Treatment Of Uterine Bleeding Research Articles

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review.

Risk-reducing hysterectomy (RRH) is the gold-standard prevention for endometrial cancer (EC). Knowledge of the impact on quality-of-life (QoL) is crucial for decision-making. This systematic review aims to summarise the evidence. We searched major databases until July 2022 (CRD42022347631). Given the paucity of data on RRH, we also included hysterectomy as treatment for benign disease. We used validated quality-assessment tools, and performed qualitative synthesis of QoL outcomes. Four studies (64 patients) reported on RRH, 25 studies (1268 patients) on hysterectomy as treatment for uterine bleeding. There was moderate risk-of-bias in many studies. Following RRH, three qualitative studies found substantially lowered cancer-worry, with no decision-regret. Oophorectomy (for ovarian cancer prevention) severely impaired menopause-specific QoL and sexual-function, particularly without hormone-replacement. Quantitative studies supported these results, finding low distress and generally high satisfaction. Hysterectomy as treatment of bleeding improved QoL, resulted in high satisfaction, and no change or improvements in sexual and urinary function, although small numbers reported worsening. There is very limited evidence on QoL after RRH. Whilst there are benefits, most adverse consequences arise from oophorectomy. Benign hysterectomy allows for some limited comparison; however, more research is needed for outcomes in the population of women at increased EC-risk.

The optimization of abnormal uterine bleeding treatment in women with chronic psychogenic stress

The objective: to assess the effectiveness of the complex optimized treatment approach to abnormal uterine bleeding (AUB) in women with chronic psychogenic stress on the quality of life.Materials and methods. We examined 100 women of reproductive age with AUB and chronic psychogenic stress, 50 patients of them consisted the I group and received the optimized treatment, and 50 persons (II group) received the standard AUB treatment. 30 women without AUB and chronic stress were included in the control group. The examination of all persons included: anamnesis, clinical and gynecological examinations, ultrasound examination, general blood test, blood ferritin, vitamin D in serum blood. The quality of life was determined according to the 36-Item Short Form Health Survey before treatment and after three months. The standard approach included diagnostic and therapeutic measures according to the recommendations of Order N 353 dated 13.04.2016 of the Ministry of Health of Ukraine. The optimized treatment additionally included recommendations for lifestyle changes, melatonin, the use of vitamin D depending on its level, the medicament correction of iron deficiency without anemia.Results. The results of the questionnaire 36-Item Survey scales indicate that in patients with AUB and chronic psychogenic stress there is a decrease in the scales relative to the values of healthy women, especially in psychological component. In the persons of the II group there was no significant dynamics of the scales “Bodily pain” and “Physical role functioning” relative to the indicators before treatment, while the scales “Physical function” (p<0,001) and “General health perceptions” (p=0.01) increased significantly. The optimized treatment lead to a significant increase in all physical component scales compared till normal indices. In patients of the II group the indicators of psychological scales after treatment were significantly lower than the average values of healthy women. Thus, the value of the scale “Mental Health” was lower by 14,34% relative to the control group (p=0,18), “Emotional role functioning” – 18,38% (p=0,007), “Social role functioning” – 15,46% (p=0,003), “Vitality” – 23,27% (p=0,005). In the women of the I group there was a significant increase in the indicators of the psychological scales, which after treatment reached the values of healthy women.Conclusions. In women with AUB and chronic psychogenic stress, there is an insufficient positive dynamics in improving the quality of life after the standard treatment, especially the scales of the psychological component. The optimized treatment approach leads to the improvement of all parameters of quality of life of the patients.

For the treatment of uterine bleeding of ovarian origin. Hеnkel (Zentr. F. Gyn., 1926, No. 14)

At one time, Hеnkel proposed for this purpose to produce a wedge-shaped resection of the ovaries.

