- Email: [email protected]
Nerve entrapment after Pfannenstiel incision
Correspondence 499
Volume 161 Number 2
REFERENCES I. Bronson R, Cooper G, Rosenfeld D. Sperm antibodies;
their role in infertility. Fertil Steril 1984;42: 171-83. 2. Jager S, Kremer J, Van Siochteren-Draaisma T. A simple method of screening for antisperm antibodies in the human male. IntJ FertilI978;23:12-21. 3. Haas GG Jr, Cines DB, Schreiber AD. Immunologic infertility: identification of patients with antis perm antibodies. N Engl J Med 1980;303:722-7. 4. Witkin SS. David S. Effects of sperm antibodies on pregnancy outcome in a subfertile population. AM J OBSTET GvNECOL 1988; 158:59-62. 5. Haas GG Jr. How should sperm antibody tests be used clinically? Am J Reprod Immunol Microbiol 1987; 15: 10611. 6. Ayvaliotis B, Bronson R, Rosenfeld D, Cooper G. Conception rates in couples where autounmunity to sperm is detected. Fertil Steril 1985;43:739-42. 7. Clark GN. Elliott PJ, Smaila C. Detection of sperm antibodies in semen using the Immunobead test: a survey of 813 consecutive patients. AmJ Reprod Immunol Microbiol 1985;7: 118-23. 8. Meinertz H. Indirect mixed antiglobulin reaction (MAR) as a screening procedure for antis perm antibodies. Am ] Reprod Immunol MicrobioI1987;15:101-5. 9. Bronson R, Cooper G, Rosenfeld D, Witkin SS. Detection of spontaneously occurring sperm-directed antibodies in infertile couples by Immunobead binding and enzymelinked immunosorbant assay. NY Acad Sci 1984;438: 504-7.
Vaginosonographic examinationRoutine procedure? To the Editors.' The article by Bernaschek et al. (Bernaschek G, Rudelstorfer R, Csaicsich P. Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy. AM J OBSTET GVNECOL 1988; 158:608-12) refers to the use of a vaginal transducer to diagnose pregnancy as early as 4 weeks and 2 days and for early diagnosis of ectopic pregnancy. The authors suggest repeating the scan within 2 days if the initial study is equivocal. Unfortunately, they make no unequivocal reference to a need for patient selection. In view of their emphasis on the suitability of vaginal scanning as an office procedure, it could be interpreted as suggesting that this is a reasonable means of routine diagnosis of pregnancy. It is totally inappropriate to publish such an article without any cautionary comment with regard to the safety of ultrasonography. Margaret E. Furness, FRACR, DDU DIrector of Radiology Queen Victoria Hospital Rose Park, South Australia 5067
Reply
To the Editors: The allegations center on three issues: (1) safety of ultrasound; (2) need for patient selection for repeat scans; and (3) reasonable means of routine diagnosis of pregnancy. 1. The energy output of this modern vaginal ultrasonographic transducer is well beyond the safety mar-
gins of the American Institute of Ultrasound in Medicine (i.e., considerably <100 mWfcm 2 ). The recommendations of the World Federation of Ultrasound in Medicine and Biology are not based on scientific evidence that ultrasound delivered clinically is deleterious, but rather on the realization that scientific evidence is inconclusive. To date, studies with negative results predominate. Nevertheless. exposures should be as short as possible and administered by qualified personnel. I 2. An indication for a repeat scan after 2 days is only suggested when no intrauterine gestational sac has been seen in connection with a positive pregnancy test «750 mlU / ml) and the absence of any clinical evidence of spontaneous abortion. 3. In consideration of the very low energy output and the great value of a definite identification of an intrauterine pregnancy, we believe that vaginal ultrasonography is a new means for routine diagnosis of early pregnancy. There are patients for whom the very early diagnosis of an intrauterine pregnancy is of great value (e.g., patients with first-trimester bleeding or with a history of ectopic pregnancy, pelvic inflammatory disease, or tubal surgery or after in vitro fertilization).2 Finally, years ago the monitoring of follicles was introduced into fertility praxis with the same equipment without any reported hazard to the oocytes. Gerhard Bernaschek, MD Rudolf Rudelstorfer, MD Second Universitiits-Frauenklinik Spitalgasse 23 A-I090 Vienna, Austria REFERENCES I. Martin CA. Biologic effects. In: Sabbagha RE, ed. Diag-
nostic ultrasound applied to obstetrics and gynecology. Philadelphia: Lippincott, 1987:41. 2. Goldstein STR. Snyder JR. Watson C, Danon M. Very early pregnancy detection with endovaginal ultrasound. Obstet Gynecol 1988;72:200-6.
