Cases Of Uterine Perforation Research Articles

Outpatient hysteroscopic removal of retained products of conception: evaluation of effectiveness, safety and patient satisfaction

ObjectiveTo assess effectiveness, safety and patient satisfaction of hysteroscopic removal of retained products of conception using a tissue removal system in the outpatient setting. Study designA prospective observational study was carried out in a tertiary care hospital over a 10-month period. Fifty-two women who underwent an outpatient hysteroscopy for removal of retained products of conception were included. Effectiveness was evaluated as complete removal of retained products of conception in a one-time procedure. Safety was determined based on the rate of complications using the Clavien–Dindo classification system. Patient satisfaction and pain were assessed using a visual analogue scale survey completed by patients after the procedure. ResultsComplete removal of retained products of conception in a one-time procedure was achieved in 98.1% of cases. The mean morcellation time was 6.0 min. The complication rate recorded in this study was 9.6%; most complications were mild, but there was one case of uterine perforation. A global satisfaction ratio of 8.9 out of 10 was reported by patients. The study did not find any significant differences in complete removal of retained products of conception based on type of hysteroscope, presence of symptoms or Gutenberg classification. Although not significant, a linear relationship was observed between a higher volume of retained products of conception and a higher Gutenberg classification (p=0.229). ConclusionOutpatient management of retained products of conception using a tissue removal system is effective and safe, and has a high level of patient satisfaction. The results of this study have the potential to alter the standard approach to the management of retained products of conception.

Enhancing M&M rounds with the OR black box: A case of uterine perforation at hysteroscopy

Surgical complications happen, but it is essential to review these events to learn how to optimize care and avoid similar situations in the future. The Operating Room (OR) black box is a new technology that records audio and video footage from the operating room which is analyzed to improve patient care. It is also a promising tool to enhance morbidity and mortality rounds by reviewing surgical complications with real-time footage of the adverse event and context in which it happened. This video reviews the operating room (OR) black box, its functions and utility in enhanced morbidity and mortality rounds. A case of uterine perforation at hysteroscopy is presented using OR black box footage in the style of an enhanced morbidity and mortality rounds to demonstrate its utility and review important safety considerations for hysteroscopy.

Uterine Perforation as a Complication After Unsafe Abortion: Serial Case

The demand for abortion and the incidence of unsafe abortion are still very high. About 45% of all abortions worldwide are unsafe abortions. Unsafe abortion is still a public health problem and one of the causes of maternal morbidity and mortality. In this article, we report 2 cases of uterine perforation after provocation or induced abortion due to unwanted pregnancy. The diagnosis of uterine perforation was established by clinical suspicion and exploratory laparotomy. Many factors affect access to abortion and one of them is the law regarding abortion. Countries with almost no deaths from unsafe abortions are countries that allow abortion on demand without restrictions. Meanwhile, unsafe abortion can be prevented through prevention and controlKeywords: unsafe abortion, uterine perforation.

産褥早期に挿入した子宮内避妊具が子宮穿孔をきたし、腹腔鏡下手術で除去した４症例

産褥早期に挿入した子宮内避妊具が子宮穿孔をきたし、腹腔鏡下手術で除去した４症例

Implementation of a training protocol on intrauterine device insertion for resident physicians

Objective: To implement a training protocol on intrauterine device (IUD) insertion for resident physicians to improve women’s access to this method. Methods: The staff identified poor access to family planning, in Vila Lobato health center, specially to IUD, there were only 15 IUD insertions in 2015. This implementation research evaluated and identified the barriers of access to IUD use. Then, stakeholders and staff defined the access flow of patients to the health unit and, eventually, the training provided to resident physicians in gynecology and obstetrics (GO) and family medicine (FM). This is a retrospective cohort of the IUD insertions performed by residents between 2016 and 2018. Results : 252 copper IUDs were inserted from 2016 to 2018 and there was a progressive increase in the number of insertions (45 in 2016, 80 in 2017, and 126 in 2018). Thirty-four (16.4%) inadequate insertions and 15 (8.6%) expulsions were observed. There was no case of uterine perforation. Conclusion: The implementation of the protocol on IUD insertion for residents in the primary care setting increased the local number of IUD insertion and might be a strategy to improve the access to the contraceptive method.

