Chlamydia trachomatis infection in patients attending an Early Pregnancy Unit: prevalence, symptoms, pregnancy location and viability.

Objective: To assess the prevalence of Chlamydia trachomatis and its relationship to age, ethnicity, symptomatology, pregnancy location and viability in women attending an Early Pregnancy Unit.

Method: Women were offered screening for Chlamydia over a 4-month period. Presenting complaints, maternal age, ethnic origin, gestational age, pregnancy location, pregnancy viability and swab results were recorded.

The hCG ratio can predict the ultimate viability of the intrauterine pregnancies of uncertain viability in the pregnancy of unknown location population.

Background: To determine whether hCG ratio at 48 h can predict ultimate viability of intrauterine pregnancies of uncertain viability (IPUVs) in the pregnancy of unknown location (PUL) population.

Methods: Prospective observational study from June 2001 to October 2004. All women classified with PUL had serum hCG levels measured at 0 and 48 h to calculate hCG ratio (hCG 48/hCG 0 h).

Is ultrasound the new gold standard for the diagnosis of ectopic pregnancy?

Ultrasound technology and in particular the use of transvaginal imaging has taken the guesswork out of ectopic pregnancy diagnosis. The vast majority of ectopic pregnancies can and should be diagnosed with a high degree of certainty before management is commenced. More and more women with ectopic pregnancy are eligible for nonsurgical intervention because ultrasound has enabled clinicians to make the diagnosis much earlier in its natural history.

Enough is enough! Time for a new model of care for women with early pregnancy complications.

Australian women with early pregnancy complications, like their English counterparts, should have access to ultrasound-based early pregnancy units (EPUs) nationwide. This modern approach to women with first trimester problems would not only streamline individual care pathways but also reduce the impact that early pregnancy problems have on already overburdened public emergency departments. Dedicated EPUs, with trained gynaecological sonologists experienced in the management of first trimester complications, should become the benchmark standard of care for Australian women in early pregnancy.

The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy.

Background: To determine the effectiveness of an initial transvaginal ultrasound scan (TVS) in the detection of ectopic pregnancy in consecutive women attending an early pregnancy unit (EPU).

Methods: This was a prospective observational study. Unselected women attending a dedicated EPU underwent a TVS.

Clinical information does not improve the performance of mathematical models in predicting the outcome of pregnancies of unknown location.

Objective(s): To see if the incorporation of clinical variables can improve the diagnostic performance of logistic regression models in the prediction of pregnancy of unknown location (PUL) outcome.

Design: Prospective observational study.

Setting: Early Pregnancy Unit, St George's Hospital, University of London, London.

Prediction of ectopic pregnancy in women with a pregnancy of unknown location.

Objective: We have previously published on the use of mathematical Model M1 to predict ectopic pregnancy in women with no signs of intra- or extrauterine pregnancy. The aim of this study was to improve on the performance of this model for the detection of developing ectopic pregnancies in women with pregnancies of unknown location (PULs). We therefore generated and evaluated a new logistic regression model from simple hormonal data and compared it with Model M1.

What is the value of preoperative bimanual pelvic examination in women undergoing laparoscopic total hysterectomy?

Unlabelled: OBJECTIVE STUDY: To estimate the value of preoperative bimanual examination of the pelvis in women undergoing total laparoscopic hysterectomy (TLH).

Design: Prospective observational cohort study.

Setting: Private hospitals and centre.

Rationalizing the follow-up of pregnancies of unknown location.

Background: To develop a strategy to rationalize the follow-up of pregnancies of unknown location (PULs) based on the predicted outcome using a mathematical model.

Methods: Prospective interventional study. Women classified with a PUL had serum hCG levels taken at 0 and 48 h.

Primer on risk management for the gynaecological laparoscopist.

The gynaecologist practising operative laparoscopy should be seen as part of a team that actively promotes patient safety, minimizing risks and optimizing outcomes. Building a culture of safety which focuses on proactive initiatives to manage risk and remove individual 'blame' should be an integral part of any operative laparoscopy unit. Thus, when adverse clinical incidents or outcomes occur, reporting of such events is encouraged and seen to be acceptable behaviour within the framework of complete patient care.

Ultrasound diagnosis of ectopic pregnancy.

The diagnosis of tubal ectopic pregnancy should be based upon the positive visualization of an adnexal mass using transvaginal ultrasound rather than the absence of an intrauterine gestational sac. Ultrasound diagnosis earlier in the natural history of the condition has meant that more conservative treatment options can be considered and implemented in clinically stable women. Although laparoscopy traditionally is accepted as the gold standard in the diagnosis of tubal ectopic pregnancy, there is substantial evidence that transvaginal ultrasound is the diagnostic tool of choice in modern practice.

