History Of Cervical Procedure Research Articles

Routine Transvaginal Ultrasound at the Time of the Anatomy Scan: To Do or Not To Do?

There are no universal guidelines for transvaginal ultrasound (TVUS) at the time of the anatomy scan. TVUS can provide information on placental location and cervical length (CL) but may lead to more interventions. As a quality assurance initiative, a universal TVUS (UTVUS) protocol at the time of the anatomy scan was started at our institution. This study was conducted to assess whether there was a decrease in preterm birth (PTB), postpartum hemorrhage (PPH), and neonatal intensive care unit (NICU) admission once UTVUS was implemented. This was a retrospective cohort study performed on singleton gestations from February 2021 to January 2022. In the first 6 months of the study period, patients only had TVUS based on risk factors (pre group). In the second half of the study period, UTVUS was implemented at the time of the anatomy scan (post group). A total of 2,118 patients were included in the study. There were 1,037 patients in the pre group, of which 161 underwent TVUS based on high-risk factors (history of the cervical procedure, history of prior PTB, and placenta appearing low lying or cervix appearing short on abdominal ultrasound). The post group/UTVUS included 1,081 patients. Patients in the pre group had statistically significantly earlier gestational age at first TVUS (p < 0.0001), were less likely to have had a prior PTB <36 weeks (p = 0.03), and were more likely to have a history of cervical procedure (p = 0.0006) than patients in the post group. There was an increased use of vaginal progesterone in the UTVUS with 33 patients (as opposed to 10 patients in the pre group; p = 0.0007). The proportion of patients with PTB, PPH, or NICU admission did not significantly differ between the two groups even after adjusting for cofounders (p > 0.05). Our data show that UTVUS did not decrease the adverse pregnancy outcomes. In addition, the implementation of UTVUS adds more discomfort for a patient, more time to the patient's scan, and is an additional cost. Therefore, surveillance by abdominal ultrasound and adding TVUS based on risk factors may be a reasonable alternative. · UTVUS showed no difference between CLs.. · There is not sufficient evidence to conclude a difference between PTB or PPH in the two groups.. · There was significantly more placenta previa diagnosed in the post group, yet most resolved..

Cold Compress for Pain Associated With Intrauterine Device Insertion: A Randomized Controlled Trial [5G

INTRODUCTION: Pain with intrauterine device (IUD) insertion is identified as a barrier to compliance with this highly effective long acting reversible contraceptive. Several studies have assessed the efficacy of interventions to alleviate patient discomfort associated with IUD insertion, but no interventions have been clearly shown to improve procedural pain. The aim of this study was to determine if use of a cold compress on the abdomen during intrauterine device insertion improves pain. METHODS: This study is a prospective, randomized controlled trial comparing cold compression to no intervention during IUD device insertion. Study participants were women who desired IUD placement at Virginia Commonwealth University OB/GYN clinics. Subjects were randomized to control (n=40) versus cold compress (n=47) and they completed a pre- and post-procedural visual acuity scale for pain. Additional data was collected regarding gravidity, parity, history of cervical procedures and socioeconomic status as well as history related to chronic pain. RESULTS: There was no difference in pre and post-insertional pain in those who received a cold compress versus the control during insertion of intrauterine device (3.6 versus 2.8, P=0.223). The insertional pain was rated at 4.5 and 4.7 for patients who received the cold compress and the control group, respectively (P=0.724). CONCLUSION: While a cold compress is a simple, inexpensive and safe method of pain control this study shows no improvement in insertional pain for intrauterine device placement.

A Rare Case of Hematometra and Hematotrachelos

Introduction Hematometra and hematotrachelos are a rare condition, which means retention of blood in uterine cavity and cervix, respectively. It is usually due to obstruction at the level of cervix or uterus. In older women, the obstruction is usually acquired; the causes may be history of cervical procedures like cervical biopsy or cervical cone biopsy, cryosurgery, and LEEP.

Predictors of Positive Margins at Time of Loop Electrosurgical Excision Procedure.

The aim of the study was to identify factors associated with the presence of high-grade squamous intraepithelial lesion (HSIL) at surgical margins of loop electrosurgical excision procedure (LEEP) pathology specimens. All women evaluated for lower genital tract disease at a single academic institution were prospectively entered into a database. The database was queried for all women who had a LEEP performed for indications within contemporary American Society of Colposcopy and Cervical Pathology guidelines between April 1, 2013, and April 30, 2015. Factors extracted from the database included demographics, contraception, weight, tobacco use, provider volume, resident participation, history of cervical procedure, and pathology features including preceding Pap test category. A positive margin was defined as HSIL on either the endocervical or ectocervical margin of the LEEP specimen or in endocervical curettage specimen after LEEP. We performed univariable statistics to identify factors associated with positive margins and then logistic regression modeling on significant factors for the outcome of positive margins. Two hundred sixty-nine women were identified. Seventy five (27.8%) of these women had positive margins. Only tobacco use, gravity, parity, and preceding Pap category were significant on univariable analysis. After multivariable analysis, smokers remained more likely to have positive margins (odds ratio = 2.01; CI = 1.12-3.6; p < .01) as did those with preceding HSIL Pap tests (odds ratio = 1.96; CI = 1.13-3.41; p < .01). In our population, of all the factors assessed, only tobacco use and preceding high-grade Pap tests were associated with positive margins at time of LEEP. This information may be helpful in preprocedural planning to optimize treatment.