Uterine leiomyosarcoma is an uncommon malignancy for which the management varies widely between individual gynaecologists and gynaecological oncology units. We have performed a retrospective review of patients treated at both the Royal Women's Hospital in Melbourne (1970-1997) and King George V Hospital in Sydney (1987-1993). In addition we have performed a survey of Certified Gynaecological Oncologists (CGO's) to assess the current management of uterine leiomyosarcomas in Australia. The results show varied management practices exist in Australia, many of which are not supported by evidence in the current literature. Oophorectomy in the premenopausal patient appears unnecessary unless the ovaries are macroscopically involved. The role of pelvic lymphadenectomy is debatable. This practice was recommended by many CGO's, yet these nodes are rarely positive unless obvious extrauterine disease is present. Adjuvant chemotherapy appears not to have a role at present unless in a trial setting. Adjuvant radiotherapy does appear to have a potential palliative role as it prevents locoregional relapse, although survival is not prolonged. Until suitable phase 3 trials are available, gynaecological oncology units should be meticulous in prospectively recording the clinical course of their patients and critically analyzing their current management strategies.

Cervical incompetence is a well recognized cause of recurrent mid-trimester pregnancy loss. Treatment of this condition is traditionally prophylactic cerclage either in the nonpregnant state or at 10 to 16 weeks' gestation (1). Under these ideal conditions, the fetal survival rate increases from approximately 20% before elective cerclage to 78437% after elective cervical cerclage (2,3). As no universally accepted diagnostic test exists for this functional entity it remains a diagnosis of exclusion and the decision to embark on cervical cerclage usually depends on the history of repeated pregnancy losses occurring in the second trimester. Other indications may include multiple terminations of pregnancy, deep conization of the cervix, cervical amputation, cervical laceration or congenital uterine anomalies. A policy of prophylactic cerclage results in many unnecessary procedures being performed (4) and accordingly some would advocate screening an at-risk population with weekly vaginal assessment of the cervix (5) or ultrasonographic assessment (6).Despite meticulous screening and surveillance, cervical incompetence may not be diagnosed until a patient presents with painless dilatation of the cervix and the fetal membranes protruding through the dilated 0s. Such a presentation is high risk for both the mother and fetus, demanding emergency management if the pregnancy is to be salvaged. Fetal survival rates of 48-68% have been reported after emergency cerclage (2). We present 3 such cases of emergency cervical cerclage assisted by amnioreduction which we believe may be a useful tool in some circumstances. CASE REPORTS Case 1A 34-year-old woman presented to her obstetrician for management of her fourth pregnancy at I5 weeks' gestation by dates. The pregnancy had been complicated by a threatened abortion at 6 weeks' I. Obstetric/Gynaecology Fellow.

We present a case of spontaneous evisceration of the small bowel through the vaginal vault in a 61-year-old women. The predisposing factors and management are discussed.

A case of chronic urinary retention due to bladder outflow obstruction presenting at 7 months postpartum, following a history of early puerperal voiding difficulties, is outlined. The cause was found to be a markedly retroverted uterus obstructing the urethra. Laparoscopic ventrosuspension was performed, converting preoperative urinary residuals of over 400 ml to zero postoperatively.