OBGYN.net Staff

Articles by OBGYN.net Staff

One of our own Ultrasound@OBGYN.net participants has published an article in the British Medical Journal proposing the use of electronic publication to include the original data with research articles. The article, by David J R Hutchon, consultant obstetrician and gynaecologist. Memorial Hospital, Darlington, County Durham DL3 6HX, proposes several advantages to having the original data available to the readers.

This overview describes and illustrates the clinical applications of three-dimensional transvaginal sonography in reproductive medicine. Its main applications include assessment of uterine anomalies, intrauterine pathology, tubal patency, polycystic ovaries, ovarian follicular monitoring and endometrial receptivity. It is also useful for detailed evaluation of failed and/or ectopic pregnancy. Three-dimensional color Doppler sonography provides enhanced depiction of uterine, endometrial, and ovarian vascularity.

At a resident's education conference, Dr. Richard M. Soderstrom, M.D. presented the following handout on today's evidence based evaluation of laparoscopic sterilization methods. Dr. Soderstrom is the author covering this subject in the USA'a first textbook on Laparoscopy, Ed. JM Phillips, Williams & Wilkins, 1977. Since then he has published widely on the subject and continues to act as a consultant to the FDA when new devices for sterilization are entertained.

Diagnostic Medical Sonography, often referred to as "ultrasound", is one of the newest and fastest growing diagnostic imaging modalities. Most people today know Sonography from intrauterine fetal images or sonograms. It is a very safe and useful medical tool that was first attempted after W.W.II using surplus, nondestructive testing, sonar equipment.

As important as having mature lungs at birth are to the baby, in the last 25 years ultrasound professionals have only proposed two methods of judging their maturity, neither of which have been effective. Neither echo texture of the lungs in comparison to the liver, or placental maturity have correlated as closely with lung maturity as was once hoped.

Unroofing the ureter in the cardinal ligament is the most important step during radical hysterectomy. At our institution we developed a modified laparoscopic technique to free the ureter from its roof through the cardinal ligament. The technique is based on the advantages of laparoscopic surgery which mainly are: more accurate haemostasis, magnification of the anatomical structures and positioning of the scope parallel to the ureteral course instead of perpendicular like in open surgery.

In spite of readily available alternatives to hysterectomy such as endometrial ablation, hysterectomy rates have not fallen. Several comparative trials of hysterectomy have shown shorter hospital stay and convalescence after laparoscopic approach compared to an abdominal approach.

The diagnosis of uterine and/or tubal pathology as causes of female infertility represents a fundamental step in the evaluation of the infertile couple. Apart from the invasive diagnostic procedures, several others diagnostic techniques useful to the clinical evaluation of the uterine cavity and tubal anatomy are: transvaginal sonography (TVS), hysterosalpingography (HSG), hysteroscopy and hydrosonography (HDS) and laparoscopy.

The role of reproductive surgery has been questioned in the current environment of improving techniques and success rates with in vitro fertilization (IVF). Another emerging obstacle is the declining number of these types of surgeries being performed in response to the increasing numbers of patients opting for IVF.

More than ten years have passed by since we first performed a laparoscopic myomectomy in our Department using Semm’s technique. As far as a subserous myoma is concerned, there are no particular problems; difficulties arise when dealing with intramural myomas.

From its beginnings back in 1991, in our Department, the laparoscopic approach to pelvic prolapse has changed considerably over the decade. Initially limited to strict reproduction of the techniques carried out by laparotomy, the introduction of a number of complementary procedures has provided an answer to all the situations encountered in the field of female genital prolapse repair.

After having been almost abandoned, supracervical hysterectomy has been recently re-advocated, especially after the development of laparoscopy, because it is stated to have less morbidity and minor intra-operative complications. However, long term outcomes report high incidences of late complications

Vaginal hysterectomy can be the standard procedure for removing the uterus, but surgical skills and indications to vaginal surgery are variable. Laparoscopic assistance to vaginal hysterectomy is a way to change the approach to hysterectomy. In this paper we describe our retroperitoneal technique for laparoscopic securing of the uterine pedicles.

The medical literature has reported an increase in myomectomy during caesarean section in the past decade. However, myomectomy performed during pregnancy remains a rarity. The management of uterine fibroids during pregnancy is usually expectant and surgical removal is generally delayed until after delivery. We present a case of a large, symptomatic uterine fibroid diagnosed during pregnancy which was successfully managed by antepartum myomectomy.