after microsurgical transection and anastomosis

SummaryTen rabbits underwent either bilateral microsurgical isthmic (6) or ampullary (4) transection and anastomosis. Four weeks later methyl methacrylate corrosion vascular casts were prepared and examined by dissection and scanning electron microscopy. A serosal vascular proliferation (which indicates connective tissue growth) was observed at the isthmic anastomotic site; this may account for the known delay in isthmic ovum transport after isthmic microsurgery. Discontinuity in the otherwise normal longitudinally oriented plical vascular skeleton was observed at the ampullary anastomosis; the myosalpingeal, subserosal and serosal microvasculature was consistent with that observed in control oviducts. A transluminal vascular band and longitudinally oriented vascular bands between divided plicae were observed at one ampullary-ampullary anastomosis; these bands may predispose to delay in ovum transport or ectopic implantation at this site. Observed variations in tubal vasculature were limited to the site o...

Microvascular Architecture of the Pregnant Rabbit Oviduct

Methyl-methacrylate vascular corrosion casts of the oviducts were prepared in 7 rabbits which were 2-3 weeks pregnant. Scanning electron microscopy of the acrylic casts revealed little change in tubal microvascular connections when compared with control oviducts. Venous distension in the isthmic subserosal venous plexus, ampullary subserosal vasculature and in the fimbrial core was substantially greater than that observed in controls. These changes are interpreted as indicating a sensitivity of tubal microvasculature to the increased levels of circulating placental hormones in pregnancy. The implications of this interpretation in the role of tubal microvasculature at the time of ovulation are discussed.