EP22.17: An unusual case of uterine perforation in second trimester: a case report

EP22.17: An unusual case of uterine perforation in second trimester: a case report

Intrauterine Instillation of Tranexamic Acid in Hysteroscopic Myomectomy: A Double-Blind, Placebo-Controlled, Parallel-Group Randomized Clinical Trial

To evaluate the hemostatic effect of intrauterine instillation of tranexamic acid (TXA) with the distention medium during hysteroscopic myomectomy. Prospective, parallel-group, double-blind, placebo-controlled randomized clinical trial. Early Cancer Detection Unit in Ain Shams University Maternity Hospital, Cairo, Egypt. Eighty women with type 0 or I submucous myoma undergoing hysteroscopic myomectomy using unipolar resectoscope. The participants were randomly assigned to receive either 1 g of TXA for every 1000 mL of the distending medium (intervention group) or 10 mL of placebo (10 mL of 1.5% glycine) in the same form inside every 1000 mL of the distention medium. The primary outcome was a change in hemoglobin level 24 hours after surgery compared with preoperative values, and the secondary outcomes were the surgeon's rating of intraoperative bleeding and the quality of operative view, the duration of surgery, the volume of injected media, intraoperative complications, and the completion of myomectomy in 1 procedure. The mean difference in hemoglobin level was 1.11 ±.58 g/dL in the TXA group and 1.46 ± 0.61 g/dL in the placebo group (p = .015). The quality of hysteroscopic view was better in the TXA group (p = .001), with good operative view in 23 (60.5%) cases in TXA vs 8 (20.5%) in the placebo group. The surgeon's rating of bleeding as excessive was reported in 1 (2.6%) case in the TXA group and in 9 (23.1%) cases in the placebo group. There was no difference between the groups regarding the duration of surgery, the volume of injected media, completion of myoma resection in 1 session, and intraoperative complications. Three cases of uterine perforation with the thermal loop were reported, and all were associated with poor operative field in the placebo group. Intrauterine instillation of TXA with the distention medium during hysteroscopic myomectomy resulted in a statistically significant decrease in hemoglobin level 24 hours after surgery, albeit with minimal clinical significance. TXA resulted in better visualization of the field throughout the procedure.

Intrauterine Device Insertion during Cesarean Section in Women without Prenatal Contraception Counseling: Lessons from a Country with High Cesarean Rates.

The moment of admission for delivery may be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections. This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans. Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections. Two thirds of the women who continued with IUD at 6 months had undergone 2 or more cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.

OUTCOMES OF SECOND TRIMESTER SURGICAL ABORTION: THE EXPERIENCE OF A TERTIARY HEALTH FACILITY IN ETHIOPIA

ABSTRACTBACkGROUND: Abortion is defined as expulsion or extraction of a fetus before fetal viability. It is a very common occurrence globally (40-50 million per annum. There is increasing evidence to suggest that dilation and evacuation (D&E) leads to fewer complications than medical abortion for second trimester termination of pregnancy. However, there is no recent documentation of the outcome of such a method in Ethiopia. Hence the aim of this study is to document the outcome of second trimester D&E performed at St Paul Hospital and Millennium Medical College (SPHMMC). OBJECTIVE: To describe clinical characteristics and short-term outcomes of second trimester surgical abortion at SPHMMC. METHODS AND SUBJECTS: A retrospective cross-sectional study design was employed to review all cases of dilation and evacuation performed in the six months period from January 1, 2018- July 30, 2018. A structured questionnaire was used to collect selected socio-demographic data, clinical characteristics and acute complications. Data was entered and analyzed using IBM SPSS Statistics, version 20.0 (IBM Corp, Released 2011). RESULT: A total of 43 client records were reviewed and used for this analysis. The median (IQR) age of the study participants was 24 (20,26), with age range of 16 to 34 years old. The average gestational age is 16 weeks + 2 days (ranging from 13 weeks + 1 day to 20 weeks + 6 days). All women received doxycycline prior to performing D&E. No ultrasound was used during all the procedures. Over all complication rate is 2.3%, with 1 case of uterine perforation. The contraceptive uptake rate was 88.4% (38/43). The most common post abortion family planning method was long acting reversible contraceptives (LARC). CONCLUSION: Our review demonstrated that D&E is safe after applying recommended procedures in a tertiary health facility in Ethiopia. Further analysis using a larger sample should be undertaken and comparison should be made with medical induction in order to establish the safety and effectiveness of second trimester surgical abortion. kEY WORDS: second trimester safe abortion, Dilation & Evacuation (Ethiopian Journal of Reproductive Health; 2019; 11;1:1-8)

