Objective To assess whether ultrasound detection of vault haematoma can be used as a predictor of postDesign Prospective observational study of consecutive cases of vaginal hysterectomy performed between Sample Two hundred and twenty-three women having undergone vaginal hysterectomy.Methods All women had transvaginal ultrasound examination by an independent observer on the third post-operative day. Routine observations and clinical assessments were made by established management protocol, by staff blinded to the ultrasound findings.Main outcome measures Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re-admission rate and length of stay.Results Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (3 1% vs 7%), postoperative haemoglobin drop (2-5 g/dL vs 1.6 g/dL), need for blood transfusion (145% vs 1.2%), representation to hospital (25.5% vs 5.4%) and length of hospital stay (8.87 days vs 6.25 days) were seen in the haematoma group. ConclusionUltrasound detection of vault haematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, need for blood transfusion, longer hospital stay and higher re-admission rate. In view of increasing demand for early discharge, driven by purchasers and patients, post-operative ultrasound identifies a high risk population and is both convenient and noninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trial of prophylactic antibiotics in this identified subset.operative morbidity following vaginal hysterectomy.1991 and 1994.

The presence of lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are associated with recurring pregnancy loss. Of 387 consecutive patients investigated at a Recurring Miscarriage Clinic over a three year period, 63 (16%) were positive for LA and ACA or both. Fifty-nine patients by definition were classified as having antiphospholipid syndrome and four also had systemic lupus erythematosus (SLE). Fifty-three subsequent pregnancies occurred in 63 patients and of these 37 ended in a live birth giving an overall livebirth rate of 70%. Treatment included low dose aspirin alone in 37 pregnancies and low dose aspirin and low molecular weight heparin (LMWH) in 16 pregnancies. The decision for treatment was made empirically on past obstetric history and level of LA and ACA, and past history of venous thromboembolic disease. Obstetric outcome was worst in the group who were positive for both LA and ACA, with a success rate of 53%, compared to 72 or 81% in the single parameter groups. Complications in the 37 successful pregnancies included eight Caesarean sections, four cases of intra-uterine growth restriction, one case of pregnancy induced proteinuric hypertension, one deep vein thrombosis and one pulmonary embolism. Patients with antiphospholipid syndrome are at high risk of pregnancy loss as well as maternal morbidity, especially thrombo-embolic disease. A randomised prospective controlled trial is necessary to determine the optimum therapy for pregnancy conservation and thrombprophylaxis.

In order to assess whether markers of cell senescence are related to reproductive failure, the expression of telomerase and telomere length in endometrial biopsies from women with and without reproductive failure were assessed. This pilot study included 45 women of whom 10 had idiopathic recurrent loss of empty gestational sacs, 10 had idiopathic recurrent fetal loss (miscarriage following identification of fetal cardiac activity), 10 had recurrent implantation failure and 15 had two or more normal pregnancies (control group). An endometrial sample was collected during the window of implantation from each woman. The mean endometrial telomere length was determined by quantitative polymerase chain reaction. Telomerase expression was evaluated by immunohistochemistry. The endometria of the control group showed virtually no telomerase immunoreactivity during the window of implantation. However, the immunostaining for telomerase was significantly and differentially increased in various endometrial cellular compartments in women with recurrent reproductive failure (P < 0.05). There were no significant differences in mean telomere length between groups. These data provide a novel insight into the biological correlates of clinical types of recurrent reproductive failure and suggest that specific alterations in the regulation of endometrial cell fate are associated with different types of recurrent reproductive failure.