Dominic Byrne

Parvovirus as a Differential Diagnosis of Hydrops fetalis in the First Trimester

We report a case of fetal parvovirus B19 infection which appears to have resulted in hydrops in the first trimester. An ultrasound scan performed at the booking visit of a woman in the first trimester showed generalised oedema. Karyotyping to exclude a fetal abnormality was normal. Maternal radioimmunoassay serological investigations showed parvovirus B19 IgG and IgM. Post-mortem analysis revealed intranuclear inclusion bodies typical of parvovirus in the erythroid cells in the liver and in the myocardium.

Descriptive terms for women attending antenatal clinics: mother knows best?

Objective To determine the noun for ‘women who attend antenatal clinics’ that is most accepted by the women themselves.

Two abnormalities on diagnostic laparoscopy

A 29 year old nulliparous woman presented with a two year history of cyclical pelvic pain and dyspareunia. She underwent a diagnostic laparoscopy to identify a cause for the pain, and this revealed two gynaecological abnormalities (fig 1). What are these abnormalities? Fig. 1 Pelvic structures at diagnostic laparoscopy for pelvic pain The image shows a unicornuate uterus with a rudimentary uterine horn (fig 2, A) on the left side, and an incidental left ovarian cyst (fig 2, B). Fig. 2 (A) Rudimentary uterine horn. (B) Ovarian cyst (incidental finding) Embryologically, the unicornuate uterus is thought to result from partial or complete failure of development of one of the paramesonephric (Mullerian) ducts. The unicornuate uterus …

Variable pressure cornual resection. Does radical hysteroscopic surgery give better results

The radicality of the resective technique at transcervical endometrial resection (TCRE) may affect both the safety and efficacy. We evaluated both a more and a less extreme technique and compared results with our standard TCRE. A nonrandomised, prospective cohort study of three standardised endometrial resection/ablation techniques, each with differing tissue destruction profiles, was performed on 270 patients. Percentage reduction in bleeding, satisfaction, complications, and failures were recorded. Group 1 had standard loop resection circumferentially from the fundus to the internal os with current blend 1, power 120/60 W. The method for group 2 was the same as for group 1, with additional radical cornual resection followed by rollerball ablation to the entire cavity and cervical canal using the same power settings. To establish the safety of the cornual resection component, 25 cases were performed under laparoscopic control. In the first 15 cases, the extra cornual material excised was weighed separately and its contribution to the total weight calculated. Group 3 had slow low-power rollerball ablation to the cavity, cornua, and cervical canal with unmodulated power at 30 W. There were 68, 131, and 71 patients in the respective groups, followed up for a maximum of 36 months, with amenorrhoea rates of 31%, 36%, and 31%. Failure (a need for a further procedure) occurred in 18%, 12%, and 20%, respectively, and the preoperative to postoperative percentage reduction in bleeding between groups 2 and 3 was 78% (standard deviation 26) and 79% (standard deviation 33). There were no statistical differences in clinical outcome measures, complications, or satisfaction rates. The extra cornual endometrium comprised a mean additional 9%. This study did not support the premise that more radical techniques confer advantage in clinical outcome, although a trend towards a lower failure rate with the radical resection method may achieve significance with greater numbers. Principally, the greater failure rate in the rollerball group was due to cyclical pain despite improvement in bleeding score. Where satisfaction and safety is consistently high, the most straightforward procedure of rollerball ablation may be preferable, but the possible higher failure rate with this technique will require further qualification.

An unusual case of trapped ovary in a peritoneal pouch causing extrinsic ureteric compression associated with endometriosis

A 35-year-old woman presented with long-standing right loin to groin pain and a right ovarian cyst. The ovarian cyst was considered physiological at the initial gynaecological evaluation. A subsequent transvaginal scan demonstrated a cystic immobile ovary adherent to the pelvic side wall. Laparoscopy revealed endometriosis and a peritoneal defect holding the cystic ovary against the ureter and causing compression with secondary loin pain. The trapped ovary was removed and the patient was cured of the long-standing ureteric colic. This is the first reported case of extrinsic ureteric compression caused by trapped ovary in a peritoneal pouch associated with endometriosis. The diagnosis was suspected preoperatively from the transvaginal scan findings demonstrating a cystic immobile ovary adherent to the pelvic side wall. This case demonstrates that in women with unresolved ureteric compression where adnexal cyst is found, the investigator should look for features that suggest entrapment to the pelvic side wall.