Phytochemical screening, phenolic and flavonoid contents, antioxidant and cytogenotoxicity activities of Combretum leprosum Mart. (Combretaceae)

ABSTRACT Combretum leprosum Mart. (Combretaceae), a shrub popularly known as mofumbo, is used in folk medicine for treatment of uterine bleeding, pertussis, gastric pain, and as a sedative. The aim of this study was to (1) determine the phytochemical profile,(2) identify chemical constituents and (3) examine antioxidant and cytogenotoxic activity of ethanolic extracts and fractions of stem bark and leaves. The plant material (leaf and stem bark) was submitted to extraction with ethanol, followed by partition using hexane, chloroform, and ethyl acetate. It was possible to identify and quantify the epicatechin in the ethanolic stem bark extract (0.065 mg/g extract) and rutin in the leaf extract (3.33 mg/g extract). Based upon in vitro tests a significant relationship was noted between findings from antioxidant tests and levels of total phenolic and flavonoid. Comparing all samples (extracts and fractions), the ethyl acetate fractions of stem bark (411.40 ± 15.38 GAE/g) and leaves (225.49 ± 9.47 GAE/g) exhibited higher phenolic content, whereas hexanic fraction of stem bark (124.28 ± 56 mg/g sample) and ethyl acetate fraction of leaves (238.91 ± 1.73 mg/g sample) demonstrated a higher content of flavonoids. Among the antioxidant tests, the intermediate fraction of stem bark (28.5 ± 0.60 μg/ml) and ethyl acetate fraction of leaves (40 ± 0.56 μg/ml) displayed a higher % inhibition of free radical DPPH activity, whereas intermediate fraction of stem bark (27.5 ± 0.9 μg/ml) and hydromethanol fraction of leaves (81 ± 1.4 μg/ml) demonstrated inhibition of the free radical ABTS. In biological tests (Allium cepa and micronucleus in peripheral blood), data showed that none of the tested concentrations of ethanolic extracts of leaves and stem bark produced significant cytotoxicity, genotoxicity, and mutagenic activity.Abbreviations AA%: percentage of antioxidant activity; ABTS: 2,2′-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid); CEUA: Ethics Committee in the Use of Animals; TLC: Thin Layer Chromatography; DNA: deoxyribonucleic acid; DPPH: 1,1-diphenyl-2-picrylhydrazyl; ROS: Reactive oxygen species; EEB: ethanol extract of the stem bark; HFB: Hexanic fraction of stem bark; IFB: Intermediate fraction of stem bark; CFB: Chloroform fraction of stem bark; EAFB: Ethyl acetate fraction of stem bark; HMFB: Hydromethanol fraction of the stem bark; EEL: Ethanol extract from leaves; HFL: Hexane fraction of leaves; CFL: Chloroform fraction of leaves; EAFL: Ethyl acetate fraction of leaves; HMFL: Hydromethanol fraction of leaves; GAE: Gallic Acid Equivalent; IC50: 50% inhibition concentration; HCOOH: Formic acid; HCl: hydrochloric acid; HPLC: High-performance liquid chromatography; MN: micronucleus; WHO: World Health Organization; UFLC: Ultra-Fast Liquid Chromatography; UESPI: State University of Piauí.

LNG-IUS: The best tool for non-surgical treatment of abnormal uterine bleeding and endometriosis

Introduction: The levonorgestrel- releasing intrauterine system (LNG-IUS) is the best tool for the non-surgical treatment for uterine bleeding and endometriosis. Materials and methods: Fifty-two women between the age 32 – 55 years were studied over a period of three years. Results: LNG-IUS caused 85% decrease in the amount of menstrual blood loss at 6 month and complete amenorrhea at two years. Conclusion: LNG-IUS was the best and effective to surgical management and other modes of medical treatment of abnormal uterine bleeding. The patient showed better compliance and satisfaction to the LNG-IUS. Keywords: Levonorgestrel-releasing intrauterine system (LNG-IUS), Abnormal Uterine Bleeding (AUB).

