The agreement between two observers for sonographic transvaginal measurement of the lower uterine segment can be considered good, compared with poor to moderate agreement using the transabdominal approach.

Summary. Background: D-dimer (DD) measurement has proved to be very useful to exclude venous thromboembolism (VTE) in outpatients. However, during pregnancy, the progressive increase as well as the interindividual variations of DD means that in this instance they are of poor value to rule out VTE. Only a few studies have reported measurements of DD levels in the postpartum. Objectives: To measure DD sequentially in the puerperium in order to determine when DD levels return to values obtained in non-pregnant women and can again be used in the exclusion of VTE. Patients and methods: After uncomplicated pregnancies, 150 women delivering at term either vaginally (n ¼ 100) or by cesarean section (n ¼ 50) were included. DD levels were measured immediately following delivery and next at days 1, 3, 10, 30 and 45. Results: There was a marked elevation of DD at delivery, especially when instrumental. All DD measurements were above 500 ng mL )1 at delivery, at day 1 and at day 3 postpartum. A sharp decrease in DD was observed between day 1 and day 3, followed by a slight increase at day 10. At day 30 and day 45, respectively, 79% and 93% of women in the vaginal delivery group and 70% and 83% in the cesarean group had levels below 500 ng mL )1. Bleeding, breastfeeding and heparin prophylaxis did not modify DD levels significantly. Conclusion: Using the Vidas DD new assay, our study provides reference intervals for DD in the postpartum period. Using a cut-off at 500 ng mL , DD measurement for ruling out VTE was found to be useful again 4 weeks after delivery.

Pat UPD14 is associated with a distinct clinical phenotype. Prognosis is poor because of severe respiratory insufficiency and neurodevelopmental retardation. Our report confirms salient postnatal signs of previous descriptions, especially the characteristic radiological abnormalities with ribs showing a 'coat-hanger' configuration. Retrospective fetal ultrasound of our case allowed the identification of this pathognomonic feature prenatally, which makes it possible to consider pat UPD14 at routine prenatal sonography, in particular in combination with a small bell-shaped thorax and polyhydramnios.

Objectives

Please cite this paper as: Antonelli E, Irion O, Tolck P, Morales M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG 2006; 113:846-847. Case reportA 27-year-old black African primigravida with an uneventful antenatal course was admitted in active labour at term. Six hours following admission, the cervix was fully dilated. The second stage of labour lasted 45 minutes and a 3200-g male infant was born without apparent complications. Five units of oxytocin were given intravenously with delivery of the anterior shoulder, and the complete placenta delivered spontaneously 15 minutes later without any need for cord traction. The postpartum period was uneventful until day 4 when the woman complained of acute pelvic pain associated with the desire to pass urine. Increased vaginal bleeding was noted at the same time. Vaginal examination revealed complete uterine inversion. The woman was taken immediately to the operating theatre, where an initial attempt at manual replacement under epidural analgesia was unsuccessful because of a constricted cervix. Terbutaline was administrated intravenously but a further effort at replacement failed and it was decided that a surgical reduction should be undertaken. Laparotomy revealed a complete uterine inversion, with bladder and ovaries pulled down through the inverted uterus. A Silastic Ò cup (Silc-cup; Menox AB, Gothenburg, Sweden) was easily inserted into the inverted uterus ( Figure 1A), a vacuum was created and a gentle traction achieved reduction of the inversion ( Figure 1B). Digital examination demonstrated an empty uterine cavity and an intact cervix. Twenty units of oxytocin were then administrated intravenously by slow infusion over 12 hours and broad-spectrum antibiotics were prescribed. The woman was discharged well 4 days later.