Hysteroscopic Procedures Research Articles

Audit of operative hysteroscopies among infertile women in a resource-poor setting.

To evaluate the operative hysteroscopy procedures performed among infertile women at two hospitals in Nigeria. A prospective case series was undertaken among all patients with infertility who underwent operative hysteroscopy between November 2015 and April 2017. The outcome measures included the frequency and type of operative hysteroscopy and the reproductive outcome. The series included 159 women, 70.4% (n=112) of whom had abnormal findings at hysteroscopy. A total of 162 operative hysteroscopic procedures were performed; the most common procedures were adhesiolysis (76 [46.9%]), polypectomy (28 [17.3%]), and septum resection/incision (17 [10.5%]). The instruments used were mainly scissors (65 [40.1%]) and a resectoscope (52 [32.1%]). Complete removal of the lesions was achieved in 86.4% (n=140) of the procedures and a normal cavity in 87.0% (n=141). The complication rate was 6.8% (n=11); the most common complication was minor hemorrhage (5 [3.1%]). The main challenges included poor distention (10 [6.2%]) and poor vision (8 [4.9%]). Menstrual normalization was achieved in 64 (40.3%) of the patients, the cumulative pregnancy rate was 19.5% (n=31), and the live birth rate was 3.8% (n=6). Operative hysteroscopy was feasible and safe in the present resource-poor region. There is a need to build capacity for the performance of hysteroscopy to facilitate the management of infertility in the region.

Retained Intrauterine Bony Fragments as a Cause of Secondary Infertility in a Tertiary Level Indian Hospital.

Background:Midtrimester surgical abortions often result in retained intrauterine fetal bones and consequent secondary infertility.Aim:To study the incidence of women presenting with retained intrauterine bones as a cause of secondary infertility in a tertiary level Indian hospital and pregnancy rates following retrieval of these fragments.Setting and Design:Retrospective data analysis in the infertility clinic of PGIMER (Post Graduate Institute of Medical Education and Research), a tertiary level hospital of Northern India.Materials and Methods:Women diagnosed with retained intrauterine bony fragments were subjected to hysteroscopic removal of these fragments. Incidentally diagnosed retained bones on hysteroscopy were also removed. Such women were followed for spontaneous resumption of fertility or were subjected to ovulation induction, and pregnancy rates were noted.Results:Retained fetal bones accounted for 0.28% of all women with infertility and 12% (22/144) of all the uterine causes of infertility requiring an operative hysteroscopic procedure for treatment. Only 5 (27.7%) of 18 women conceived after the hysteroscopic retrieval of bony fragments: three had full-term vaginal deliveries, one had a midtrimester abortion, and one woman is in her third trimester.Conclusion:Despite surgical retrieval, fertility rates may be lower due to inflammatory damage to the endometrium.

Operative hysteroscopy intravascular absorption syndrome: The gynecological transurethral resection syndrome

Hysteroscopy is becoming fairly common in most centers these days, both as a diagnostic and therapeutic tool especially for short day-care procedures, reducing unnecessary hospital admissions and overuse of resources. However, these procedures are not without complications, and some could be delayed and potentially fatal if a high index of suspicion is not maintained. One such rare yet one with a high mortality among urological patients is the transurethral resection syndrome on which there is a cornucopia of literature in the form of articles and chapters. There are very few highlighting a similar syndrome of sorts called the operative hysteroscopy intravascular absorption syndrome. Here, we describe one such case, and in brief, the anesthetic management options for hysteroscopic procedures to prevent such a complication.

Evaluation of the Impact of Laparoscopic Supracervical Hysterectomy for the Treatment of Adenomyosis on Pain Intensity and Patient Satisfaction

Objectives. Common symptoms of adenomyosis include pain and bleeding disorders and can severely impact a patient’s quality of life. Few studies report on the impact of hysteroscopy procedures on improving these symptoms. This study evaluates the effect of laparoscopic supracervical hysterectomy (LASH) in adenomyosis patients on pain in general, pain during intercourse, bleeding disorders and general satisfactoriness of the procedure. Methods. This prospective observational single-arm, single-center study included 256 patients treated with LASH and whose histological analysis revealed adenomyosis. Other inclusion criteria were completed family planning and no more symptom relief with conservative therapy. They completed questionnaires before and after the procedure which evaluated pain in general, pain during intercourse, bleeding disorders and general satisfactoriness of the procedure. Results. Our results showed a significant (p < 0.0001) reduction of pain (from 1261 to 428 pain points), dyspareunia (from 763 to 224 pain points) and bleeding dis-orders when compared before and after LASH treatment. Furthermore, we found a high satisfaction rate of 98.4%. Conclusion. As a minimal invasive procedure associated with low major complication rates, LASH is a qualified therapeutic choice to treat pain and bleeding disorders in adenomyosis patients with completed family planning and in where conservative therapy failed.