Treatment of uterine bleeding in pubertal girls without application of hormonal therapy on the background of related thyroid pathology

Pubertal uterine bleeding occupies an important place in the structure of gynecological pathology since, in the years, it can lead to persistent and irreversible changes in the process of formation of the reproductive system.The purpose of the work is to investigate the effectiveness of non-hormonal therapy in the treatment of uterine bleeding in adolescent girls against the background of concomitant thyroid pathology.Material and methods. Thirty adolescent girls with pubertal uterine bleeding were examined and treated against the background of concomitant thyroid pathology, which were treated in the gynecological department of the city clinical maternity hospital No. 1 in Chernivtsi. All examined patients also underwent a comprehensive examination to determine the level of hormones in the blood serum and to determine individual indicators of hemostasis.Results. It was established that the complex therapy used in adolescent girls suffering from pubertal uterine bleeding against the background of thyroid pathology is effective, as indicated by the positive feedback mechanism, namely the release of follicle-stimulating hormone in response to an increase in the level of estradiol in peripheral blood.Conclusion. The comprehensive treatment technique developed and used by us in adolescent girls with uterine bleeding with concomitant thyroid pathology contributes to the gradual normalization of the level of sex and thyroid hormones in the blood serum, shortens the treatment period in the hospital, and helps to normalize the overall hormonal profile of the examined girls with concomitant thyroid pathology.

Effect of herbal medicine Shenghua decoction on uterine bleeding after early medical abortion: A protocol for a systematic review and meta-analysis.

Background:Excessive and prolonged uterine bleeding is an important obstacle for medical abortion to get popularized. Shenghua decoction (SHD) is widely used for treating uterine bleeding after early medical abortion. However, the clinical evidence is unclear.Methods:Two researchers will dependently search literatures of SHD for the treatment of uterine bleeding after medical abortion from Web of Science, PubMed, Embase, and The Cochrane Library; traditional Chinese medicine databases; China National Knowledge Infrastructure (CNKI); Chinese Scientific Journal Database (VIP database); and Wan-Fang Database. These inclusive data of included studies will be conducted by RevMan V5.3 software.Results:This systematic review and meta-analysis will provide a detailed summary of the current evidence related to the efficacy of SHD in treating uterine bleeding after early medical abortion, including the duration and volume of uterine bleeding, the medical abortion pain.Conclusion:This systematic review and meta-analysis will provide a detailed summary of the current evidence related to the efficacy of SHD in treating uterine bleeding after early medical abortion,Registration Number:PROSPERO CRD42020184465.

Dr. W. J. Smyly. - The Treatment of uterine Haemorrhage during the last two Months of Pregnancy. (British medic. Journal '1895, Januar 12, pp. 62-65). Treatment of uterine bleeding in the last two months of pregnancy. Roh. Barnes, prof. Byers, More Madden, et al. (Ibidem). About the same

Bleeding in women in the last two months of pregnancy often depends on the premature separation of the last (accidental), rather than on its presentation (inevitable bleeding).

Prophylaxis of Ischemic Damage to the Ovaries, Taking Into Account Peculiarities of Blood Supply to the Uterus During Endovascular Treatment of Le Yo Fibroids

SUMMARY Uterine arteries embolization (UAE) is one of the modern trends in the treatment of uterine bleeding caused by uterine leiomyomas (UL). However, unfavourable results of this method of treatment are observed in 10–15% of cases. This is primarily concerned with the emerging ischemia of ovarian tissue after embolization.Material and methods Complex examination and treatment was performed in 48 patients admitted with UL complicated by the development of uterine bleeding. Patients with UL were divided into two groups. In the Group I of patients (n=29) standard embolization was performed, while the patients of the Group II (n=19) with diagnosed interarterial utero-ovarian anastomosis underwent separating technique of UA occlusion using different types of emboli.Results and discussion The features of the uterine blood supply in patients with UL were analyzed from the perspective of the effecacy and safety of endovascular intervention. A methodology of staged EUA was developed, which involved the staged aortography of the infrarenal aorta (for visualization of the ovarian arteries); pelvic arteriography (for evaluating the vascular anatomy of the pelvis and identifying utero-ovarian intearterial anastomoses); selective arteriography followed by UAE first with cylindrical emboli, and then with standard emboli in the form of microspheres. The application of the developed technique did not show dysfunction of the ovaries in both the short and long-term follow-up period up to 18 months in the Group II.Conclusion The separating UA occlusion is a safe and effective way of preventing ischemic damage in the presence of signoficant utero-ovarian inter-arterial nastomoses.

