Mats Hahlin

Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy*

OBJECTIVE Women with ectopic pregnancy (EP) who have been operated on by laparoscopy are thought to have improved subsequent fertility, probably because of less adhesion formation. We aimed to evaluate the adhesion formation after laparoscopy as compared with laparotomy in a randomized trial. DESIGN One hundred five patients with tubal pregnancy were stratified with regard to age and risk factors and randomized to surgery by laparoscopy or laparotomy. To evaluate adhesion formation and tubal status, 73 patients with strong desire of pregnancy underwent a second-look laparoscopy. The adhesion status at the ipsilateral and contralateral side at primary surgery was compared with the status at second-look laparoscopy. RESULTS Patients operated on by laparotomy developed significantly more adhesions at the operated side than patients operated on by laparoscopy (P less than 0.001). Substantially more patients in the laparotomy group underwent adhesiolysis at second-look laparoscopy than did patients in the laparoscopy group. Tubal patency did not differ between the groups. CONCLUSIONS Laparoscopic treatment of EP results in less impairment of the pelvic status compared with conventional conservative surgery.

Randomised trial comparing expectant with medical management for first trimester miscarriages

Objective To compare the efficacy of antiprogesterone (mifepristone) in combination with a synthetic prostaglandin E, analogue (misoprostol) for outpatient treatment of miscarriages.

Laparoscopic surgery in ectopic pregnancy : a randomized trial versus laparotomy

A randomized, prospective clinical trial was conducted to compare the efficacy of laparoscopic treatment with conventional conservative abdominal surgery for tubal pregnancy. Entry criteria were: size of the ectopic gestation < 4 cm, hemodynamic stability, accessibility for laparoscopic treatment and a trained laparoscopist on duty. There was no difference between the groups regarding gestational duration, size and location of the ectopic gestation, or the mean preoperative hCG values. The groups differed with respect to total operation time (73 min for the laparoscopy group vs. 88 min for the laparotomy group), hospital stay (2.2 vs. 5.4 days) and convalescence period (11 vs. 24 days). The rates of elimination of hCG was similar in the groups, and there were no statistical difference in the rate of second intervention.

LOCAL PROSTAGLANDIN F2α INJECTION FOR TERMINATION OF ECTOPIC PREGNANCY

Abstract In nine women with unruptured ectopic pregnancy, prostaglandin F 2α was injected under laparoscopic control into the affected oviduct and in eight patients also into the ovary containing the corpus luteum. Termination of the pregnancy was achieved in all cases (in one at the second attempt), without complications. Fertility after this procedure needs to be compared with that after conventional surgery.

A randomized trial comparing changes in psychological well-being and sexuality after laparoscopic and abdominal hysterectomy

Background.  To evaluate changes in psychological well‐being and sexuality 1 year after laparoscopic and abdominal hysterectomy.

Combined use of progesterone and human chorionic gonadotropin determinations for differential diagnosis of very early pregnancy.

Progesterone (P) level and daily change in human chorionic gonadotropin (hCG) were determined in the serum of 307 patients with suspected ectopic pregnancy (EP). Of the viable intrauterine pregnancies (IUP), 99% had P values above 30nmol/L, whereas 75% of the EP and 81% of the spontaneous abortions had P values

Pain and pulmonary function following laparoscopic and abdominal hysterectomy: a randomized study

BACKGROUND The aim of this study was to evaluate pain and pulmonary function the first two days after abdominal and laparoscopic hysterectomy. METHODS Women scheduled for abdominal hysterectomy were prospectively randomized to either laparoscopic (n=20) or abdominal (n=20) hysterectomy. Analgesics were self-administered by the patients by means of a programable infusion pump containing morphine. Postoperative pain was evaluated using a visual analog scale. Oxygen saturation was measured with an oxymeter. Pulmonary function was assessed using a peak flow meter measuring peak expiratory flow and a vitalograph measuring forced vital capacity and forced expiratory volume in one second. RESULTS Pain scores were lower after laparoscopic hysterectomy at the first (p<0.05) and second postoperative day (p<0.01). Lung function was impaired on days 1 and 2 postoperatively, measured as peak expiratory flow, forced vital capacity and forced expiratory volume in one second, in both groups compared to the preoperative values. The patients undergoing laparoscopic hysterectomy had less impairment of lung function measured by peak expiratory flow (p<0.01), forced vital capacity (p<0.05) and forced expiratory volume in one second (p<0.05) the first postoperative day compared to the patients undergoing abdominal hysterectomy. The second postoperative day differences between the groups remained for peak expiratory flow (p<0.05) and forced expiratory volume in one second (p<0.05). CONCLUSIONS Laparoscopic hysterectomy results in less pain and less impairment of respiratory function compared to abdominal hysterectomy.

Treatment of tubal pregnancy by laparoscope-guided injection of prostaglandin F2α*

Twenty-six cases of unruptured tubal pregnancy were treated by laparoscope-guided injection of prostaglandin (PG) F2α into the affected tube and the ovary containing the corpus luteum. Preoperative serum human chorionic gonadotropin (hCG) levels were 22 to 2,050 IU/L (mean 328 IU/L). The procedure was successful in 24 patients (92%), as indicated by reduction of hCG values to

Unsuccessful treatment of missed abortion with a combination of an antiprogesterone and a prostaglandin E1 analogue

In a prospective clinical trial the effectiveness of a combination of 400 mg of mifepristone (antiprogesterone) and 400 g misoprostol (synthetic prostaglandin E1 analogue), both taken orally, was evaluated for the treatment of missed abortion. Of the 31 patients included, 16 (52%) had an empty uterine cavity at follow up six days after inclusion, 11 (35%) required surgical evacuation for retained intrauterine products of conception found at follow up, and four (13%) required emergency surgical evacuation due to severe pain or bleeding. The results do not support the use of mifepristone and misoprostol for women wishing the miscarriage to be resolved quickly.

Local luteolytic effect of prostaglandin F2α in the human corpus luteum

Objective To evaluate the effects of prostaglandin (PG)F 2α on human corpus luteum (CL) function in vivo. Design The effects of a single injection of PGF 2α into the CL was studied. Setting The patients underwent elective surgery at the Department of Obstetrics and Gynecology, Sahlgrenska Hospital, University of Goteborg, Sweden. Participants Twenty women with regular menstrual cycles undergoing laparoscopy for legal sterilization with tubal clips volunteered for the study. Interventions Prostaglandin F 2α (3mg) was injected through the abdominal wall into the CL. In control cases, vehicle was injected into the CL or PGF 2α into the contralateral ovary. Main Outcome Measure After the injections, serum was analyzed for progesterone (P) and luteinizing hormone using fluoroimmunoassay and enzyme-immunoassay, respectively. Menstrual data were recorded. Results In contrast to control cases, intraluteal injection of PGF 2α caused both an immediate fall of >30% in serum P and a shortening of the luteal phase by 2 to 5 days. Luteinizing hormone varied independently of the changes in serum P levels. Conclusion The results suggest a local role for PGF 2α in human luteolysis.