Uterine Sounding: Is There a Difference between Blind and Hysteroscopically Directed Measurements?

Study ObjectiveTo evaluate the accuracy of traditional blind uterine sounding in measuring uterine cavity length (UCL), compared with measurement by hysteroscopic guidance. DesignA cross-sectional descriptive study (Canadian Task Force classification III). SettingAcademic multispecialty medical center. PatientsFifty-eight women undergoing elective hysteroscopic procedures. InterventionUCL measurement. MeasurementsUCL measurements were obtained by the traditional blind sounding technique and by hysteroscopically directed measurement. Hysteroscopic measurements were assumed to represent true uterine cavity length. Differences between the 2 measurements were calculated to analyze error and bias. ResultsMean UCL for blind sounding and hysteroscopically directed measurements were 80.81 mm and 86.55 mm, respectively. The magnitude of error between measurements was >10 mm in 36.2% of cases, with underestimation of true UCL in 55.17% of cases. ConclusionTrue UCL is underestimated by blind sounding, and the frequency, magnitude, and direction of error may be greater than are clinically acceptable.

Fertility Preserved Hysteroscopic Approach for the Treatment of Stage Ia Endometrioid Carcinoma.

ObjectiveThis study aims to explore the feasibility of a hysteroscopic procedure combined with progestin therapy in young patients with stage Ia endometrioid carcinoma (EC) to avoid sterilization.Materials and MethodsEleven young women with stage Ia EC (International Federation of Gynecology and Obstetrics grade 1) who were treated with a hysteroscopic approach combined with progestin from July 2004 to June 2016 were retrospectively analyzed and followed up to monitor their general recovery and pregnancy outcome.ResultsThe patients' median age was 27.3 years (range, 25–39 years). Comorbidities consisted of primary infertility in 8 patients, polycystic ovary syndrome in 4, uterine fibroids in 2, and diabetes in 1. The results of immunohistochemical analysis were positive for all estrogen and progestin receptors. After treatment, 9 patients attained complete remission, and 2 patients achieved partial remission. The results of peritoneal cytology in 4 patients were negative. As of this writing, 6 of the 11 patients have given birth to 7 infants, and 1 patient had an ectopic pregnancy. Two patients ultimately underwent radical resection. The average follow-up time was 82.3 months (range, 15 to 152 months), and all patients remain disease-free.ConclusionsHysteroscopic surgery combined with progestin treatment for stage Ia EC in young patients to avoid sterilization was practical and may represent a new option for patients with stage Ia EC who wish to preserve their fertility.

The role of antibiotic therapy and hysteroscopy technique in the prevention of infectious and inflammatory complications

Inflammatory complications are relatively frequent in the hierarchy of complications of hysteroscopy. The article describes two clinical case scenarios of hysteroscopic procedures complicated by pelvioperitonitis. The analysis of contemporary local and international literature is presented, and shows different attitude towards the antibiotic prophylaxis of inflammatory complications related to hysteroscopy. Taking into account that potential spread of infected material from the uterine cavity through the tubes into Douglas space plays role in the pathogenesis of inflammatory complications, it is advisable to consider the value of intra-uterine pressure as one of the main factors responsible for the development of inflammatory complications. It is also prudent to use the technique and values of in-office hysteroscopy to prevent tubal reflux and thus reduce the chance of infectious complications. The possibility of complete abandonment of antibiotic prophylaxis requires additional research and confirmation with clinical studies.

Indications, limitations and complications of operative hysteroscopy: a retrospective study of an 8-year experience

Operative hysterectomy (HSC) is now considered the gold standard treatment of most benign intrauterine pathologies [2]. The exam is performed using general anesthesia in day surgery procedure. Operative HSC enables the gynecologist to make diagnoses, obtain targeted endometrial specimens for histological examination, apply therapies (e.g. endometrial ablation), and perform a variety of surgical procedures (e.g. adhesiolysis, myomectomy, polypectomy). Operative HSC is also indicated for Mullerian anomalies (e.g. uterine septa), retained intrauterine contraceptives, endocervical lesions, and abnormal uterine bleeding unresponsive to medical treatment. The aim of the study was to analyze hysteroscopic procedures performed over an 8-year experience, highlighting indications, limitations, and complications of this technique in a sample of 1,412 women.