Hydrastinine with uterine bleeding.

Analyzing the pharmaceutical treatment of uterine bleeding, the author quite rightly stops at ergot preparations and hydrastis canadensis, as the most effective means. Ergot acts mainly on the very muscle of the uterus and, therefore, is shown in atonic bleeding, depending for example. from insufficient postpartum involution of the uterus, while hydrastis is most useful for so-called secondary bleeding that occurs under the influence of diseases of the uterine appendages, with chronic endometritis, in the menopausal period, in girls, etc. The disadvantage of this remedy, in the form of a liquid extract, is that it does not work well when used when bleeding has already occurred, and that to get the proper effect, it must be taken long (two weeks) before the expected Meno-or metrorrhagia.

Role of Uterine Artery Embolization in Management of Uterine Lesions with Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding is one of the most frequent gynecological and obstetrics problems. Till the recent decades, myomectomy and hysterectomy were the only treatment options available to control uterine bleeding regardless the morbidity and mortality. Over the past decade, uterine artery embolization (UAE) has become a popular alternative treatment. Our study aim is to evaluate the efficacy of UAE for the treatment of uterine bleeding of different etiologies as Fibroids & uterine arterio-venous malformation (AVM). Material & Methods: Thirty patients were enrolled in the study: 28 patients with fibroids & 2 patients with AVM, all underwent UAE by PVA for fibroid & Hystroacryl with lipidol & coils for AVM. Bleeding as an end point was Followed up for 6 months. Results: Cessation of bleeding with no recurrence through the 6 months of follow up. UAE significantly decreased the bleeding towels from 4.4 to 2 towels after 6 months. As well, the menstrual duration was reduced from 7.6 to 4.4 days (p < 0.05*). Hemoglobin level was boosted from 10.7 to 11.4 gm/dl after 6 months (p=0.001*). As well, the fibroid size was significantly reduced from 314.7 to 70.4 cm3 after 6 months (p < 0.05*). The AVM cases have completely recovered & one of them got pregnant with delivery of normal fetus with no reported complication. The majority of our patients showed high level of satisfaction with the obtained outcomes. Conclusion: UAE, either unilateral or bilateral, is a safe and effective technique for management of abnormal uterine bleeding of fibroids & AVM origin. A high clinical success rate and fibroid volume with the mean menstrual duration& amount reduction can be achieved.

Cytotoxicity study of Shalmali extract on human endometrial stromal cells

Various herbs are extensively used by the customary medical practitioners for curing numerous diseases in their day-to-day practice. Shalmali (Bombax ceiba) is a recognized plant used in the customary system for the management of various diseases. It has an extensive range of pharmacological and medicinal applications. In the current study, efforts have been made to summarize diverse aspects of scientific studies on the role of Shalmali extract on uterine bleeding. Therefore the cytotoxicity study of Shalmali extract was performed on endometrial cell lines using MTT assay. The absorbance by human endometrial stromal cells (T HESCs cells) was noted and the percentage of cell viability of T HESCs with varying treatment concentration of Shalmali extract was calculated in contrast to the standard placebo. The Shalmali extract showed cytotoxicity effect on T HESCs cells and the IC50 of the extract is 110µg/ml. To conclude that Shalmali extract showed a positive correlation was found to exist between the presence of antioxidant compounds and cytotoxicity against cells. Our results concluded that Shalmali extract could be used for the treatment of uterine bleeding.