Postpartum intrauterine contraception device, a method of contraception: A study from rural north India

Background: PPIUCD is not commonly used in developing countries because of lack of awareness, social taboos and fear of complications of IUCD devices. Low acceptance of immediate PPIUCD usage results in high unmet needs and low utilization of the contraceptive method. Therefore we planned this study to see the acceptability and safety of PPIUCD in our local population. Material & Methods: A cross sectional, prospective study was conducted on 2540 women attending antenatal clinic at District hospital Samba, Jammu; Jammu and Kashmir from March 2016 to February 2018. All women attending antenatal clinic and in labour room were counseled for immediate PPIUCD and after written consent were included in the study. All these women were called for follow up visit after 6 weeks of insertion of PPIUCD. Results: A total of 2540 women were counseled for PPIUCD during their antenatal visits in third trimester and in early labour. Out of which 811 (31.9%) PP IUCD insertions were done. Most common age group was 26 – 30 year. Most of PPIUCD insertions were done in vaginal deliveries i.e. 678(83.6%) out of 811 and intracesarean PPIUCD insertions were only 133(16.40%) out of 811. Most of the women were either Para 2 or Para 1. 396 (48.82%) women came for follow-up after 6 weeks. There was no case of uterine perforation or any unplanned pregnancy. Unusual vaginal discharge were reported by 76(19.19%) women at follow-up. In 32 women IUCD was removed because of heavy menstrual loss, PID and personal reasons. IUCD strings were not seen on per vaginum examination in 40(10.10%) cases. All women with undescended strings underwent ultrasonographic confirmation of intrauterine placement of the device and women were assured for continuation of PPIUCD. Conclusion: To achieve the goal of Health Services for all, all women should have access to family planning services. If family planning services are provided to all women then only we will be able to decrease maternal and infant mortality. Acceptance of PPIUCD as method of contraception is low, though PPIUCD is an effective, safe, rapidly reversible and convenient contraceptive method. PPIUCD should be encouraged considering the advantages that come along, although there is a relatively higher incidence of expulsions

SONOGRAPHIC DETECTION OF UTERINE PERFORATION IN SURGICAL ABORTIONS: CASE REPORT FROM A DEVELOPING COUNTRY.

Uterine perforation is a rare major complication of surgical abortion which can be detected by ultrasound. In the last four decades, over 70% of case reports on uterine perforation in surgical abortions were from developing countries. Yet ultrasound was rarely used in detecting uterine perforation. This case report presents two cases of uterine perforation in surgical abortions which were detected by ultrasound prior to laparotomy. In the first case, a 34-year old woman was referred to our facility as a case of hypovolaemic shock following termination of pregnancy. An ultrasound examination performed to exclude an intra-abdominal abscess collection revealed a 1.2cm defect in the fundal region of the uterus with extrusion of abdominal contents into the endometrial cavity through the defect. In the second case, a 31-year old woman presented with a history of vomiting, abdominal pain, abdominal distension and absolute constipation after undergoing an evacuation of the uterus for a spontaneous abortion at 7 weeks’ gestation. Transabdominal ultrasound showed a defect of 1.4cm wide at the fundus of the uterus, with a structure extending from the abdominal cavity through the defect and into the endometrial cavity. It also showed distension of multiple bowel loops within the abdominal cavity. Sonographic detection of uterine perforation led to appropriate management in both cases. In developing countries, where the incidence of major complications of abortion is still very high, utilizing ultrasound can be helpful in detecting complications such as uterine perforation.