362 - Improving Patient Access Through Office Hysteroscopy Clinic Redesign

Study Objective: To improve patient appointment wait times for office hysteroscopy procedures without negatively impacting appointment “no show” and fill rates.

Metastasis of breast cancer to an endometrial polyp, the cervix and a leiomyoma: A case report and review of the literature.

Haematogenous metastases of breast cancer tumors has previously been demonstrated to frequently occur at the sites of the lung, bones, liver and brain, however presence in the uterine remains a rare occurrence. Metastatic carcinoma of the uterus usually originates from other genital sites, most frequently from the ovaries. The current review presents the first reported case of lobular breast carcinoma metastasizing to an endometrial polyp, the cervix and a leiomyoma simultaneously. The patient (58 years, female) first presented with abnormal uterine bleeding. Invasive ductal carcinoma had previously been diagnosed in her right breast, with lobular and ductal cancer cells observed to be present in her lymph nodes. A hysteroscopic procedure to examine the postmenopausal bleeding revealed an endometrial polyp, which was subsequently resected. The morphology and immunohistochemical studies confirmed the diagnosis of metastasis of lobular breast carcinoma to an endometrial polyp. An 18F fludeoxyglucose positron emission tomography/computed tomography (PET-CT) scan performed following the diagnosis, revealed a slightly increased uptake in the myoma, which is often observed in benign uterine leiomyoma. The patient then underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and partial colectomy. Pathology results demonstrated that the uterine leiomyoma and cervix shared the same histopathological features as those presented by the primary lobular breast carcinoma. Although rare, breast tumors may metastasize to an endometrial polyp, cervix and leiomyoma concurrently in patients, therefore physicians may now consider the potential of the diagnosis of metastatic spread to the genital tract, in a patient with abnormal uterine bleeding and a history of lobular breast cancer. Gynecologists planning a laparoscopic hysterectomy for a patient with a history of lobular breast carcinoma may consider abdominal rather than laparoscopic hysterectomy, as lobular carcinoma is difficult to detect. The use of PET-CT may be beneficial for the identification of an unexpected mass.

The feasibility, safety, and effectiveness of hysteroscopic sterilization compared with laparoscopic sterilization

In contrast to conventional laparoscopic sterilization, newer hysteroscopic approaches avoid the need for hospital admission, general anesthesia, and prolonged recovery. However, there are concerns that the feasibility, safety, and efficacy of hysteroscopic sterilization may be lower than established laparoscopic sterilization. We sought to evaluate the outcomes of hysteroscopic sterilization compared with laparoscopic sterilization in routine clinical practice in a comparative observational cohort study. This study was carried out at University of Birmingham, United Kingdom, National Health Service teaching hospital, office hysteroscopy clinics, and day-case hospital unit. In all, 1085 women underwent hysteroscopic sterilization and 2412 had laparoscopic sterilization. Hysteroscopic sterilization was carried out using the tubal implant permanent birth control system in the office setting and laparoscopic sterilization using the tubal ligation system as a day-case under general anesthesia. Outcome data were collected regarding feasibility (technical completion of the sterilization procedure, satisfactory radiological confirmation at 3 months-hysterosalpingogram or transvaginal pelvic ultrasound scan), safety events within 30 days of procedures, reoperations, and unintended pregnancies within 1 year of procedures. Hysteroscopic sterilization was successful in 992/1085 (91.4%; 95% confidence interval, 89.6-93.0%) at the first attempt. In comparison, bilateral tubal ligation was successfully performed in 2400/2412 (99.5%; 95% confidence interval, 99.2-99.8%) of patients who underwent laparoscopic sterilizations (odds ratio, 18.8; 95% confidence interval, 10.2-34.4). In all, 902/1085 (83.1%; 95% confidence interval, 80.8-85.2%) of successfully performed hysteroscopic procedures attended for radiological confirmation testing were considered satisfactory. The rate of adverse events within 30 days were similar: 2/1085 (0.2%) vs 3 (0.12%; 95% confidence interval, 0.04-0.36%). There were 3/1085 (0.3%; 95% confidence interval, 0.1-0.8%) unintended pregnancies after hysteroscopic sterilization compared with 5/2412 (0.2%; 95% confidence interval, 0.1-0.5%) laparoscopic sterilization (odds ratio, 1.3; 95% confidence interval, 0.3-5.6). Median length of follow-up for pregnancy outcome was 5 years. Hysteroscopic sterilization was associated with a higher risk of reoperation at 1 year compared to laparoscopic sterilization (odds ratio, 6.2; 95% confidence interval, 2.8-14.0) and the commonest reintervention was unilateral salpingectomy (12/22, 54.5%). Hysteroscopic sterilization has been introduced as a more convenient, office-based method of permanent fertility control. However, while the small risk of unintended pregnancy is comparable to conventional laparoscopic sterilization, women should also be counselled regarding its lower success rate in successfully completing the procedure and its higher rate of failed reoperation.

