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O658 The value of hysterosalpingoscintigraphy in evaluating fallopian tube patency
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
O655 A study of relationship between delivery type and menstrual disorders F. Nahidi Background: High incidence of menstrual disorders at late ages of fertility accounts for 20% of clinical visits and 25% of gynecological surgeries. In addition, Caesarian may cause endometrial distortion by producing scar in uterus wall. Purpose: This retrospective case–control study was conducted to identify the relationship between delivery type and menstrual disorders in women referring to hospitals affiliated to Medical Universities in Tehran in 2006. Methods: 160 women were selected by purposive sampling and divided into two equal groups with and without menstrual disorders. They were between 36 and 44 with no history of uterus operation except Caesarian, any condition affecting on menstrual cycle, both normal vaginal delivery (NVD) and Caesarian, severe stress, and contraceptive methods either hormonal or intrauterine at the beginning of study. Data collection tools consisted of a questionnaire in two demographic and obstetrical parts, Higham pictorial chart (scores less than 20 and more than 80 denoted menorrhagia), a verbal multidimensional scoring scale (VMSS) (from 0 [painless] to 3 [severe pain]), and Holmes-Rahe scale (scores more than 300 denoted severe stress and scores more than 200 were excluded from the study). Results: Demographic characteristics of women in both groups were: mean age=39.8±1.4, body mass index (BMI) = 26.1±2.3, parity = 2.5±0.94, Fars ethnicity = 67.5 and being married = 92.5. The most common reasons for Caesarian were first dystocia and second elective section in the groups with (44.2% and 23.3%) and without (40.9% and 22.7%) menstrual disorders respectively. 53.7% and 72.5% of women in the groups with and without menstrual disorders had normal vaginal delivery respectively with a significant difference (P = 0.001). The most common menstrual disorders in the Caesarian group (65.7%) and in the NVD group (34.3%) were spotting and metrorrhagia. Conclusion: Caesarian is a risk factor for menstrual disorders particularly at late ages of fertility. O656 Patient satisfaction and outcomes following microwave endometrial ablation M. Naidu, N. Mc Whinney, V. Kakumani Objective: To evaluate the effectiveness and patient satisfaction 1 year after microwave endometrial ablation. Design and Methods: A retrospective case note review of patients who underwent microwave endometrial ablation for heavy periods over 2 years period at Epsom and St helier’s NHS trust, UK. 82 patients were identified, progesterone and GnRH analogue were used as pre-operative endometrial thinning agent. Patient satisfaction questionnaire was sent 1 year after the surgery. Results: 36% had light periods, 14% were amenorrhoeic, patient satisfaction survey showed that 24% experienced light periods, 26% developed amenorrhoea, 66% of patients were satisfied with the outcome and 72% said would recommend it to a close friend. There was no difference in amenorrhoea, bleeding and dysmenorrhoea rates between the two groups of pre-operative endometrial thinning agents used. Conclusions: Microwave endometrial ablation technique is a safe and effective method of treating dysfunctional uterine bleeding. Progesterones can be used more cost effectively as an alternative to GnRh for pre-operative endometrial thinning.