Retained Intrauterine Device (IUD): Triple Case Report and Review of the Literature

Background Throughout the world, intrauterine contraceptive devices (IUDs) are a frequently used, reversible, popular contraceptive method. They are usually placed without major complications. Uterine perforation is a rarely observed complication. Migration of the IUD to the pelvic/abdominal cavity or adjacent structures can occur after perforation. We present 3 cases of uterine perforation, possibly due to scarred myometrium associated with a cesarean delivery. We describe 3 perforations with IUDs lodged in the bladder serosa, the posterior cul-de-sac, and tissue adjacent to the cardinal ligament and external iliac artery. Cases Case 1. 26-year-old, Gravid 4, Para 2113, nonpregnant female with a history of a cesarean delivery underwent placement of an IUD one year after an elective pregnancy termination, presenting with abdominal pain requesting removal of the IUD. On speculum, although the IUD strings were visualized, the IUD could not be removed. Sonogram imaging identified an empty endometrial cavity with the IUD in posterior cul-de-sac. The IUD was removed via laparoscopy. Case 2 34-year-old Gravida 5, Para 4004, at 27 weeks and 3 days gestation, female with history of two previous cesarean deliveries underwent a third cesarean after spontaneous rupture of membranes with comorbid chorioamnionitis. Reproductive history was significant for placement of an IUD that had not been removed or imaged during obstetrical sonograms. The clinical evaluation revealed that the IUD had been spontaneously expelled. On the fifth operative day, the patient is febrile with CT demonstrating the IUD penetrating the anterior surface of bladder. On cystoscopy the bladder mucosa was intact. The IUD was removed via laparotomy with repair of the bladder, serosa, and muscular layer. Case 3 26-year-old, Gravid 4, P3013, nonpregnant female with three previous Cesarean deliveries had an IUD in place. However, with the IUD in situ, the patient conceived and had a spontaneous abortion. After the spontaneous abortion, she presented to clinic to have the IUD removed due to pain that was present since placement. Although the IUD strings were visualized, attempts to remove it were unsuccessful. Imaging identified the IUD outside the uterine cavity. Palpation with a blunt probe laparoscopically revealed a hard object within the adhesion band, close to the cardinal ligament. As per radiology evaluation, IUD was embedded 1cm from the external iliac artery on the right side outside the uterus in the adnexal region. A multidisciplinary procedure with gynecologic-oncologist was scheduled for removal due to the high risk of perioperative bleeding. Conclusion Patients in whom uterine perforation and IUD migration are suspected should have appropriate evaluation that includes transvaginal or transabdominal ultrasound or radiographs to confirm the position of the IUD, regardless of whether they are asymptomatic or present with symptoms. It is particularly important in the presence of a scarred uterus that imaging is used to identify the location of a missing IUD. The uterine scar of a cesarean may facilitate migration of the IUD. Cross sectional imaging, such as CT or MRI scan, may be needed to rule out adjacent organ involvement before surgical removal.

Uterine perforation following abortion in Tikur Anbessa Hospital, Addis Ababa, Ethiopia: A case series study

AbstractObjective: determine incidence, describe patient characteristics, examine clinicalpresentation, associated complications and describe mode of management of cases withuterine perforation.Methods: Operation registry, abortion care logbook and patients’ clinical records werereviewed in a teaching hospital in Addis Ababa, Ethiopia, between January 1, 1999 andDecember 31, 2000. Cases with laparatomy proven uterine perforation are described.Setting: obstetric and gynecologic department of a tertiary referral and teaching hospitalin Addis Ababa, Ethiopia.Outcome measures: clinical presentation, intraoperative findings, site of perforation,mode of management, associated complications and outcome of treatment.Results: there were a total of 927 abortions of which 25 were laparatomy proven cases ofuterine perforation following unsafe abortion, making the prevalence 27/1000 abortions.Majority were fond to be single, nulliparous, young and dependent member of the family.In 36% (9/25) termination was attempted after 14 weeks of gestation. Plastic and metallicmaterials are used frequently. Eight of the cases came after seven days of interference.The main clinical presentations were: abdominal pain (100%), signs of peritonitis(100%), pallor (96%), fever (76%) and vaginal bleeding (76%). Common intraoperativefindings include abdominal abscess, adhesions, and inflamed ovaries and tubes. Frequentareas of perforation are posterior aspect of the body and cervico-isthmic region of theuterus. Drainage and lavage of the abdominal cavity (80%), hysterectomy (76%) andremoval of adnexa (60%) were mainstays of management. All cases had sepsis andperitonitis, 24 had anemia, nine suffered from adult respiratory distress syndrome andeight developed wound infection. Duration of hospital stay ranged from one to 45 days.The case fatality rate was 32% (8/25). Only six came back for follow up.Conclusion: Uterine perforation is associated with increasing number of complicationsincluding death. Physicians catering the health care of women with unsafe abortion shallexhibit a high index of suspicion for uterine perforation. (Ethiop. J. Repro Health May2007, 1(1):17-27)