There is no Correlation Between Long-Term Hysteroscopic Access to the Uterine Cavity and Menstrual Bleeding Status Following use of Water Vapor Ablation to Treat Heavy Menstrual Bleeding (HMB)

Study Objective Endometrial ablation often results in uterine cavity adhesions which preclude later evaluation and/or treatment of uterine bleeding. Prior studies of available ablation technologies have found a correlation between the severity of intrauterine adhesions and menstrual bleeding reduction. This analysis evaluates the correlation, if any, between preservation of long-term hysteroscopic access to the uterine cavity and menstrual bleeding status after water vapor endometrial ablation. Design Prospective, multicenter, observational. Setting Eight office and outpatient centers in the U.S. and Mexico. Patients or Participants 70 subjects who underwent water vapor endometrial ablation a mean of 3.9 years earlier as part of the AEGEA Pivotal Clinical Trial (NCT01979861). Interventions All subjects were screened for infection and general health risks through an IRB-approved process. Menstrual bleeding status was reported at screening prior to the hysteroscopy. Measurements and Main Results The mean duration since the endometrial ablation was 3.9 years. 27% (19/70) reported amenorrhea, 44% (31/70) light bleeding, 21% (15/70) moderate and 7% (5/70) heavy or very heavy bleeding. Overall cavity access for all subjects was 90% (63/70). The cavities were accessed in 89% of subjects reporting amenorrhea, 87% reporting light bleeding, 100% reporting moderate bleeding and 80% reporting heavy/very heavy bleeding. The Spearman Rank Correlation Coefficient was 0.19 (95% CI of -0.05 to 0.4), indicating no correlation of menstrual bleeding status with the ability to hysteroscopically access the uterine cavity. Selection bias analysis demonstrated comparability of subjects enrolled in this trial to the remaining subjects completing three-year follow-up in the Pivotal Trial. Conclusion Water vapor endometrial ablation provides lasting therapeutic effect for the treatment of HMB while preserving long-term uterine cavity access in the majority of subjects, irrespective of menstrual bleeding status.

Dramatic response of Mirena (levonorgestrel intrauterine system) in treatment of menorrhagia

Background: Menorrhagia is a type of menstrual disorder that is characterized by the presence of red vaginal discharge from the uterine cavity on a regular basis, but excessive in quantity (greater than 80 ml) and / or duration (greater than 7 days). Objective: To study the dramatic response of levonorgestrel intrauterine system (LNG-IUS) Mirena for treatment of menorrhagia during its use as contraceptive. Matera and methods: 30 women between 30 and 50 year with menorrhagia were included in a study over two year. Response was assessed monthly for first 4 month and then yearly for maximum 2 year. Result; Mirena caused decrease in blood loss (MBL) in 16.7% of the patients at 4 month, 73.3% decrease in(MBL) by one year and 100% decrease by 2 years, and improved the mean Hb level in 100% of the patients after 2 years. Mirena has an effective in treatment of abnormal uterine bleeding and this made surgical intervention (Hysterectomy) is last choice. Conclusion: LNG locally released on endometrium cavity is both a safe and reliable method of abnormal uterine bleeding treatment.

Chemical constituents of Patrinia heterophylla Bunge and selective cytotoxicity against six human tumor cells

