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Spontaneous abortion is the commonest complication of pregnancy and its frequency has been estimated to be between 15 and 20% of all clinical pregnancies. A comprehensive classification of etiologic factors that may cause repeated abortions is made and the importance of a precise program of the necessary diagnostic steps is underlined.

The Authors compare the efficiency of laparoscopic treatment with laparotomic surgical management of endometriosis. When the disease causes mechanical distortions and adnexal adhesions, there is an obvious explanation for infertility; in these cases laparotomic surgery has so far proved the only treatment to produce significantly valid results. No findings have yet been reported to demonstrate that cytoreduction, either pharmacological, laparoscopic or laparotomic, offers concrete advantages compared with simple observation when the disease is in the early stage.

The surprising disagreement in treatment results obtained by the various authors treating endometriosis is in large part due to differences in the severity of the disease. Only the adoption of a satisfactory staging system allows valid comparison between homogeneous groups of patients. This paper reviews and analyzes the various classifications proposed with the aim of showing the original aspects and the defects that led to the development of new systems including the most recent one published by the American Fertility Society. Devising a classification system presents unexpectedly great problems, but it is essential to be able to compare treatment results.

GnRH agonists, synthetic peptide analogs of GnRH, desensitize pituitary receptors for the native molecule, thus causing reversible hypogonadotropic hypogonadism. Numerous clinical studies have suggested that these compounds are efficacious in the treatment of endometriosis, but it is not clear whether they are superior to the other drugs used in treatment of this disease. The frequency of recurrence of pain symptoms at the end of treatment is high and the data on recovery of fertility are conflicting. Long-term administration of GnRH agonists is a safe and well tolerated treatment but its role in the management of endometriosis is still not well defined.

In the 12 subsep uteri the endometrium covering the septum was studied using light microscopy, electronic scanning microscopy and electronic transmission microscopy for the purpose of determining if it should be considered a reason for inadequate implantation and therefore justify an anomalous evolution of pregnancy. The results show that compared with a normal endometrium there is only a slight difference with the basal state. This alteration could however negatively influence the stages of development following implantation and particularly the structure of the maternal-fetal relationships which preclude placentation.

In the period 1979-1983, 102 patients with endometriosis underwent conservative surgery at Ia Clinica Ostetrica e Ginecologica, Milan University. Treatment indications, techniques and results are presented. 34.3% of the women were in stage I, 51% in stage II and 14.7% in stage III of the American Fertility Society classification. Postoperatively, the incidence of dysmenorrhea fell from 63.7% to 15.7%, deep dyspareunia from 53.3% to 17.6% and chronic pelvic pain 21.6% to 11.8%. In 1-6 years' follow-up of the 53 women wanting children, the postoperative birth-rate was 68.3% in stage I patients, 59% in stage II and 37.5% in stage III. Endometriosis treatment is still only symptomatic, and conservative surgery, using atraumatic procedures, should aim at restoring fertility and resolving pain symptomatology.

A hysteroscopic second look has been performed following sixteen intracavitary myomectomies, twenty-nine metroplasties and thirty-four intra-uterine adhesiolyses. This control has been performed three months after laparotomic operation and after forty-five days of sequential estro-progestogen treatment in cases of transcervical operation. The hysteroscopic second-look proved to be an excellent follow-up method after uterine conservative surgery and it avoids the use of X-rays, allows a detailed morphological evaluation of the uterine cavity and offers the possibility of complementary surgery, when necessary.

One case of left fallopian tube prolapse following vaginal hysterectomy is reported. Modifications of the endosalpinx at S.E.M. show a mucosa relatively resistant to biological assault.

Through sonographic sections with mid-empty bladder it is possible to evaluate all uterine biometric data. This technique was evaluated in thirty-four cases of uterine malformations and satisfactory results were obtained in thirty-two of them. If further studies on randomized patients confirm the specificity of this technique, it could become a basic non invasive investigation for the screening of uterine malformations.

Endometrial biopsies were obtained in 12 volunteers between 18 and 35 years old who had used SHB 209 AE oral contraceptive during the previous six months. Three main types of endometrial patterns were observed: proliferative, very similar to a normal proliferative phase; early secretory: similar to early postovulatory endometrium; late secretory: characterized by diffuse predecidual changes in the stroma. At SEM after one week a great prevalence of nonciliated cells was observed. During the 2nd and the 3rd week, the endometrial surface appears still flattened with scanty glandular outlets.

Authors report the endosalpingeal scanning electron microscopy (S.E.M.) findings in eleven tubes removed for ectopic pregnancies. The first aim of this study is to verify whether there is a corresponding morphological common aspect in all cases. The second aim is that of locating, with the aid of S.E.M. findings, some prognostic indications for predicting the future fertility of the patient.