Clinical characteristic and intraoperative findings of uterine perforation patients in using of intrauterine devices (IUDs)

BackgroundIntrauterine devices (IUDs) are the most popular form of contraception used worldwide; however, IUD is not risk-free. IUD migrations, especially uterine perforations, were frequently occurred in patients. The aim of this study was to investigate the clinical characteristics and intraoperative findings in patients with migrated IUDs.Results29 cases of uterine perforation associated with migrated IUDs and 69 control patients were followed between January 2008 to March 2015. Patients who used IUDs within first 6 months from the last delivery experienced a characteristically high rate of the perforation of the uterine wall. A significantly larger number of IUD insertion associated with uterine perforation were performed in rural hospitals or operated at a lower level health care system. There was no clear difference in the age and presented symptoms in patients between two groups. Majority of contraceptive intrauterine devices was the copper-releasing IUDs. Furthermore, patients who used V-shaped IUD showed significantly higher incidence of pelvic adhesions when compared with the users of O-shaped IUDs.ConclusionsUnique clinical characteristics of IUD migration were identified in patients with uterine perforation. Hysteroscopy and/or laparoscopy were the effective approaches to remove the migrated IUDs. Improving operating skills is required at the lower level of health care system.

Sonohysterography in a suspected case of uterine perforation after dilatation and curettage for retained placenta

Abstract A 35-year-old woman, gravida 3, para 2, spontaneously delivered an infant without any major complications. On the 38th day after delivery, she returned to the hospital due to irregular bleeding. Transvaginal ultrasound showed a mass in the cervix; therefore, dilatation and curettage was performed, using placental forceps, to remove the retained placenta. During the procedure, a uterine perforation was suspected. Sonohysterography was performed in order to confirm the uterine perforation. The sonohysterogram revealed that the high echogenic mass that was suspected to be retained placenta was adhered on the posterior uterine myometrium. Saline that had been injected into the uterine cavity escaped into the Douglas pouch via a small hole in the posterior uterine wall. An emergency laparotomy was performed. Pathological examination of the removed uterus revealed placenta increta in the posterior wall, as well as an adjacent perforated fistula. Sonohysterographic diagnosis of uterine perforation in the present case was not only validated with diagnosis, but also the residual placenta was clearly visible. The use of sonohysterography for detection of a suspected case of uterine perforation after dilatation and curettage was accurate and provided a safe procedure for fast evaluation.

Ten years clinical experience with hormonal IUDS Mirena

Mirena is a recent long acting reversible contraceptive (LARC) which is producing 20 micrograms of levonorgestryl/day. It is indicated as a contraceptive and in management of different medical conditions. This study is designed to study the safety, effectiveness and tolerability of mirena as contraceptive. Also, study the effectiveness of merina in different other medical indications. The study was conducted on 490 cases who were followed for 5 years. The most common menstrual pattern in the 1st follow up visit was irregular spotting. After that in the next follow up visits, amenorrhea and hypomenorrhea were the commonest menstrual patterns in Mirena users in the different indications. The commonest cause of loop removal was heavy menstrual bleeding in non contraceptive group and desire for pregnancy in contraceptive group. There was no cases of uterine perforation and only one case of occurrence of pregnancy in the 4th year of IUDS use.