Ethnopharmacological relevancePatrinia heterophylla Bunge, known as “Mu-Tou-Hui” in China, is distributed in most provinces and regions of China. As a traditional medicinal plant, which was first found in <Ben- Cao-Gang- Mu>. In many traditional herbal books, there are records of “Mu-Tou-Hui” of treatment for uterine bleeding, cancer, swelling pain, leukemia, etc. However, there are few studies on the chemical constituents of Patrinia heterophylla Bunge. Aim of the studyTo investigate the chemical constituents of P. heterophylla and the basis of their antitumor activity. Materials and methods15 compounds were isolated from roots and rhizomes of P. heterophylla by repeating various column chromatography techniques, whose structures were determined by organic spectrum analysis methods and compared with published data. The cytotoxicities were evaluated by MTT assay on six cancer cell lines: human melanoma cell (A375), human hepatocellular carcinoma cell (SMMC-7721), human gastric cancer cell (SGC-7901), human cervical cancer cell (HeLa), human colon cancer cell (HCT-116), and human breast cancer cell (MDA-MB-231). The apoptosis-inducing activities of compounds 1, 5, 12 and 15 in A375 tumor cell determined by flow cytometry. ResultFive phenylpropanoids, ethyl caffeate (1), coniferaldehyde (5), trans-p-coumaryl aldehyde (6), caffeic acid methyl ester (12), and 3,4-dihydroxycinnamic acid (15), four acetophenones, 1-(2,4-dihydroxyphenyl) ethanone (2), 2′,5′-Dihydroxyacetophenone (3), cynanchone A (8), and cynandione A (10), two phenols, vanillin (4) and catechol (9), two iridoids, sarracenin (7) and patriscabrol (11), one alkane, tetracosane (14), and one coumarin, scopoletin (13), were isolated from the EtOH extracts. Of them, compounds 1–10, 12 and 14–15 were isolated for the first time from the roots of P. heterophylla. Compounds 1 and 15 were reported for the first time with in vitro inhibitory activity against tumor cells. MTT assay showed that compounds 1, 5–9, 12–13 and 15 had selective cytotoxic activities (IC50 27.20–163.03 μM) against tumor cells. Apoptosis detected by flow cytometry revealed that compounds 1, 5, 12 and 15 can induce apoptosis for A375 at low concentrations when the concentrations of compounds 1, 5, 12 and 15 are the value of 14, 40, 34, 108 μM, the percentages of apoptotic cells were about 50%. ConclusionsCompounds 1–10, 12 and 14–15 were isolated for the first time from the P. heterophylla. This result enriches the previous studies on the chemical constituents of P. heterophylla. Compounds 1 and 15 were reported for the first time to have cytotoxic activities against tumor cells. Compounds 1, 5, 6, 7, 12, 15 showed cytotoxic activities against tumor cells. This result reveals that the active ingredient of P. heterophylla are composed of phenylpropanoids, iridoids and coumarins. This study provides some theoretical basis for the anti-tumor research of P. heterophylla.

Approaches to non-hormonal treatment of uterine bleeding in adolescents girls

Approaches to non-hormonal treatment of uterine bleeding in adolescents girls

The Standardized Extract of Limonium tetragonum Alleviates Chronic Alcoholic Liver Injury in C57Bl/6J Mice.

Background:In traditional folk medicine, Limonium tetragonum is used in the treatment of uterine hemorrhage, tinnitus, and oligomenorrhea.Objective:This study aimed to identify the therapeutic effect of L. tetragonum EtOAc extract (EALT) on liver of mice with chronic alcohol poisoning.Materials and Methods:C57BL/6J mice were administered 100 mg/kg of EALT with a single binge ethanol/Lieber-DeCarli liquid diet for 8 weeks.Results:The chronic-binge ethanol diet induced a significant increase in liver marker enzyme activities. Coadministration of EALT reversed the elevation of serum total cholesterol and triglyceride as well as aspartate aminotransferase and alanine aminotransferase due to chronic alcohol consumption. Histologic findings including markedly attenuated fat accumulation in hepatocytes were observed in EALT-treated mice. EALT supplementation prevented alcoholic liver injury through attenuation of inflammatory mediators such as toll-like receptor-4, cytochrome P4502E1, and cyclooxygenase-2, and inflammatory cytokine interleukin-6.Conclusion:Results provided direct experimental evidence for the hepatoprotective effect of EALT in the NIAAA mouse model. Therapeutic attempts with the L. tetragonum extract might be useful in the management of alcoholic liver disease.SUMMARY Halophyte Limonium tetragonum has recently been of interest in Korea for its nutritional value and salty taste which made it an ideal vegetablePhytochemical analysis of L. tetragonum EtOAc extract (EALT) resulted in nine compounds including catechins and myricetin glycosides as main componentsAdministration of EALT for 8 weeks showed hepatoprotective effect on Lieber-DeCarli diet-fed mouse modelA significant decrease in liver marker enzymes and inflammatory mediators was also detected. Abbreviations used: EALT: L. tetragonum EtOAc extract; TC: Total cholesterol; TG: Triglyceride; ROS: Reactive oxygen species; CYP2E1: Cytochrome P4502E1; TLR-4: Toll-like receptor-4; COX-2: Cyclooxygenase-2.

