Daphne Chun

A long term follow-up study of 1,055 cases of postpartum tubal ligation.

During the period 1957 to 1962 postpartum sterilization was performed on 5968 patients. Of these 1055 patients (34%) were followed up in 1965. The patients were interviewed by a doctor and a detailed history was taken followed by a general abdominal and pelvic examination including a cervical smear for exfoliative cytology. The commonest indication for postpartum sterilization was grand multiparity (973 or 93.2% of the patients had 5 or more chldren) followed by obstetrical or medical indications (eg toxemia of pregnancy; antepartum hemorrhage); ceasarian section and socioeconomic reason. Average age for postpartum sterilization was 33 years; parity was 6.0 and number of living children at time of interview was 5.7. Tubal ligation by Pomeroys technique using No. 2 plain catgut was done in 1049 cases. The findings show that postpartum tubal ligation does not significantly affect body weight nor the general state of health. No alteration in the menstrual pattern was observed among half of the patients. Minor menstrual disorders were observed in the other half. 4 cases had severe menorrhagia requiring hysterectomy. No gross pelvic pathology was seen. Psychological effects were also minimal and most patients had satisfactory marital relationship. 98.7% were happy about the operation. It was concluded that postpartum sterilization is a safe and reliable contraceptive method for women desiring permanent contraception.

PERINATAL MORTALITY IN HONG KONG AND IN ABERDEEN, SCOTLAND

BETWEEN 1951 and 1958 the official stillbirth rate in Hong Kong fell from 17 to 12 per 1,000 and during this time the rate in England and Wales remained fairly stationary at about 23 per 1,000. Taking into account the adverse social conditions in Hong Kong and the influx of about 1 million refugees from China since 1949 one might be justified in assuming that the official statistics were grossly inaccurate and misleadingly low. During a brief visit to the Colony in 1957 one of us (D.B.) found reason to believe that the explanation might be less simple. It was accordingly arranged, with financial support from the Colonial Office, for Dr. Thomson to visit Hong Kong for 6 weeks during October-November, 1959, to examine the situation more closely and to make any observations that might be feasible in that time. It became clear that a comparison of perinatal mortality in Hong Kong and Aberdeen would be very worth while, because conditions differed greatly in many respects, and the data made available by the Director of Medical Services and the University Teaching Hospital were so complete and carefully compiled that vital statistics could be estimated with a high degree of accuracy. In addition, since the standard of obstetric care given in the Tsan Yuk University Teaching Hospital was up to that found in teaching hospitals in Britain, any differences in perinatal mortality between the Aberdeen Maternity Hospital and the Tsan Yuk Hospital are unlikely to be due to differing standards of obstetric care.

TREATMENT OF HYDATIDIFORM MOLE.

IN the course of analyzing a series of 265 patients who were in the first instance admitted into our unit for treatment of hydatidiform mole during the years 1953 to 1961 it was found that certain methods of treatment produced a lowering of the three major complications of haemorrhage, infection and chorionepithelioma. This paper describes the various methods used and the final results obtained during follow-up periods ranging from 2 to 10 years. These 265 patients may be divided conveniently into 3 clinical groups as follows: In group I the diagnosis was obvious on admission as vesicles were present on the vulva1 pads-63 cases. In group I1 the diagnosis became obvious as vesicles were passed before the investigations were completed-87 cases. In group III the investigations were completed and the diagnosis was made but vesicles were not passed-1 15 cases. As the initial treatment in the three groups of patients varied slightly it will be discussed separately for each group. The subsequent management of all three groups will be dealt with together.

THE HONG KONG CHINESE FEMALE BONY PELVIS AND ITS INFLUENCE ON LABOUR

THE maternal bony pelvis-its shape and sizeconstitutes but one of many factors which influence the course of labour; it is the only factor which can be determined with precision by the use of radiographic methods. During 1955 and 1956 a combined radiographic and clinical study was made of 1,005 patients in Hong Kong. Its purpose was to investigate the shape and size of their bony pelves and the influence they had on the course of labour. An attempt was also made to compare these findings with those of European pelves.

Endometriosis, adenomyosis and pregnancy.

A REVIEW of the literature suggests that pregnancy associated with endometriosis is infrequent partly due to the late age incidence of the disease and partly due to the pelvic pathology associated with it. Reynolds and Maccomber (1942) quote 88 per cent as the normal fertility in marriage. This contrasts markedly with the relative sterility rate of 53 per cent in women suffering from endometriosis reported by Haydon (1942). Scott (1944) made a study of forty-seven reports on endometriosis associated with pregnancy and added two of his own. The ultimate results were ascertained in only 31 cases, amongst which were 12 cases of adenomyosis and 19 cases of diffuse pelvic endometriosis. In the 12 cases of uterine endometriosis, there was spontaneous rupture of the uterus in 3 cases, post-partum haemorrhage in 3 and dystocia in 2 cases. Complications were less frequently met with in pelvic endometriosis with an unaffected uterus. Thus out of 19 cases there was 1 case each of rupture of an ovarian endometrial cyst, a ruptured ectopic pregnancy in the same ovary with endometriosis, and 1 case of dystocia. Other complications were 7 cases of abortion and 2 more cases of ectopic pregnancy in the whole series of 47 reports. Lock and Myers (1946) reported 2 cases of endometriosis in which patients were treated conservatively. Subsequently both conceived and had a normal pregnancy, delivery and puerperiurn. There are many similar reports to be found in the literature. Conservative treatment has been advocated in women of childbearing age with endometriosis. Novak (1931) referred to the wellknown fact that many patients had complete relief of symptoms after a conservative operation. He mentioned two patients seen in one year in whom unilateral cysts were removed and pregnancy followed in both cases before the recurrence of symptoms necessitating another operation. Bacon (1949) reported the results in 138 cases of pelvic endometriosis treated by conservative surgery. Of these, 30 (26.8 per cent) conceived and had living children after operation. Ware (1950) presented 13 cases of pregnancy in which endometriosis was proved by operation either before or during gestation. There were 2 cases of abortion and the others were delivered at term with no complications. Gainley, Keeler and Nicolay (1952) reported 38 cases of pregnancy associated with endometriosis and noted improvement in most of them after delivery. Other writers have reported the same long-term relief of symptoms, even in very widespread disease, after a successful pregnancy. Among Gainley’s cases there was almost total involution in a patient with extensive recto-vaginal endometriosis. The complications were abortion in 6 cases, torsion of an ovarian endometrial cyst and one case of ovarian pregnancy with a nidus provided by endometriosis. Brewer and Maher (1954) found symptomatic relief in cases of endometriosis treated with oestrogen or androgen and many became pregnant before surgery was called for. It was their opinion that, when endometriosis was encountered during an abdominal operation, approximately one-third of the patients would subsequently conceive if conservative procedures were adopted provided that there was no other cause of sterility. Of the cases reported above only 13 were uterine disease per se, the rest were all pelvic endometriosis associated with pregnancy. There

CHEMOTHERAPY IN THE TREATMENT OF UNDELIVERED HYDATIDIFORM MOLE

Methotrexate and 6‐mercaptopurine given to five cases of undelivered hydatidiform mole brought about degeneration of molar vesicles in utero, which was indicated by a fall in urinary gonadotrophin and a reduction in the size of the uterus. Spontaneous evacuation of the molar tissue occurred in three cases and artificial termination in two. All evacuated and surgical specimens showed various degrees of degeneration of the molar vesicles. In the last follow‐up 28 months later all five patients were alive and well with no evidence of trophoblastic disease.