No abstract

EDITORIAL COMMENT: This paper is provocative and we accepted it for publication so that interested readers, as well as the editorial subcommittee, could be provoked! Our reviewer reminded us that ‘one swallow does not a summer make’ and also that the GNRH agonist did not seem to reduce the size of the fibroids greatly. Not every gynaecologist would tackle such a uterus vaginally (for what it is worth the editor certainly would not). Stovall and colleagues have reported again on the problem of having treated 90 women with uterine size of 14–18 weeks and 60 with uterine size greater than 18 weeks' gestational size. Patients in both groups were randomized to either immediate hysterectomy or 2 months of preoperative gonadotrophin‐releasing hormone agonist. The results were favourable and more or less support the views expressed in this case report. The reference is given for interested readers, but please note that vaginal hysterectomy was attempted only ‘iftheuterus wasmobileand s 14 weeks'gestational size on bimanual examination’. (Stovall TG, Sumit RL, Washburn SA, Ling FW. Gonadotrophin‐releasing hormone agonist use before hysterectomy. Am J Obstet Gynecol 1994; 170: 6: 1744–1751. Response from author to editorial comment: I am happy with your editorial comment except that the GNRH agonist did reduce the size of the fibroids by 50% (volume). If you look at the ultrasound size and convert this to volume and compare the pathology specimen, you will note that the volume has reduced from approximately 280 ml to 125 ml. This agrees with references 7 to 9 where a volume reduction of approximately 50% was obtained. Summary: A case utilising GNRH agonist to reduce the bulk of uterine fibroids to allow vaginal hysterectomy is presented.

No abstract

EDITORIAL COMMENT: We accepted this paper for publication because cord problems should interest readers and it is generally accepted, as the author notes, that a true knot is seldom a cause of death before the onset of labour in contradistinction to entanglement of the cord around the babyS limbs and body. As far as the Editor is aware, diminished or absence of fetal movements has never been shown cardiotocographically to be caused by a true knot with successful delivery of the fetus although one can imagine that this could occul: It is interesting to speculate, as the author has done, concerning how a true knot tightens when the unzbilical cord is of normal length. In Chew's (A) paper the cardiotocographic findings were analyzed in 2,601 women who reported diminished fetal movements and there was no example of a knotted cord in any of the 21 perinatal deaths or in any of the 24 infants who had loss of baseline variation and type 2 decelerations, which was regarded as evidence of critical fetal reserve. A Medline search ident$ed a case where a sinusoidal fetal was congestion-of the other 2 vessels. The appearances were consistent with fetal asphyxia due to a tight true umbilical cord knot.

No abstract