Nerve entrapment after Pfannenstiel incision To the Editors: I was surprised to read the conclusion made by Sippo et al. (Nerve entrapment after Pfannenstiel incision. AM J OBSTET GVNECOL 1987;157:420-1) that entrapment of the iliohypogastric nerve is a common complication of the Pfannenstiel incision. Because the authors have not reported the total number of patients who had undergone a Pfannenstiel incision. the prevalence rate of nerve entrapment after Pfannenstiel incision in their patients cannot be calculated. Thus, their statement that "entrapment of the iliohypogastric neve is a common complication of the Pfannenstiel incision" might be a result of their beliefs rather than a conclusion based on statistical calculations. We perform each year at the Soroka Medical Center in Beer-Sheva, Israel, some 700 laparotomies by the Pfannenstiel incision and have never encountered such a complication. However, I must admit that we have
Volume 161 Number 2
REFERENCES I. Bronson R, Cooper G, Rosenfeld D. Sperm antibodies;
their role in infertility. Fertil Steril 1984;42: 171-83. 2. Jager S, Kremer J, Van Siochteren-Draaisma T. A simple method of screening for antisperm antibodies in the human male. IntJ FertilI978;23:12-21. 3. Haas GG Jr, Cines DB, Schreiber AD. Immunologic infertility: identification of patients with antis perm antibodies. N Engl J Med 1980;303:722-7. 4. Witkin SS. David S. Effects of sperm antibodies on pregnancy outcome in a subfertile population. AM J OBSTET GvNECOL 1988; 158:59-62. 5. Haas GG Jr. How should sperm antibody tests be used clinically? Am J Reprod Immunol Microbiol 1987; 15: 10611. 6. Ayvaliotis B, Bronson R, Rosenfeld D, Cooper G. Conception rates in couples where autounmunity to sperm is detected. Fertil Steril 1985;43:739-42. 7. Clark GN. Elliott PJ, Smaila C. Detection of sperm antibodies in semen using the Immunobead test: a survey of 813 consecutive patients. AmJ Reprod Immunol Microbiol 1985;7: 118-23. 8. Meinertz H. Indirect mixed antiglobulin reaction (MAR) as a screening procedure for antis perm antibodies. Am ] Reprod Immunol MicrobioI1987;15:101-5. 9. Bronson R, Cooper G, Rosenfeld D, Witkin SS. Detection of spontaneously occurring sperm-directed antibodies in infertile couples by Immunobead binding and enzymelinked immunosorbant assay. NY Acad Sci 1984;438: 504-7.
Vaginosonographic examinationRoutine procedure? To the Editors.' The article by Bernaschek et al. (Bernaschek G, Rudelstorfer R, Csaicsich P. Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy. AM J OBSTET GVNECOL 1988; 158:608-12) refers to the use of a vaginal transducer to diagnose pregnancy as early as 4 weeks and 2 days and for early diagnosis of ectopic pregnancy. The authors suggest repeating the scan within 2 days if the initial study is equivocal. Unfortunately, they make no unequivocal reference to a need for patient selection. In view of their emphasis on the suitability of vaginal scanning as an office procedure, it could be interpreted as suggesting that this is a reasonable means of routine diagnosis of pregnancy. It is totally inappropriate to publish such an article without any cautionary comment with regard to the safety of ultrasonography. Margaret E. Furness, FRACR, DDU DIrector of Radiology Queen Victoria Hospital Rose Park, South Australia 5067
Reply
To the Editors: The allegations center on three issues: (1) safety of ultrasound; (2) need for patient selection for repeat scans; and (3) reasonable means of routine diagnosis of pregnancy. 1. The energy output of this modern vaginal ultrasonographic transducer is well beyond the safety mar-
gins of the American Institute of Ultrasound in Medicine (i.e., considerably <100 mWfcm 2 ). The recommendations of the World Federation of Ultrasound in Medicine and Biology are not based on scientific evidence that ultrasound delivered clinically is deleterious, but rather on the realization that scientific evidence is inconclusive. To date, studies with negative results predominate. Nevertheless. exposures should be as short as possible and administered by qualified personnel. I 2. An indication for a repeat scan after 2 days is only suggested when no intrauterine gestational sac has been seen in connection with a positive pregnancy test «750 mlU / ml) and the absence of any clinical evidence of spontaneous abortion. 3. In consideration of the very low energy output and the great value of a definite identification of an intrauterine pregnancy, we believe that vaginal ultrasonography is a new means for routine diagnosis of early pregnancy. There are patients for whom the very early diagnosis of an intrauterine pregnancy is of great value (e.g., patients with first-trimester bleeding or with a history of ectopic pregnancy, pelvic inflammatory disease, or tubal surgery or after in vitro fertilization).2 Finally, years ago the monitoring of follicles was introduced into fertility praxis with the same equipment without any reported hazard to the oocytes. Gerhard Bernaschek, MD Rudolf Rudelstorfer, MD Second Universitiits-Frauenklinik Spitalgasse 23 A-I090 Vienna, Austria REFERENCES I. Martin CA. Biologic effects. In: Sabbagha RE, ed. Diag-
nostic ultrasound applied to obstetrics and gynecology. Philadelphia: Lippincott, 1987:41. 2. Goldstein STR. Snyder JR. Watson C, Danon M. Very early pregnancy detection with endovaginal ultrasound. Obstet Gynecol 1988;72:200-6.
Nerve entrapment after Pfannenstiel incision To the Editors: I was surprised to read the conclusion made by Sippo et al. (Nerve entrapment after Pfannenstiel incision. AM J OBSTET GVNECOL 1987;157:420-1) that entrapment of the iliohypogastric nerve is a common complication of the Pfannenstiel incision. Because the authors have not reported the total number of patients who had undergone a Pfannenstiel incision. the prevalence rate of nerve entrapment after Pfannenstiel incision in their patients cannot be calculated. Thus, their statement that "entrapment of the iliohypogastric neve is a common complication of the Pfannenstiel incision" might be a result of their beliefs rather than a conclusion based on statistical calculations. We perform each year at the Soroka Medical Center in Beer-Sheva, Israel, some 700 laparotomies by the Pfannenstiel incision and have never encountered such a complication. However, I must admit that we have