Utility of anesthetic block for endometrial ablation pain: arandomized controlled trial.

Second-generation endometrial ablation has been demonstrated safe for abnormal uterine bleeding treatment, in premenopausal women who have completed childbearing, in short-stay surgical centers and in physicians' offices. However, no standard regarding anesthesia exists, and practice varies depending on physician or patient preference and hospital policy and setting. The aim of this study was to evaluate whether local anesthetic, in combination with general anesthesia, affects postoperative pain and associated narcotic use following endometrial ablation. This was a single-center single-blind randomized controlled trial conducted in an academic-affiliated community hospital. A total of 84 English-speaking premenopausal women, aged 30 to 55 years, who were undergoing outpatient endometrial ablation for benign disease were randomized to receive standardized paracervical injection of 20 mL 0.25% bupivacaine (treatment group) or 20 mL normal saline solution (control group) upon completion of ablation. The study was designed to test a 40% 1-hour mean visual analog scale (VAS) pain score difference with an average standard deviation of 75% of both groups' mean VAS scores, using a 2-tailed test, a type I error of 5%, and statistical power of 80%. A sample of 36 patients per study group was required. Assuming a 15% attrition rate, the study enrolled 42 patients per study arm randomized in blocks of 2 (84 total). Two-tailed cross-tabulations with Fisher exact significance values where appropriate and Student t tests were used to compare patient characteristics. Backward stepwise regressions were conducted to control for confounding. Between April 2016 and February 2017, a total of 108 women scheduled for endometrial ablation were screened (refusals, n= 21; ineligible, n= 3) to determine whether there were meaningful differences in postoperative VAS pain scores and postoperative narcotic use. Of the 84 randomized women, 2 age-ineligible women were excluded. Intent-to-treat analyses included 1 incorrect randomization (in which the provider consciously decided to provide analgesia regardless of the protocol, after which the provider was excluded from further study participation) and 3 women having no ablation because of operative difficulties. Three were lost to second-day follow-up. Treatment group patients (n= 41) experienced 1.3 points lower 1-hour postoperative VAS pain scores than the control group (n= 41, P= .02). The difference diminished by 4 hours (P= .31) and was negligible by 8 hours (P= .62). Treatment group patients used 3.6 less morphine equivalents of postoperative pain medication (P= .05). Regression analyses controlled for confounding reduced the 1-hour postoperative treatment group pain scoredifference to 0.8 (confidence interval [CI],-0.6 to 0.1) but slightly increased theaverage postoperative morphine equivalents to 3.7 (CI,-6.8 to-0.7). This randomized controlled trial found that local anesthetic with low risk for complications, used in conjunction with general anesthesia, decreased postoperative pain at 1 hour and significantly reduced postoperative narcotic use following endometrial ablation. Further research is needed to determine whether the study results are generalizable and whether post procedure is the best timeto administer the paracervical block to decrease endometrial ablation pain.