Reproducibility of the interpretation of coronal 3D ultrasound view of the uterus to evaluate the position of Essure® 3 months after hysteroscopic procedure

ObjectiveThree-dimensional sonography is a good alternative method to assess the position of microinserts. Adequate position after three months allows for the interruption of other contraception. Objective is to evaluate inter-observer reproducibility of the interpretation of coronal transvaginal 3D ultrasound view of the uterus to evaluate the position of Essure®. Study designInter-observer reproducibility study. Fifty women underwent successful bilateral placement of microinserts (Essure®) by hysteroscopy in the Department of Gynaecology of a teaching hospital and were included in the study. At three month, 3D ultrasound coronal views of the fifty uterus (accounting for one hundred microinserts) were assessed by five different observers and microinsert position was classified according to the classification described by Legendre et al. Inter-observer reproducibility in reading the 3D coronal view of the uterus was evaluated. ResultsThe k-value was disparate, from 0.26 to 0.82. Inter-observer reproducibility then ranged from fair to almost perfect, depending on a prior knowledge of the position classification. ConclusionsTransvaginal 3D coronal view of the uterus is sufficient to assess the positioning of the microinserts when the practionner or the surgeon is familiar with the classification method.

Management of persistent caesarean scar pregnancy after curettage treatment failure

BackgroundCaesarean scar pregnancy (CSP) is a late serious complication of caesarean section. The incidence of CSP has increased worldwide in recent years. Early diagnosis and prompt therapy are crucial to avoid catastrophic complications. There are various strategies for CSP treatment, but there is no consensus on the best management for CSP. Dilation and curettage (D&C) and hysteroscopy are common and effective treatments with their advantages and disadvantages. No in-depth study of the clinical effects of hysteroscopic management of CSP after D&C treatment failure has been conducted. The purpose of this study is to evaluate the effectiveness and safety of hysteroscopic removal of residual CSP tissue (persistent CSP) as a rescue after failed D&C management.MethodsThis is a retrospective clinical research study. Forty-five patients underwent operative hysteroscopy to remove the residual gestational tissue in the caesarean scar after failed D&C treatment. The clinical characteristics and outcomes of hysteroscopic surgeries of 45 CSP cases were investigated. All data analyses were conducted with SPSS 17.0.ResultsForty-three CSP cases after unsuccessful curettage treatment were successfully treated by operative hysteroscopy. The estimated intraoperative blood loss was 20.00 (10.00–500.00) mL, the hysteroscopic operating time was 20.00 (15.00–45.00) min, the decline of serum β-hCG the day after surgery was 71.91 ± 14.05%, the total hospitalisation time was 7.87 ± 2.26 days, the medical cost was 13,682.71 ± 3553.77 China Yuan (CNY), the time of bleeding after surgery was 7.42 ± 2.48 days, and the time of serum β-hCG resolution after surgery was 13.84 ± 9.83 days. Follow-up after discharge demonstrated that there were no severe complications for any patients.ConclusionsHysteroscopy therapy could treat persistent CSP effectively and safely after curettage treatment failure. Therapy should be individualised, and the risks and cost of the hysteroscopy procedure and anaesthesia must be considered and fully discussed with the patients before surgery.

Misoprostol for cervical priming prior to office hysteroscopy works in premenopausal nulliparous but not in postmenopausal women.