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O657 Management of idiopathic polyhydramnios M. Nair, B. Thompson, V. Mulik, J. Shaw, B. Karunakaran Background: By definition, polyhydramnios is diagnosed if the deepest vertical pool is more than 8 cm or amniotic fluid index (AFI) is more than 95th percentile for the corresponding gestational age. Various studies have demonstrated adverse maternal and perinatal outcome with this. The incidence of polyhydramnios in a general obstetric population ranges from 0.2 to 1.6 percent. Reported rates are influenced by variations in diagnostic criteria, the population studied, the threshold used and the gestational age. Idiopathic hydramnios is a diagnosis of exclusion when no other cause of polyhydramnios can be identified. Aims: To assess if patients identified with polyhydramnios had appropriate investigations. (GTT, virology screen, detailed anomaly scan specifying stomach and bladder). Assess maternal and neonatal outcome in idiopathic polyhydramnios (mode of delivery, induction rate, birth weight, requirement for neonatal intensive care). Methodology: All patients who had AFI greater than 95th centile for the gestational age. Mothers who had pre-existing diabetes, multiple pregnancies were excluded in the initial screening.46 patients were identified in total over a period of 2 years. Results: Mean gestational age of diagnosis was 32–36 weeks. Stomach and bladder was reported in all the cases. 31 patients had virology screen and 36 had GTT. There were 4 cases of malpresentation. No cases of cord prolapse. 25 patients had spontaneous delivery. Mean gestation at delivery was 38–40 weeks. Average birth weight was 3500 gms. Majority of the babies had normal APGAR scores and did not require any intensive care. Conclusions: This study has demonstrated that the staff are good in performing the appropriate investigations an polyhydramnios. However there are no clear policies in the management of idiopathic polyhydramnios. Majority of patients have had repeated scans at varied intervals ranging from weekly to four weekly with no documentation of a plan of management. This illustrates the need for a protocol for the management of these patients to avoid undue maternal anxiety as well as better use of our scanning resources. O658 The value of hysterosalpingoscintigraphy in evaluating fallopian tube patency A. Nalewczynska, B. Osuch, K. Cendrowski Objective: To assess the role of hysterosalpingoscintigraphy (HSSG) in the evaluation of patency and function of fallopian tube. Material and Methods: 49 patients, hospitalized in our Clinic from 1999 to 2007, were included to this study. Before histerosalpingography (HSG), histerosalpinoscintigraphy was performed. 99mTechnetium-macroaggregated albumin (99mTcMAA) were administered into posterior vaginal fornix. Static images with Gamma camera were acquired in supine position at 1, 2, 3, 4 and 5 hours and, if needed, at 24 hours. The results were compared to the findings after HSG. Results: Out of 49 patients, 18 (36.7%) patients had bilateral patent tubes, 19 (38.8%) patients had bilateral blocked tube, 7 (14.3%) patients had blocked right tube and 5 (10.25%) patients had blocked left tube. The agreement between HSSG and HSG was found in 33 out of 49 patients. Conclusions: 1. Our data clearly indicate that the use of HSSG could give a new tool in diagnose of infertility. 2. HSSG is potentially useful and painless diagnostic method. Moreover during HSSG the radiation exposure to the ovaries is about 1/9th of the exposure from a normal radiologic hysterosalpingography.
O655 A study of relationship between delivery type and menstrual disorders F. Nahidi Background: High incidence of menstrual disorders at late ages of fertility accounts for 20% of clinical visits and 25% of gynecological surgeries. In addition, Caesarian may cause endometrial distortion by producing scar in uterus wall. Purpose: This retrospective case–control study was conducted to identify the relationship between delivery type and menstrual disorders in women referring to hospitals affiliated to Medical Universities in Tehran in 2006. Methods: 160 women were selected by purposive sampling and divided into two equal groups with and without menstrual disorders. They were between 36 and 44 with no history of uterus operation except Caesarian, any condition affecting on menstrual cycle, both normal vaginal delivery (NVD) and Caesarian, severe stress, and contraceptive methods either hormonal or intrauterine at the beginning of study. Data collection tools consisted of a questionnaire in two demographic and obstetrical parts, Higham pictorial chart (scores less than 20 and more than 80 denoted menorrhagia), a verbal multidimensional scoring scale (VMSS) (from 0 [painless] to 3 [severe pain]), and Holmes-Rahe scale (scores more than 300 denoted severe stress and scores more than 200 were excluded from the study). Results: Demographic characteristics of women in both groups were: mean age=39.8±1.4, body mass index (BMI) = 26.1±2.3, parity = 2.5±0.94, Fars ethnicity = 67.5 and being married = 92.5. The most common reasons for Caesarian were first dystocia and second elective section in the groups with (44.2% and 23.3%) and without (40.9% and 22.7%) menstrual disorders respectively. 53.7% and 72.5% of women in the groups with and without menstrual disorders had normal vaginal delivery respectively with a significant difference (P = 0.001). The most common menstrual disorders in the Caesarian group (65.7%) and in the NVD group (34.3%) were spotting and metrorrhagia. Conclusion: Caesarian is a risk factor for menstrual disorders particularly at late ages of fertility. O656 Patient satisfaction and outcomes following microwave endometrial ablation M. Naidu, N. Mc Whinney, V. Kakumani Objective: To evaluate the effectiveness and patient satisfaction 1 year after microwave endometrial ablation. Design and Methods: A retrospective case note review of patients who underwent microwave endometrial ablation for heavy periods over 2 years period at Epsom and St helier’s NHS trust, UK. 82 patients were identified, progesterone and GnRH analogue were used as pre-operative endometrial thinning agent. Patient satisfaction questionnaire was sent 1 year after the surgery. Results: 36% had light periods, 14% were amenorrhoeic, patient satisfaction survey showed that 24% experienced light periods, 26% developed amenorrhoea, 66% of patients were satisfied with the outcome and 72% said would recommend it to a close friend. There was no difference in amenorrhoea, bleeding and dysmenorrhoea rates between the two groups of pre-operative endometrial thinning agents used. Conclusions: Microwave endometrial ablation technique is a safe and effective method of treating dysfunctional uterine bleeding. Progesterones can be used more cost effectively as an alternative to GnRh for pre-operative endometrial thinning.
