For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial physiotherapy, results in higher rates of subjective improvement and subjective and objective cure at 1 year. (Funded by ZonMw, the Netherlands Organization for Health Research and Development; Dutch Trial Register number, NTR1248.).

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All hospital-based gynecologists in The Netherlands were sent a questionnaire on the termination of pregnancy with off-label drugs in the absence of treatment protocols. Response was received from 93.2% of the teaching hospitals and 87.9% of the non-teaching hospitals, thus representing practice of nearly all gynecologists working in The Netherlands. More than 40 different regimens were used for five different indications. Gynecologists embarked on a large number of different regimens of which a distressing number do not have any merits to be found in studies or guidelines illustrating that, without clear protocols or guidelines, the implementation of new medical treatments is potential haphazard and based on personal preference. Suboptimal treatment regimens will frustrate patients and doctors and deprive future patients from the most efficacious and patient friendly treatment regimes available.

Purpose and methodsWe reviewed the existing literature on medical termination of pregnancy in cases of congenital uterine malformation. Is medical termination of pregnancy safe in the presence of a uterine anomaly? Can termination of pregnancy still be performed when information concerning the presence of congenital uterine malformation is not available?ResultsThe risk of adverse outcome, i.e. uterine rupture, was high in class 2 uterine anomalies, whereas the risks in classes 3–6 were negligible. However, the very low incidence of class 2 anomalies in pregnant women results in a calculated risk of uterine rupture in medical termination of pregnancy on the basis of this anomaly of 1 in 300,000 pregnancies. Ultrasound scanning is of limited diagnostic value to diagnose congenital uterine malformations.ConclusionsThe implications of uterine anomalies are not an argument in the discussion whether to use misoprostol for termination of pregnancy in developing countries with scarce diagnostics tools.