The simple outpatient management of Bartholin's abscess using the Word catheter: a preliminary study.

Introduction: Bartholin's cysts/abscess affects 2% of women. Conventional treatment is marsupialisation under general anaesthetic. We evaluated a conservative approach in a non-randomised prospective interventional study over 12 months.

The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole.

Objective: Previous studies have examined ultrasound findings in histopathologically confirmed cases of hydatidiform mole. The aim of this study was to assess the first-trimester ultrasonographic findings in all women suspected of having hydatidiform mole on ultrasound and those subsequently diagnosed with hydatidiform mole after histological examination of removed products of conception after surgical evacuation of the uterus. The aim was to obtain a true sensitivity and positive predictive value for ultrasound in the diagnosis of hydatidiform mole.

Prospective cross-validation of three methods of predicting failing pregnancies of unknown location.

Background: We compared the performance of each of three tests for predicting pregnancy failure in the pregnancy of unknown (PUL) population.

Methods: In a prospective observational study, we compared the performance of three models for the prediction of pregnancy failure in women with a PUL: (i) logistic-regression model incorporating vaginal bleeding, endometrial thickness (ET), initial serum progesterone and hCG levels; (ii) serum progesterone at 0 h; and (3) the hCG ratio.

Results: A total of 5942 consecutive pregnant women attending the Early Pregnancy Unit were scanned and 439 (7.

Ectopic pregnancy--risk factors and diagnosis.

Background: Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities.

Objective: Detailed management will not be discussed in this review. However, risk factors for tubal ectopic pregnancy, ultrasound diagnosis and the benefits of early pregnancy units will be discussed.

A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy.

Background: Currently, the likely success of single-dose methotrexate (MTX) (50 mg/m(2)) for the treatment of ectopic pregnancy is indicated by a >15% decrease in hCG from days 4-7 after administration. The aim of this study was to assess this protocol and to develop new rules that could be used to predict the outcome at an earlier stage.

Methods: Data were collected prospectively.

Impact of the availability of sonography in the acute gynecology unit.

Objective: The initial assessment of acute gynecology patients is usually based on history and clinical examination and does not involve ultrasound. The aim of this study was to investigate the impact of the availability of transvaginal sonography at the time of initial assessment of the emergency gynecology patient.

Methods: This was a prospective observational study carried out over a 5-month period in the acute gynecology unit of an inner London teaching hospital.

There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location.

Background: The aim of this study was to generate and evaluate a new protocol that defined non-viability in the pregnancy of unknown location (PUL) population and therefore ensured no viable intra-uterine pregnancy (IUP) would be interrupted if uterine curettage was performed. A secondary aim was to evaluate published biochemical criteria that define non-viability in a PUL population to establish if these criteria could result in inadvertent termination of pregnancy (TOP) if uterine curettage was performed.

Methods: All clinically stable women classified as having a PUL were included in this study.

Hyperemesis gravidarum: is an ultrasound scan necessary?

Background: Traditionally, in cases of hyperemesis gravidarum (HG), an ultrasound evaluation is recommended to confirm viability and to exclude multiple pregnancies and gestational trophoblastic disease (GTD). Our aim was to perform a case-control study to evaluate the incidence of these findings.

Methods: Each case of HG was matched for gestational age with the next ultrasound examination performed in an asymptomatic pregnancy.

Male-to-female transsexualism: laparoscopic pelvic floor repair of prolapsed neovagina.

The incidence of prolapse of the neovagina after male-to-female gender reassignment surgery is unknown. We present the first case of laparoscopic total pelvic floor repair in a male-to-female transsexual. This surgical procedure combined an understanding of the anatomy of the male pelvis with the principles of laparoscopic pelvic floor repair in the XX female.

Failing pregnancies of unknown location: a prospective evaluation of the human chorionic gonadotrophin ratio.

Objective: To assess the performance of the human chorionic gonadotrophin (hCG) ratio (hCG 48 hours/hCG 0 hour) to predict spontaneous resolution of pregnancies of unknown location (PUL).

Design: Prospective cohort study.

Setting: Teaching Hospital Early Pregnancy Unit.

Predicting the outcome of pregnancies of unknown location: Bayesian networks with expert prior information compared to logistic regression.

Background: As women present at earlier gestations to early pregnancy units (EPUs), the number of women diagnosed with a pregnancy of unknown location (PUL) increases. Some of these women will have an ectopic pregnancy (EP), and it is this group in the PUL population that poses the greatest concern. The aim of this study was to develop Bayesian networks to predict EPs in the PUL population.