Medium-term Follow-up of the Intravaginal Slingplasty Operation Indicates Minimal Deterioration of Urinary Continence With Time

An assessment of the medium term efficacy of stress incontinence cure in a group of patients who had undergone the intravaginal slingplasty (IVS) operation is presented. Eighty-five unselected patients, aged 27 to 83 years at the time of surgery, 12 with pure stress symptoms, and 73 with mixed incontinence symptoms underwent the IVS procedure between 31 and 57 months previously (mean 3.9 years). The patients were assessed with the same self-administered semiquantitative questionnaire used in the initial assessment. The results were compared with the original cure rate which was 88% at 1.75 years with another 2.5% more than 70% improved (total 90.5%). The cure rate in the 75 patients assessed at 3.9 years was 81%, with another 8% reporting more than 70% improvement (total 89%). Included in the latter were 2 patients who, though originally designated as failures, gradually achieved almost 100% continence within 2 years of surgery. Deterioration of continence following the IVS operation appears more like the Burch colposuspension than needle suspensions. It is possible to explain deterioration of continence with time in terms of age-related connective tissue laxity of the vaginal hammock. Improvement in 2 women with time can be explained by tightening of the hammock via paraurethral scar contraction with time. Whether the IVS operation improves or deteriorates in the longer term may depend on which process predominates.     

Maternal Serum Screening and Routine 18-week Ultrasound in the Detection of all Chromosomal Abnormalities

Summary: Over a 15-month period, maternal serum screening (alpha fetoprotein, oestriol, chorionic gonadotrophin) and ultrasound were evaluated in the detection of all chromosomal abnormalities. Of the 981 screened, there were 8 chromosomally abnormal pregnancies. Six of these were considered to be at increased risk on serum screening, all of which were detected. Of the remaining 2, one was detected by ultrasound and the other resulted in a liveborn baby with trisomy 21. The positive and negative predictive values for serum screening for all chromosomal abnormalities was 7.8% and 99.9% respectively. The sensitivity and specificity were 87.5% and 91.5% respectively. Serum screening is useful in the detection of many chromosomal abnormalities, not just Down syndrome. The combination of maternal serum screening and ultrasound has a high negative predictive value and is valuable in providing reassurance of no underlying chromosomal abnormality. With a positive predictive value of 7.8% a chromosomal abnormality will be found once in every 13 amniocenteses performed.     

A Prospective Randomized Study Comparing the Clinical Effects of a Norethisterone and a Levonorgestrel Containing Low Dose Oestrogen Oral Contraceptive Pills

Summary: The two types of low dose oral contraceptives one containing levonorgestrel the other containing norethisterone have been compared in a randomized prospective study. We have found that cycle control was much poorer with the norethisterone pill and would therefore recommend that if the norethisterone-containing pill needs to be prescribed then either the 1 mg or the 'synphasic' preparation should be considered.     

DIFFICULTIES AND DILEMMAS IN THE MANAGEMENT OF CONGENITAL ANOMALIES IN TWIN PREGNANCY

Both the incidence of twin pregnancy and the demand for prenatal diagnosis are increasing. Unfortunately, biochemical screening and ultrasound scanning are less reliable for prenatal diagnosis in twin pregnancies than in singletons. Amniocentesis and chorionic villous biopsy are usually diagnostic in singleton pregnancies but may be marred by sampling errors in twin gestations. Where a congenital anomaly has been diagnosed in a twin pregnancy, difficult decisions may have to be made, especially if one twin is unaffected. In these cases, special skills are required to ensure that adequate information, psychological support and optimal medical care are provided.     

AUDIT OF THE RELATIONSHIP BETWEEN EPISIOTOMY AND RISK OF MAJOR PERINEAL LACERATION DURING CHILDBIRTH

SUMMARY The beneficial effect of mediolateral episiotomy in reducing major perineal lacerations during childbirth has been questioned. In a test of the hypothesis of no association between episiotomy and the incidence of major perineal lacerations, the incidence of major perineal laceration was determined in three cohort groups in one maternity unit between 1984 and 1991. Among those undergoing non-instrumental delivery, no reduction in the incidence of major lacerations could be demonstrated following episiotomy. Among those undergoing episiotomy, the incidence of major lacerations was significantly higher following instrumental delivery.     

Outpatient Hysteroscopy - Problems

Summary: Outpatient hysteroscopy is now a routine procedure, but difficulties may be encountered. It was decided to assess the problems found in one practice over a period of time. Between August 1, 1989 and July 31, 1996 there were 1,080 examinations performed by the author; pain was sometimes significant, but already has been well covered in the literature. The other important problems were vasovagal reactions and failure to complete an adequate examination. This report emphasizes these problems. Being aware of potential problems allows one to anticipate them and often allows the procedure to be carried out successfully. At the very least, this awareness should save the patient major medical problems or discomfort.     

Urinary Voiding Patterns of Apparently Normal Women

A survey of 886 women who considered themselves to be normal was carried out to determine voiding habits in the population and the prevalence of urinary incontinence of any degree. Eighty-eight percent voided at 3-6 hourly intervals. Increasing age did not affect the frequency of micturition but parturition did. Nocturia was present in 18% but increased with age. Thirty-two percent of the study group admitted to having had one or more episodes of incontinence. Having borne a child increased the prevalence of incontinence but increasing age did not. There was a small but significant occurrence of apparent sphincter weakness in nulliparas.