Our study shows that there is an increased risk of antenatal anemia, multiple pregnancy, primary postpartum hemorrhage, and adverse perinatal outcomes in grandmultiparous women independent of maternal age.

conventional laparoscopic surgical treatments for endometriosis performed by one surgeon experienced in both techniques. Included were all patients treated between July 2009 and October 2012 for endometriosis stage III or IV (American Society for Reproductive Medicine criteria). Compared between robotic-assisted laparoscopic surgery and conventional laparoscopic surgery groups were median age, body mass index, race, extent of surgery, median estimated blood loss, operating room time, length of stay, and intraoperative and postoperative complications. For continuous variables, medians and first and third quartiles were calculated; medians were compared with the Wilcoxon rank-sum test. Distributions of categorical variables were compared with x 2 or Fisher's exact tests. All analyses were two-sided with P,.05 considered significant.RESULTS: Included were 86 conventional laparoscopic surgery and 32 robotic-assisted laparoscopic surgery cases. Compared with the patients undergoing conventional laparoscopic surgery, those who underwent robotic-assisted laparoscopic surgery had a higher body mass index (27.36 kg/m 2 [23.90-34.09 kg/m 2 ] compared with 24.53 kg/m 2 [22.27-26.96 kg/m 2 ]; P,.008; Table 1) and operating room time (250.50 [176-328.50] compared with 173.50 [123-237] minutes; P,.001; Table 2). No significant differences were noted between the robotic-assisted laparoscopic surgery and conventional laparoscopic surgery groups in age, race, hysterectomy rate, estimated blood loss, length of stay, or in rates of intraoperative or postoperative complications.CONCLUSIONS: Despite a higher mean operating room time in the robotic-assisted laparoscopic surgery group, implementation of this new technology might allow a safe minimally invasive surgical approach for obese patients with all other clinical outcomes comparable to those in nonobese patients undergoing conventional laparoscopic surgery.

No abstract

Background: Choriocarcinoma is a rare clinical condition, and its diagnosis may be difficult, especially in resource-limited settings. Case Presentation: A 38-year old para 2 woman is with a 4-month history of intractable vaginal bleeding and offensive vaginal discharge, but without antecedent pregnancy. She had previously been managed at various tertiary medical institutions where several pelvic ultrasound scans and even histology of endometrial curette could not clinch the diagnosis. The diagnosis of choriocarcinoma was made by a serial strip-based pregnancy testing, which was still positive at 1:200 dilutions. She was treated with chemotherapy involving Adriamycin, Cyclophosphamide, Methotrexate and Folinic acid. Conclusion: The diagnosis of choriocarcinoma may be difficult especially when it develops ab initio without preceding abortion, molar or term pregnancy. In settings where serum hCG assay may be not available, the simple strip-based pregnancy test in dilution could be helpful in its diagnosis and treatment monitoring.