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Communicating uteri
Volume Number
144 6
Correspondence
739
2. Edwards, R. G., Purdy, I. M., Steptoe, P. C., and Walters, D. E.: The growth of human preimplantation embryos in vitro. AM. 1. OBSTET. GYNECOL. 141:408, 1981. 3. Kreitmann, 6.. and Hodgen, G. D.: Retarded cleavage rates of preimplantation monkey embryos in vitro, JAMA 246:627, 1981. 4. Craft, I., McLeod, F., and Edmonds, K.: Embryo transfer, ectopic pregnancy, and preliminary tubal occlusion, Lancet 2:1421, 1981. 5. Steptoe, P. C., and Edwards, R. G.: Reimplantation of a human embryo with subsequent tubal pregnancy, Lancet 1:880, 1976. 6. Tucker, M., Smith, D. H., Pike, I., Kemp, J. F., Picker, R. I-I., and Saunders, D. M.: Ectopic pregnancy following in-vitro fertilization and embryo transfer, Lancet 2: 1278, 1981.
Reply to Drs. Acker and Frigoletto To the Editors:
Drs. Acker
and Frigoletto’s points are well taken GYNECOL. 143:487, 1982), but we continue to urge abandonment of the “critical titer” concept, because it is not practical today. Very few laboratories can provide the physician with “critical titer” data and, because of this, ultrasound-directed amniocentesis and evaluation of the delta optical density is recommended. The Winnipeg experience with antenatal Rh immunoglobulin suggests 100 Rh negative pregnant women need to receive prophylaxis to prevent one case of sensitization, not 10,000 as stated in the article. The last question is obviously an error in the publication, as we do not administer Rh immune globulin to patients already sensitized.
(AM. J.
OBSTET.
Stanley
A. Gall,
M.D.
Department of Obstetrics and Gynecology Division of Perinatal Medicine Duke University Medical Center Box 3313 Durham, North Carolina 27710
Communicating uteri To the Editors:
I am afraid that the “variation of the double uterus” described by Drs. Jarrel, Copeland, and Lamonti is only an artifact. The authors assume that the failure to visualize the left hemiuterus of a bicornuate communicating uterus with complete obstruction of the left hemivagina and ipsilateral renal agenesis is due to obliteration of its lumen. Their assumption relies on a hysterogram showing the presence of an isthmic communication between the right hemiuterus and the left cervical canal and obstructed hemivagina only. I suggest that the failure to visualize the left hemiuterus is due to insufficient filling of the system by the dye,
Fig. 1. Hysterograms showing failed filling of the right hemiuterus of a bicornuate communicating uterus with obstructed right hemivagina (A), followed by normal filling(B) when additional dye was injected. (B, reprinted with permission of The American College of Obstetricians and Gynecologists, from Obstet. Gynecol. 43:221, 1974.)
which was already spilling into the right hemivagina in their Fig. 1. In one of my cases of communicating uteri,2 I observed the same picture (Fig. 1, A), but the nonvisualized hemiuterus filled (Fig. 1, B) when more dye was injected. Obviously less pressure is required to fill with dye the obstructed hemivagina, which already contains a certain amount of old menstrual blood, than to distend the virtual cavity of the muscular hemiuterus. Renzo
Toaff,
M.D.
10, Hermann Cohen Street Tel Aviv 64385, Israel REFERENCES 1. Jarrell, J., Copeland, the double uterus, 1981.
L., and Lamont, AM. J. OBSTET.
J. A.: Variation of GYNECOL. 140:483,
2. Toaff, R.: A major genital malformation-communicating uteri,
Obstet.
Gynecol.
43:221,
1974.
144 6
Correspondence
739
2. Edwards, R. G., Purdy, I. M., Steptoe, P. C., and Walters, D. E.: The growth of human preimplantation embryos in vitro. AM. 1. OBSTET. GYNECOL. 141:408, 1981. 3. Kreitmann, 6.. and Hodgen, G. D.: Retarded cleavage rates of preimplantation monkey embryos in vitro, JAMA 246:627, 1981. 4. Craft, I., McLeod, F., and Edmonds, K.: Embryo transfer, ectopic pregnancy, and preliminary tubal occlusion, Lancet 2:1421, 1981. 5. Steptoe, P. C., and Edwards, R. G.: Reimplantation of a human embryo with subsequent tubal pregnancy, Lancet 1:880, 1976. 6. Tucker, M., Smith, D. H., Pike, I., Kemp, J. F., Picker, R. I-I., and Saunders, D. M.: Ectopic pregnancy following in-vitro fertilization and embryo transfer, Lancet 2: 1278, 1981.
Reply to Drs. Acker and Frigoletto To the Editors:
Drs. Acker
and Frigoletto’s points are well taken GYNECOL. 143:487, 1982), but we continue to urge abandonment of the “critical titer” concept, because it is not practical today. Very few laboratories can provide the physician with “critical titer” data and, because of this, ultrasound-directed amniocentesis and evaluation of the delta optical density is recommended. The Winnipeg experience with antenatal Rh immunoglobulin suggests 100 Rh negative pregnant women need to receive prophylaxis to prevent one case of sensitization, not 10,000 as stated in the article. The last question is obviously an error in the publication, as we do not administer Rh immune globulin to patients already sensitized.
(AM. J.
OBSTET.
Stanley
A. Gall,
M.D.
Department of Obstetrics and Gynecology Division of Perinatal Medicine Duke University Medical Center Box 3313 Durham, North Carolina 27710
Communicating uteri To the Editors:
I am afraid that the “variation of the double uterus” described by Drs. Jarrel, Copeland, and Lamonti is only an artifact. The authors assume that the failure to visualize the left hemiuterus of a bicornuate communicating uterus with complete obstruction of the left hemivagina and ipsilateral renal agenesis is due to obliteration of its lumen. Their assumption relies on a hysterogram showing the presence of an isthmic communication between the right hemiuterus and the left cervical canal and obstructed hemivagina only. I suggest that the failure to visualize the left hemiuterus is due to insufficient filling of the system by the dye,
Fig. 1. Hysterograms showing failed filling of the right hemiuterus of a bicornuate communicating uterus with obstructed right hemivagina (A), followed by normal filling(B) when additional dye was injected. (B, reprinted with permission of The American College of Obstetricians and Gynecologists, from Obstet. Gynecol. 43:221, 1974.)
which was already spilling into the right hemivagina in their Fig. 1. In one of my cases of communicating uteri,2 I observed the same picture (Fig. 1, A), but the nonvisualized hemiuterus filled (Fig. 1, B) when more dye was injected. Obviously less pressure is required to fill with dye the obstructed hemivagina, which already contains a certain amount of old menstrual blood, than to distend the virtual cavity of the muscular hemiuterus. Renzo
Toaff,
M.D.
10, Hermann Cohen Street Tel Aviv 64385, Israel REFERENCES 1. Jarrell, J., Copeland, the double uterus, 1981.
L., and Lamont, AM. J. OBSTET.
J. A.: Variation of GYNECOL. 140:483,
2. Toaff, R.: A major genital malformation-communicating uteri,
Obstet.
Gynecol.
43:221,
1974.