S281
O657 Management of idiopathic polyhydramnios M. Nair, B. Thompson, V. Mulik, J. Shaw, B. Karunakaran Background: By definition, polyhydramnios is diagnosed if the deepest vertical pool is more than 8 cm or amniotic fluid index (AFI) is more than 95th percentile for the corresponding gestational age. Various studies have demonstrated adverse maternal and perinatal outcome with this. The incidence of polyhydramnios in a general obstetric population ranges from 0.2 to 1.6 percent. Reported rates are influenced by variations in diagnostic criteria, the population studied, the threshold used and the gestational age. Idiopathic hydramnios is a diagnosis of exclusion when no other cause of polyhydramnios can be identified. Aims: To assess if patients identified with polyhydramnios had appropriate investigations. (GTT, virology screen, detailed anomaly scan specifying stomach and bladder). Assess maternal and neonatal outcome in idiopathic polyhydramnios (mode of delivery, induction rate, birth weight, requirement for neonatal intensive care). Methodology: All patients who had AFI greater than 95th centile for the gestational age. Mothers who had pre-existing diabetes, multiple pregnancies were excluded in the initial screening.46 patients were identified in total over a period of 2 years. Results: Mean gestational age of diagnosis was 32–36 weeks. Stomach and bladder was reported in all the cases. 31 patients had virology screen and 36 had GTT. There were 4 cases of malpresentation. No cases of cord prolapse. 25 patients had spontaneous delivery. Mean gestation at delivery was 38–40 weeks. Average birth weight was 3500 gms. Majority of the babies had normal APGAR scores and did not require any intensive care. Conclusions: This study has demonstrated that the staff are good in performing the appropriate investigations an polyhydramnios. However there are no clear policies in the management of idiopathic polyhydramnios. Majority of patients have had repeated scans at varied intervals ranging from weekly to four weekly with no documentation of a plan of management. This illustrates the need for a protocol for the management of these patients to avoid undue maternal anxiety as well as better use of our scanning resources. O658 The value of hysterosalpingoscintigraphy in evaluating fallopian tube patency A. Nalewczynska, B. Osuch, K. Cendrowski Objective: To assess the role of hysterosalpingoscintigraphy (HSSG) in the evaluation of patency and function of fallopian tube. Material and Methods: 49 patients, hospitalized in our Clinic from 1999 to 2007, were included to this study. Before histerosalpingography (HSG), histerosalpinoscintigraphy was performed. 99mTechnetium-macroaggregated albumin (99mTcMAA) were administered into posterior vaginal fornix. Static images with Gamma camera were acquired in supine position at 1, 2, 3, 4 and 5 hours and, if needed, at 24 hours. The results were compared to the findings after HSG. Results: Out of 49 patients, 18 (36.7%) patients had bilateral patent tubes, 19 (38.8%) patients had bilateral blocked tube, 7 (14.3%) patients had blocked right tube and 5 (10.25%) patients had blocked left tube. The agreement between HSSG and HSG was found in 33 out of 49 patients. Conclusions: 1. Our data clearly indicate that the use of HSSG could give a new tool in diagnose of infertility. 2. HSSG is potentially useful and painless diagnostic method. Moreover during HSSG the radiation exposure to the ovaries is about 1/9th of the exposure from a normal radiologic hysterosalpingography.