This randomised controlled trial (RCT) by Tasma et al. reports on pain at hysteroscopy. This is an important subject because hysteroscopy is the single most common procedure in gynaecology. There has been limited or conflicting evidence regarding misoprostol for cervical priming prior to hysteroscopy. Although there have been three meta-analyses and 25 RCTs published to date, the heterogeneity among regimens, doses, and route of administration, plus clinical diversity, make analysis of the data difficult. This well-designed, multi-centre RCT employed a novel method of measuring pain in real time throughout the hysteroscopy procedure, and provides much needed evidence for the vaginoscopic approach. Broadly in accordance with the meta-analysis of Polyzos et al. (Hum Reprod Update 2012;18:393–404), which included 21 RCTs involving 1786 patients, the results of Tasma et al. favours misoprostol cervical priming prior to office hysteroscopy for premenopausal nulliparous women, but not for postmenopausal women. Interestingly, though, a more recent systematic review by Hua et al. (Drug Des Devel Ther 2016;10:2789–2801) involving 2203 patients in 25 RCTs showed that misoprostol efficacy is related to the type of hysteroscopy (i.e. it is more beneficial in operative rather than diagnostic procedures) and route of administration (vaginal compared to other routes). There remain some unresolved uncertainties necessitating further studies, however. Firstly, this study was placebo controlled, but the placebo does not represent standard care, as analgesics are routinely offered for outpatient hysteroscopy. Secondly, although the authors provide a strong rationale for their choice of dose and timing, the optimal dose and schedule remains uncertain. So, in spite of the numerous RCTs addressing the subject, further guidance is needed on how to use misoprostol for different patient groups (parity, mode of delivery, and menopause all being relevant). Future RCTs targeting women from carefully selected populations should be performed to identify the ideal conditions for the use of misoprostol prior to hysteroscopy. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

A Rare Uterine Malformation: Asymmetric Septate Uterus

Study ObjectiveTo demonstrate a step by step surgical hysteroscopy technique in a patient with asymmetric uterine septum and transverse uterine septum that was not previously described in the literature. DesignResection of an asymmetric uterine septum by laparoscopy and ultrasound-guided hysteroscopy (Canadian Task Force classification III). The video was assumed exempt from official review by our institutional review board. SettingA septate uterus is defined as the uterus in which the uterine cavity is longitudinally divided by the septum [1]. The most common uterine anomaly, septate uterus has a spectrum of configurations ranging from complete septate to incomplete septate uterus. Asymmetric uterine septum was reported only as case reports in the literature and is described as Robert's uterus [2]. This unique malformation is described as a septate uterus with a noncommunicating hemicavity, composed of a blind uterine horn usually with unilateral hematometra, and a contralateral unicornuate uterine cavity. The external uterine shape is normal. The asymmetric septum with transverse uterine septum in the present case has not yet been reported in the literature. PatientA 29-year-old woman presented to our clinic with primary amenorrhea, cyclic pelvic pain, and the desire to have pregnancy. She previously had failed 2 laparoscopy and hysteroscopy procedures for fertility treatments. Hysterosalpingography previously had been failed. The patient previously underwent magnetic resonance imaging. The magnetic resonance imaging report states there was no connection between the uterus and cervix. On external genital organs assessment, there was no abnormal sign. Ultrasonography revealed 2 uterine cavities and hematometra. Both ovaries were in normal view. InterventionsIn view of her examination findings, the patient was scheduled for laparoscopy and hysteroscopy. Laparoscopy revealed extensive adhesions on both the pelvis and upper abdomen. Initially, the uterus and ovaries were not visualized. Adhesiolysis was performed, and normal anatomy was restored. After this step, the operation was continued by laparoscopy and ultrasound-guided hysteroscopy. Under ultrasound and laparoscopy guidance, the transverse uterine septum at the level of uterine isthmus was incised and the left endometrial cavity was observed with hysteroscopy. The asymmetric uterine septum was then incised, and the right-sided endometrial cavity was then accessed. Finally, the uterine septum was completely incised and both sides of the endometrial cavities were merged. The patient had an uncomplicated postoperative course and was discharged 24 hours after surgery. She returned for follow-up examination in the second month after surgery. She had regular menstrual cycles, and her pain was cured. ConclusionHysteroscopy and laparoscopy combined with ultrasound is a useful method for the diagnosis and treatment of asymmetric uterine septum. The skill and experience of the laparoscopic surgeon is another important factor to identify and manage unusual uterine malformations.

