LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy with significant improvement in patients outcome. Following vaginal vault prolapse, we determined the optimal fixation-site to perform the colposuspension in the intermediate portion of the uterosacral-ligament, especially if the cervical portion received a thermal damage, as occurs during the LigaSure use.

Background Evidence suggests that cervical cerclage should be offered to women after three or more previous preterm births (PTB) or second-trimester losses. Ultrasound-indicated cerclage reduces the rate of recurrent PTB in women with previous PTB or late miscarriage and a shortening cervix before 24 weeks. Patient selection is therefore critical for this intervention. Aim To assess the impact of a specialist antenatal service for women at risk of PTB on patient selection for cervical cerclage, cerclage rates and pregnancy outcome after surgery. Methods Women undergoing cervical cerclage were identified from the prospectively collected Anaesthetic Obstetric Procedure database and the PTB clinic database at University College London Hospital. Data on cervical cerclage and pregnancy outcomes were collected. Results There were 210 cases of cerclage; 85 cases before the PTB clinic was established (January 2005–December 2008), and 125 cases since (January 2009–December 2012). The rate of cerclage per 1000 women delivered fell from 6 to 5. Median gestational age at cerclage placement fell after establishment of the clinic (17+0/40, 13+2–23+3 to 15+2/40, 12+2–23+4 weeks). The proportion of rescue cerclages fell (26% to 12%) and the proportion of elective cerclages (history-indicated) doubled (44% to 88%). The median GA at delivery increased from 28+2/40 (17+0–39+5) to 35+2/40 (18+0–41+5). Conclusion The introduction of a specialist antenatal service for women at risk of PTB results in better patient selection for cerclage, earlier placement of cerclage, a reduction in rescue cerclages, and a lower rate of PTB and late miscarriage in those women who undergo surgery.

Fetal intra-abdominal umbilical vein (FIUV) varix is a rare prenatal abnormality characterised by a focal intrahepatic or extrahepatic dilatation of the intra-abdominal portion of the umbilical vein. Usually, it is an isolated finding, but in some cases it can be associated to other fetal anomalies. Thrombosis is a possible complication of FIUV varix and it can lead to poor fetal or neonatal outcome. We describe four consecutive cases of FIUV varix diagnosed in our Unit and managed with low-dose aspirin (LDA) prophylaxis until the 35th week of gestation. None of the fetuses developed thrombosis of the varix and the neonatal outcomes were good in all the cases.