Tubal flushing with oil-based or water-based contrast at hysterosalpingography for infertility: long-term reproductive outcomes of a randomized trial.

Objective: To determine the impact of oil-based versus water-based contrast on pregnancy and live birth rates ≤5 years after hysterosalpingography (HSG) in infertile women.

Design: A 5-year follow-up study of a multicenter randomized trial.

Setting: Hospitals.

Follicle stimulating hormone versus clomiphene citrate in intrauterine insemination for unexplained subfertility: a randomized controlled trial.

Study Question: Is FSH or clomiphene citrate (CC) the most effective stimulation regimen in terms of ongoing pregnancies in couples with unexplained subfertility undergoing IUI with adherence to strict cancellation criteria as a measure to reduce the number of multiple pregnancies?

Summary Answer: In IUI with adherence to strict cancellation criteria, ovarian stimulation with FSH is not superior to CC in terms of the cumulative ongoing pregnancy rate, and yields a similar, low multiple pregnancy rate.

What Is Already Known: FSH has been shown to result in higher pregnancy rates compared to CC, but at the cost of high multiple pregnancy rates. To reduce the risk of multiple pregnancy, new ovarian stimulation regimens have been suggested, these include strict cancellation criteria to limit the number of dominant follicles per cycle i.

The SUPER study: protocol for a randomised controlled trial comparing follicle-stimulating hormone and clomiphene citrate for ovarian stimulation in intrauterine insemination.

Objective: To study the effectiveness of four cycles of intrauterine insemination (IUI) with ovarian stimulation (OS) by follicle-stimulating hormone (FSH) or by clomiphene citrate (CC), and adherence to strict cancellation criteria.

Setting: Randomised controlled trial among 22 secondary and tertiary fertility clinics in the Netherlands.

Participants: 732 women from couples diagnosed with unexplained or mild male subfertility and an unfavourable prognosis according to the model of Hunault of natural conception.

Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women.

Background: Pregnancy rates among infertile women have been reported to increase after hysterosalpingography, but it is unclear whether the type of contrast medium used (oil-based or water-soluble contrast) influences this potential therapeutic effect.

Methods: We performed a multicenter, randomized trial in 27 hospitals in the Netherlands in which infertile women who were undergoing hysterosalpingography were randomly assigned to undergo this procedure with the use of oil-based or water-based contrast. Subsequently, couples received expectant management or the women underwent intrauterine insemination.

General practitioners' adherence to work-up and referral recommendations in fertility care.

Study Question: What is the current guideline adherence by general practitioners (GPs) for work-up and subsequent referral from primary to secondary care for patients suffering from infertility?

Summary Answer: Guideline adherence by GPs concerning infertility was 9.2% in couples referred.

What Is Known Already: Adherence to recommendations can decrease unnecessary referral, diagnostics and treatments, and consequently result in lower expenditures.

Complication rate of uterine morcellation in laparoscopic supracervical hysterectomy: a retrospective cohort study.

Background: Over the last decades minimally invasive surgical techniques are increasingly used to treat symptomatic leiomyomas, providing the patient decreased morbidity and more rapid return to daily activities. Morcellation is the fragmentation of a large mass into smaller pieces to make resection through port incisions possible. Over the last year there has been a discussion worldwide about the safety of morcellation.

[A woman with an unusual sonogram of the abdomen].

A 29-year-old female complained of abdominal swelling. Transvaginal sonography showed an unusual view of a cystic ovarian mass composed of various dense, round structures. A laparotomic right ovarian cystectomy was performed.

Fetal habituation to vibroacoustic stimulation in uncomplicated postterm pregnancies.

Objectives: Testing of fetal habituation to repeated vibroacoustic stimulation might give additional information concerning the fetal condition and central nervous system (CNS) functioning in postterm pregnancies. This study is designed to investigate whether healthy postterm fetuses are able to habituate and if so, if the habituation pattern of postterm fetuses differs from that of term fetuses.

Study Design: Twenty women with an uncomplicated pregnancy beyond 41 weeks gestational age (GA) participated, and 37 women with a GA between 37 and 40 weeks served as controls.

The responses to repeated vibroacoustic stimulation in a fetus with trisomy 18.

Observation of the fetal movement and fetal heart rate responses to repeated vibroacoustic stimulation might be useful as a measure to assess fetal well-being. Studies of abnormal fetuses are needed to gain insight in the spectrum of possible responses to stimulation. We present a case of a fetus with trisomy 18 that failed to respond to repeated stimulation.

Fetal habituation to vibroacoustic stimulation in relation to fetal states and fetal heart rate parameters.

Objectives: Fetal habituation to repeated stimulation has the potential to become a tool in the assessment of fetal condition and of the function of the fetal central nervous system (CNS). However, the influence of fetal quiescence and activity on habituation remains to be clarified. We studied habituation and the influence of fetal state and fetal heart rate (FHR) parameters on habituation in healthy term fetuses.

Responses to vibroacoustic stimulation in a fetus with an encephalocele compared to responses of normal fetuses.

Background: Observation of fetal movement and fetal heart rate (FHR) responses to repeated vibroacoustic stimulation (VAS) might be useful as a measure to assess fetal well-being and to assess the integrity of the fetal central nervous system (CNS). We observed the movement and FHR responses to repeated VAS of a term fetus with a serious brain anomaly as compared to responses of normal term fetuses.

Subjects, Methods, Results: In 37 normal term fetuses and in a term fetus with an encephalocele we studied movement and FHR response to repeated VAS.

Fetal learning and memory.

We used fetal habituation to repeated vibroacoustic stimulation to assess fetal memory. After the initial stimulus, we assessed the fetuses 10 min later and again after 24 h. 16 of 19 fetuses habituated rapidly to the stimuli at 10 min (p=0.

Dilation of benign strictures following low anterior resection using Savary-Gilliard bougies.

Background And Study Aims: Benign anastomotic strictures occur in up to 22% of patients after colorectal resections. Initially, treatment for these strictures was surgical, but nowadays endoscopic dilation techniques are preferred. This study was conducted to assess the efficacy of dilation using SavaryGilliard bougies.

[Discordant fetal growth in multiple pregnancy: intervention should be based on chorionicity].

In three women, aged 28, 35, and 38 years, with multiple pregnancies and discordant foetal growth, the question arose what to do in case of (threatening) intrauterine death of one twin. In one monochorionic pregnancy with single foetal death the survivor suffered irreversible neurological damage and died at the age of five months, in one monochorionic pregnancy the survivor was born healthy and in one dichorionic pregnancy both twins were born healthy although one twin showed severe intrauterine growth retardation. The problem concerning single foetal death in a monochorionic pregnancy is whether to terminate the pregnancy and accept the risk of premature birth to the surviving twin, or to continue the pregnancy and accept the risk of damage to the survivor.

Risk for surviving twin after fetal death of co-twin in twin-twin transfusion syndrome.

Objective: To determine neonatal outcome of surviving twins in pregnancies complicated by twin-twin transfusion syndrome and fetal deaths of co-twins.

Methods: We retrospectively reviewed medical records of 11 women seen during 1990-1996 in our hospital who had pregnancies complicated by twin-twin transfusion syndrome and death of one fetus.

Results: The median interval between fetal death and delivery (six by cesarean delivery and five vaginally) was 2 weeks (range, 1 day to 7 weeks).