A “See and Treat” Office Procedure for Retained Products of Conception Removal After Normal Vaginal Delivery Using Manual Vacuum Aspiration: Preliminary Efficacy and Reproductive Outcomes

Study ObjectiveTo compare the efficacy and reproductive outcomes of an ultrasound-guided manual vacuum aspiration (MVA) procedure with the widely accepted operative hysteroscopic (OH) procedure in the removal of retained products of conception (RPOCs) after normal vaginal delivery. DesignA retrospective cohort study (Canadian Task Force classification II-2). SettingA university-affiliated tertiary medical center. PatientsEighty-six patients after normal vaginal delivery diagnosed with RPOCs from 2005 through 2015. This study was approved by the local institutional review board. InterventionsTreatment with either MVA or OH for patients diagnosed with RPOCs. Measurements and Main ResultsOf 86 patients, 23 underwent remnant removal by ultrasound-guided MVA using a 6- to 7-mm catheter in a “see and treat” office procedure. Sixty-three patients underwent remnant removal using the OH procedure. Follow-up included sonographic examination 3 to 5 weeks after the procedure and long-term follow-up on complications and reproductive outcomes. Successful remnant evacuation and the overall complications rates were similar when comparing the MVA group and the OH group (95.7% vs 96.8% and 4.3% vs 4.7%, respectively). Conception rates and miscarriage rates were comparable in the MVA and OH groups (78.6% vs 72.2% and 9.1% vs 14.8%, respectively). ConclusionPreliminary results from 23 patients suggest that MVA is an efficient procedure with low complication rates and satisfactory reproductive outcomes. It does not require anesthesia or operating room facilities, allowing an immediate and inexpensive “see and treat” option for RPOCs. Further larger controlled trials are required.

Safety and effectiveness of female tubal sterilisation by hysteroscopy, laparoscopy, or laparotomy: a register based study.

To determine the safety and effectiveness of female sterilisation in the Finnish population. A national register-based study using record linkage. National data from Finland. A total of 16 272 female sterilisations performed in 2009-2014. The Register of Sterilisations was linked with the Hospital Discharge Register, Termination of Pregnancy Register, and the Medical Birth Register in order to investigate the occurrence of re-sterilisations, other surgical operations, and unwanted pregnancies after sterilisation, per method. Outcome measures included all pregnancies after sterilisation (births, miscarriages, terminations of pregnancy, and ectopic pregnancies) and operations (repeat sterilisations, other hysteroscopic and laparoscopic procedures, hysterectomies, and re-operations for a complication). The outcomes were presented by method as risk ratio (RR) with 95% confidence intervals (95% CIs). There was no significant difference in all spontaneous pregnancies between the groups. The risk ratio for any pregnancy was 1.27 (95% Cl 0.80-2.02) for Filshie® versus Essure® and 1.35 (95% Cl 0.92-1.96) for Pomeroy versus Essure® . In total, 1394 (8.6%) selected operations were identified after primary sterilisation. Re-sterilisations and hysteroscopies were most frequent among Essure® patients. Patients undergoing hysteroscopic or laparoscopic sterilisation have a similar risk of unintended pregnancy. All sterilisations are safe, and the risk of re-operations because of complications is low. Women with Essure® have a higher risk of undergoing re-sterilisation compared with patients undergoing laparoscopic sterilisation. Essure® , Filshie® , and Pomeroy sterilisations are equally effective and safe.

Definitive Contraception: Trends in a Ten-year Interval.

Objective To evaluate the trends in definitive contraception in a ten-year interval comprising the years 2002 and 2012. Method Retrospective analysis of the tubal sterilization performed in our service in 2002 and 2012, analyzing the demographic characteristics, personal history, previous contraceptive method, definite contraception technique, effectiveness and complications. Results Definitive contraception was performed in 112 women in 2002 (group 1) and in 60 women in 2012 (group 2). The groups were homogeneous regarding age, parity, educational level and personal history. The number of women older than 40 years choosing a definitive method was more frequent in group 1, 49.1% (n = 55); for group 2, the rate was 34.8% (n = 23) (p = 0.04). The time between the last delivery and the procedure was 11.6 ± 6.2 and 7.9 ± 6.4 years (p = 0.014) in 2002 against 2012 respectively. In 2002, all patients performed tubal ligation by laparoscopic inpatient regime. In 2012, the bilateral placement of the Essure (Bayer Corporation, Whippany, NJ, US) device was suggested to 56.1% (n = 37) of the patients, while laparoscopy was suggested to 43.9% (n = 29) of them. All women who underwent laparoscopic sterilization had the procedure successfully completed using silastic rings. The overall bilateral device placement rate for the Essure was 91.6%, with only one complication reported. All Essure procedures were performed in an outpatient setting; for the laparoscopy, this rate was 79% (n = 15). No intentional pregnancies occurred until this date. Conclusions There is a trend in the decrease in definitive contraception over the years in our institution, maybe as a result of the development of long-acting reversible contraceptives. The hysteroscopic procedure has become a frequent option, as it is performed in an office setting without anesthesia, being a well-tolerated, minimal invasive method.