THE RISK FACTORS OF MOLAR PREGNANCY

Objectives: Molar pregnancy is the gestational trophoblastic disease and impact on the women’s health. It has several complications such as toxicity, infection, bleeding. Molar pregnancy also has high risk of choriocarcinoma which can be dead. Aim: To assess the risks of molar pregnancy. Materials and Methods: The case control study included 76 molar pregnancies and 228 pregnancies in control group at Hue Central Hospital. Results: The average age was 32.7 ± 6.7, the miximum age was 17 years old and the maximum was 46 years old. The history of abortion, miscarriage in molar group and control group acounted for 10.5% and 3.9% respectively, with the risk was higher 2.8 times; 95% CI = 1.1-7.7 (p<0.05). The history of molar pregnancy in molar pregnancy group was 9.2% and the molar pregnancy risk was 11.4 times higher than control group (95% CI = 2.3-56.4). The women having ≥ 4 times births accounted for 7.9% in molar group and 2.2% in control group, with the risk was higher 3.8 times, 95% CI= 1.1-12.9 (p<0.05). The molar risk of women < 20 and >40 years old in molar groups had 2.4 times higher than (95% CI = 1.1 to 5.2)h than control group. Low living standard was 7.9% in molar group and 1.3% in the control group with OR= 6.2; 95% CI= 1.5-25.6. Curettage twice accounted for 87.5%, there were 16 case need to curettage three times. There was no case of uterine perforation and infection after curettage. Conclusion: The high risk molar pregnancy women need a better management. Pregnant women should be antenatal cared regularly to dectect early molar pregnancy. It is nessecery to monitor and avoid the dangerous complications occuring during the pregnancy. Key words: Molar pregnancy, pregnancy women

Embrittlement of uterus after uterine artery embolization: a case of uterine perforation

Embrittlement of uterus after uterine artery embolization: a case of uterine perforation

Microwave endometrial ablation after endometrial curettage for the management of heavy menstrual bleeding

Objectives: The aim of the present study was to evaluate the efficacy of microwave endometrial ablation after endometrial curettage, in selected patients with heavy menstrual bleeding. Material and Methods: Thirty-two premenopausal women with heavy menstrual bleeding underwent microwave endometrial ablation at the Department of Obstetrics and Gynecology of the University of Patras Medical School. All patients did not respond to previous medical treatment, had completed their childbearing, and did not desire future fertility. The authors chose endometrial curettage rather than hormonal pre-treatment (GnRH analogs, danazol) for endometrial preparation. Post-treatment follow up protocol included physical and ultrasonographic evaluation at three, six, nine, and 12 months for the first year and yearly after. Results: The authors had no cases of uterine perforation, thermal injury to adjacent organs, and infection or sepsis. During follow up, there was a gradual decrease in amenorrhea rate (90.6% - 68.8%) and in satisfaction rate (90.6% - 71.9%). Moreover during follow up, eight women underwent to total abdominal hysterectomy. Among them, seven women had uterine myomas and one woman had adenomyosis. Conclusions: Endometrial preparation with endometrial curettage seems to be a good alternative to hormonal pre-treatment. It has the advantage of avoiding delays, side effects, and cost of hormonal pre-treatment. Moreover, microwave endometrial ablation after endometrial curettage is successful and highly acceptable.

Is Cold Loop Hysteroscopic Myomectomy a Safe and Effective Technique for the Treatment of Submucous Myomas With Intramural Development? A Series of 1434 Surgical Procedures.

To assess the safety and efficacy of cold loop hysteroscopic myomectomy in a large series of cases. Retrospective study (Canadian Task Force Classification III). Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. A total of 1215 patients with 1 or more G1-G2 submucous myomas. Cold loop hysteroscopic myomectomy. A total of 1690 myomas were removed. A minimum of 1 to a maximum of 5 fibroids for each surgical procedure were totally removed. Out of 1215 patients, 1017 (83.7%) were treated with a single surgical procedure. Twelve intraoperative complications occurred (0.84%). No cases of uterine perforation with the thermal loop or clinical intravasation syndrome were reported. Cold loop hysteroscopic myomectomy seems to represent a safe and effective procedure for the removal of submucous myomas with intramural development, while at the same time respecting the anatomic and functional integrity of the myometrium. The use of a cold loop in resectoscopic myomectomy is associated with a low rate of minor intraoperative complications and an absence of major complications. This could be of primary relevance with a view to fertility and future pregnancies.