Laparoscopy is considered the gold standard for the evaluation of tubal disease but it is an invasive and costly procedure. Chlamydia trachomatis antibody testing is simple and inexpensive and causes minimal inconvenience to the patient. Using the micro-immunofluorescence technique we assessed the significance of positive serology. There was a marked association between the titre and the likelihood of tubal damage. In the group with low titres (1 in 32) there was only a 5% incidence of tubal damage; however, there was a progressive increase in the incidence of tubal damage in those with higher titres. Twenty out of 57 patients with titres higher than 1 in 32 had tubal damage (35%). The difference between the two groups was statistically significant (P < 0.0001, chi(2) test). By using C. trachomatis antibody testing more widely it may be possible to reduce the number of laparoscopies performed. It should therefore become an integral part of the fertility work-up.

This prospective study of 104 women investigated the dose-related efficacy of mifepristone combined with oral misoprostol in the management of first trimester miscarriage (missed abortion and blighted ovum). Forty-four women (group A) received 600 mg of oral mifepristone and 60 women (group B) received 200 mg of mifepristone, followed after 48 hours by oral misoprostol. Successful treatment was an empty uterus on scan and no bleeding after 10 days. This was achieved in 70.5% of group A and 66.7% of group B. Also studied were amount and time to cessation of bleeding, pain scores, analgesic requirements, adverse effects and infections. Of group A, 54.5% had heavy bleeding and bleeding stopped on average by 8 days. Median pain scores were 5.5 on a linear scale and 18% of women received intramuscular opiate analgesia. Adverse effects were nausea in 25% of women and diarrhoea in 16%. Of group B, 38.3% had heavy bleeding and bleeding stopped on average by 7 days. Median pain scores were 4.5 with 25% of women receiving intramuscular opiates. Nausea occurred in 7% of women and diarrhoea in 7%. We concluded that 200 mg of mifepristone and oral misoprostol is as effective and better tolerated than 600 mg mifepristone with oral misoprostol. Medical management of miscarriage is a valid option for those women seeking an alternative to traditional surgical management.

Objective: To examine the associated features in pregnant women with superficial venous reflux, compared with those without reflux. Methods: Pregnant women were recruited at booking and underwent colour flow duplex ultrasound scanning of the lower limbs to ascertain the presence or absence of reflux in the superficial veins. Body mass index and CEAP scores were calculated. A questionnaire regarding parity, smoking habit and family history of varicose veins was administered. Statistical analysis was carried out using ARCUS. Results: Three hundred and twenty-nine women were recruited, of whom 83 were identified as having reflux (25%). No relationship was observed between reflux and obesity, smoking or family history. Multiparity was significantly correlated with varicose veins (p<0.03). CEAP scores were higher in multiparous women with varicose veins. An increase in symptoms was associated with a positive family history (especially maternal). Smoking was associated with fewer symptoms in those with reflux, as was obesity. Conclusion: Increased parity increased the likelihood of varicose veins, but obesity and family history appeared to make no difference. Symptoms were greater in multiparous women, but less inobese women. An association was made between smoking and fewer symptoms.

This prospective study looked at the effectiveness of 400 microg oral misoprostol in the management of women with a first trimester incomplete miscarriage with retained products of conception measuring between 15 mm and 50 mm on transvaginal ultrasound scan. Of 164 eligible women, 131 agreed to participate. Successful treatment, defined as an empty uterus on scan after 10 days with no bleeding, was achieved in 77.7% of women. Some women with retained products opted to have further misoprostol or conservative management instead of surgical evacuation and in total 92.4% of women completed their miscarriage without requiring surgery. Most bleeding was mild (31.3%) to moderate (38.9%), lasting on average 6.4 days. Forty-five per cent of women needed no pain relief, 51% received oral analgesia and 4% intramuscular opiates. Adverse effects included nausea (10.93%), diarrhoea (2.34%), vomiting (7.8%) and hypotension (4.68%). There were no infections. We concluded that a single dose of 400 microg of oral misoprostol was an effective treatment for women presenting with an incomplete miscarriage.

We present a case of a miscarriage at 16 weeks of gestation due to infection and transplacental passage of Salmonella group C. This was identified as being Salmonella Virchow from genital tract swab culture, and placental Gram-staining revealed numerous colonies of Gram-negative bacilli within the fibrin between the placental villi, confirming a true villitis associated with a hematogenous infection. Based on the patient's history, it was suggested that she had contracted the salmonella infection from eating undercooked eggs. Treatment of salmonella infection in pregnancy is controversial, and antibiotic therapy should be reserved for cases of invasive disease, using amoxicillin or a cephalosporin.