A Single Institution Review of Appropriateness of Prophylactic Antibiotics in Hysteroscopy [9M

INTRODUCTION: To examine our institution's adherence to American College of Obstetricians and Gynecologists guidelines for antibiotic prophylaxis in gynecologic surgeries for which antibiotics are not recommended. METHODS: A cross-sectional study of hysteroscopy cases performed at a single tertiary care center from August 2011 to September 2015 was completed. Descriptive statistics summarized patient characteristics. Chi-square tests examined antibiotic use associated with categorical variables; t- test was used for continuous variables. Multiple logistic regressions analyzed the effects of variables on the odds of receiving antibiotics of unproven benefit. RESULTS: Among 1,075 women who underwent hysteroscopic procedures for which antibiotics are not recommended, 196 (18.23%) received antibiotics. 770 (71.62%) women had a hysteroscopy alone, and 305 (28.37%) women had additional procedure(s) that also did not warrant antibiotics. The mean age was 45 (SD 13, Range 18-88) years. The odds of having unproven antibiotics increased by 2 percent (OR 1.02) with every one year age increase, adjusted for primary procedure, diagnosis and length of stay [95% CI, 1.76-4.58]. Age (P &lt; .0045), primary procedure (P &lt; .0022), primary diagnosis (P &lt; .0019), admitted year (P &lt; .0302) and length of stay (P &lt; .0005) had statistically significant effects on the impact of having unproven antibiotics. Patients undergoing hysteroscopic ablation were 2.8 times more likely to receive antibiotics than hysteroscopic biopsy (P &lt; .0001). CONCLUSION: Non-indicated antibiotic use is high among gynecologic surgeons at our tertiary hospital and the use varies significantly with patient characteristics. This study supports close surveillance of antibiotic administration during gynecologic surgeries for which the drugs are of unproven benefit.

Risk factors for recurrence of endometrial hyperplasia in women of late reproductive and premenopausal age

According to many researchers, hyperplastic endometrial processes are not precancerous diseases. However, recurrent endometrial hyperplastic processes, as well as their combination with genital and extragenital pathologies, significantly increase the risk of malignant transformation of the endometrium. Late reproductive and premenopausal age is associated with an increase in the frequency of endometrial hyperplastic processes, extragenital pathology and operative interventions on the internal genitalia. The limited possibilities of conservative treatment in connection with concomitant diseases and the tendency of an increase in the recurring hyperplastic processes of the uterus make the problem of studying various aspects of hyperplastic endometrial processes in women of this age period extremely urgent.The purpose of research: to identify risk factors for recurrence of endometrial hyperplasia in women of late reproductive and premenopausal age.Materials and methods. We studied the clinical and medical history and long-term results of treatment of 276 women aged 35–54 years with endometrial hyperplastic processes. All patients underwent diagnostic and therapeutic hysteroscopic procedures were carried out. In 88 (31.9%) women for 1.5 years after treatment were observed relapses of the disease. These patients accounted for Рц group, the remaining 188 women included in the group K. Data processing was performed using variation statistics method, Mann-Whitney ranking test, χ2-test and Fisher’s exact test.Results and conclusions. It should be noted the high rate of recurrence of endometrial hyperplastic processes in women of late reproductive and premenopausal age and lack of nosological specificity of recurrent endometrial hyperplastic processes. At the same time, recurrence of endometrial hyperplastic processes significantly increased the risks against the backdrop of giperpolimenorei, endometrioid disease, especially, adenomyosis and ovarian cysts. The greatest chances of recurrence were associated with the presence of patients extragenital diseases: gastrointestinal disorders, iron deficiency anemia, thyroid and breast cancer, vegetative-vascular dystonia. Within the framework of all investigated factors, the chances of recurrence of endometrial hyperplastic processes are most significant increased at the vegetative-vascular dystonia, and the pathology of the lacteal and thyroid gland.