389 - Utility of Anesthetic Block for Endometrial Ablation Pain: A Randomized Controlled Trial

Background Second-generation endometrial ablation has been demonstrated safe for abnormal uterine bleeding treatment, in premenopausal women who have completed childbearing, in short-stay surgical centers and in physicians’ offices. However, no standard regarding anesthesia exists, and practice varies depending on physician or patient preference and hospital policy and setting. Objective The aim of this study was to evaluate whether local anesthetic, in combination with general anesthesia, affects postoperative pain and associated narcotic use following endometrial ablation. Materials and Methods This was a single-center single-blind randomized controlled trial conducted in an academic-affiliated community hospital. A total of 84 English-speaking premenopausal women, aged 30 to 55 years, who were undergoing outpatient endometrial ablation for benign disease were randomized to receive standardized paracervical injection of 20 mL 0.25% bupivacaine (treatment group) or 20 mL normal saline solution (control group) upon completion of ablation. The study was designed to test a 40% 1-hour mean visual analog scale (VAS) pain score difference with an average standard deviation of 75% of both groups’ mean VAS scores, using a 2-tailed test, a type I error of 5%, and statistical power of 80%. A sample of 36 patients per study group was required. Assuming a 15% attrition rate, the study enrolled 42 patients per study arm randomized in blocks of 2 (84 total). Two-tailed cross-tabulations with Fisher exact significance values where appropriate and Student t tests were used to compare patient characteristics. Backward stepwise regressions were conducted to control for confounding. Results Between April 2016 and February 2017, a total of 108 women scheduled for endometrial ablation were screened (refusals, n = 21; ineligible, n = 3) to determine whether there were meaningful differences in postoperative VAS pain scores and postoperative narcotic use. Of the 84 randomized women, 2 age-ineligible women were excluded. Intent-to-treat analyses included 1 incorrect randomization (in which the provider consciously decided to provide analgesia regardless of the protocol, after which the provider was excluded from further study participation) and 3 women having no ablation because of operative difficulties. Three were lost to second-day follow-up. Treatment group patients (n = 41) experienced 1.3 points lower 1-hour postoperative VAS pain scores than the control group (n = 41, P = .02). The difference diminished by 4 hours (P = .31) and was negligible by 8 hours (P = .62). Treatment group patients used 3.6 less morphine equivalents of postoperative pain medication (P = .05). Regression analyses controlled for confounding reduced the 1-hour postoperative treatment group pain score difference to 0.8 (confidence interval [CI], −0.6 to 0.1) but slightly increased the average postoperative morphine equivalents to 3.7 (CI, −6.8 to −0.7). Conclusion This randomized controlled trial found that local anesthetic with low risk for complications, used in conjunction with general anesthesia, decreased postoperative pain at 1 hour and significantly reduced postoperative narcotic use following endometrial ablation. Further research is needed to determine whether the study results are generalizable and whether post procedure is the best time to administer the paracervical block to decrease endometrial ablation pain.

Modern aspects of uterine bleeding treatment with placenta previa

Uterine bleeding caused by placenta previa is one of the main causes of massive blood loss and death in obstetric practice.Objectives. To analyze the efficacy and safety of various therapeutic strategies to stop uterine bleeding in women in labor and puerperants on the basis of research results.Materials and Methods. Available researches on the diagnosis and treatment of uterine bleeding with placenta previa between 2000 and 2015 were included in the study. The search was carried out in medical databases PubMed and Cochrane Library with free access to the publication.Results. 61 publications were included in the analysis. The basic principles of diagnosis and intensive therapy of uterine bleeding with placenta previa are presented from the position of obstetrician and anaesthesiologist-resuscitator. Particular attention is paid to the analysis of studies evaluating the efficacy and safety of infusion-transfusion therapy in this category of patients. Main indications and contraindications to blood clotting factors and antifibrinolytic agents are shown.Conclusion. The combined use of all available modern methods of stopping uterine bleeding can significantly reduce blood loss and help to improve disease outcomes. The most promising therapy is a targeted assignment of clotting factors concentrates under the control of thromboelastography which indicates the need for further research.