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Are We Overestimating the Efficacy of Hysteroscopic Sterilization? A Case Series from an Urban Abortion Clinic
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Measurements and Main Results: Duration of surgery was 124.2(5-33). Metrorrhagia was observed in 88.4% patients. Two patients had excessive bleeding but have not been shown to stabilize anemia. One patients was canceled of hysteroscopic surgery and emergency operation was performed because of myome delivery. The surgical field was clearly visualized in all patients.
Spontaneous menstruation resumed at approximately 20.24.3(7-31) days after operation. Conclusion: Administration of dienogest thinned the endometrium and yielded favorable surgical outcomes. Administration of dienogest could be considered as an effective medication before surgical hysteroscopy.
660 Are We Overestimating the Efficacy of Hysteroscopic Sterilization? A Case Series from an Urban Abortion Clinic Leon Peters JA, Hertz M, Hoyos LR, Berman J. Obstetrics and Gynecology, Harper-Hutzel Womens Hospital/Wayne State University, Detroit, Michigan Study Objective: Hysteroscopic sterilization (HS) has become one of the most common permanent contraception methods in the U.S. Essure has been reported by the manufacturer to be 99.97% and 99.83% effective at 1 and 5 years respectively, with Adiana having similar effectiveness. However, concerns exist as recent evidence suggests that the failure rate might not be as low as previously reported. Since 40% of unintended pregnancies in the U.S. end up in abortion and 70% of them are done in abortion clinics we hypothesize that a similar proportion of pregnancies following HS will have a termination in abortion clinics, and therefore these failures would probably be missed and not taken into account on the calculation of the method’s failure rate. Design: Case series of patients with previous HS who presented to an urban abortion clinic for pregnancy termination from October 2012 to January 2014. Patients: Measurements and Main Results: Over a period of 15 months, 8 patients with prior HS had failure of the method and an abortion. 75% underwent sterilization with Essure and 25% with Adiana. Termination of pregnancy occurred in average of 14.25 months following sterilization at a mean gestational age of 10.8 weeks. 62.5% did not have hysterosalpingogram and among those who did 66.6% had no tubal patency. Conclusion: This case series suggests that under-reporting of failures found on abortion clinics poses a significant issue and casts doubt on the exact failure rate reported in clinical trials. The cases here presented, from a single abortion clinic over 15 months, almost match and sometimes surpass the number of failures reported in multicenter case series in the literature. We can only wonder how many cases could be discovered if every abortion clinic in the U.S. reported the terminations performed following HS, thus allowing us to assess the true effectiveness of the method.
S187
661 Hysteroscopic Markers: Endometrial Tuberculosis Versus Chronic Endometritis Kumar A. Hysteroscopic Surgery Division, Women’s Health Centre, Jaipur, Rajasthan, India Study Objective: To demonstrate by way of high resolution images and videos the differences between hysteroscopic markers in chronic endometritis and endometrial tuberculosis. Design: A retrospective study. Setting: A private women’s hospital. Patients: Patients undergoing hysteroscopic surgeries in our hospital between 1993 and 2015. Intervention: High resolution hysteroscopic images were taken in all patients and the images were later analysed in detail especially in context with chronic endometritis and endometrial tuberculosis. Such images are included in this study. Measurements and Main Results: Classical hysteroscopic findings of endometrial tuberculosis is a rough dirty looking bizzare pale looking endometrium with gland openings not seen and with overlying whitish deposits and adhesions, and intraluminal adhesions in the intraluminal part of the interstitial part of the fallopian tube. At times, the whitish deposits do not overly the endometrium and instead they are anchored to flimsy adhesions by being impregnated in the same. In some cases the whitish deposits are seen only afte vital staining with methylene blue staining as hysteroscopy done immediately after chromopertubation, and termed as the Starry Sky appearance. In chronic endometritis the detection of pedunculated micropolyps less than 1 mm in size is a very useful sign. Histologically the micropolyps are small, vascular ingrowths covered by endometrium and characterized by an accumulation of inflammatory cells. Other signs are the presence of red endometrium flushed with a whitish central point, localized or scattered throughout the cavity, homogenous or more frequently non homogenous endometrial thickening and stromal edema in the proliferative phase that causes the endometrial mucosa to appear irregularly thick, pale and edematous. Conclusion: Hysteroscopy is a useful modality of differentiating between chronic endometritis and endometrial tuberculosis.
662 Morphologic and Histologic Changes in Hysterectomies After NovaSure Ablation: A Retrospective Chart Review Ferguson J,1 Kot E,1 Thiel L,2 Karreman E,3 Rattray D,1 Thiel J.1 1 Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, Saskatchewan, Canada; 2College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada; 3Research and Health Information Services, Regina Qu’Appelle Health Region, Regina, Saskatchewan, Canada Study Objective: To quantify number of hysterectomies performed for NovaSure failures and review the indication and underlying pathology in the hysterectomy specimens. Design: Retrospective chart review. Setting: Community based hospital in Canada. Patients: 203 patients underwent Novasure ablation from April 2009-March 2013 with subsequent hysterectomy. Intervention: Hysterectomy after NovaSure ablation. Measurements and Main Results: In the study period 1994 women underwent NovaSure ablation, 203 (10%) subsequently had a hysterectomy The primary indication for hysterectomy was bleeding in 117 (58%). Other indications include pain in 31 (15%), pain and bleeding in 45 (22%), and other in 10 (5%). There were 45 (2%) of the women who had new onset pain following ablation, however only 16 (0.8%) underwent a hysterectomy solely due to new onset pain. Twenty-eight (1.4%) had bleeding and new onset pain.and 1(0.05%). In the 16 patients with new onset pain, 5 had
Spontaneous menstruation resumed at approximately 20.24.3(7-31) days after operation. Conclusion: Administration of dienogest thinned the endometrium and yielded favorable surgical outcomes. Administration of dienogest could be considered as an effective medication before surgical hysteroscopy.
660 Are We Overestimating the Efficacy of Hysteroscopic Sterilization? A Case Series from an Urban Abortion Clinic Leon Peters JA, Hertz M, Hoyos LR, Berman J. Obstetrics and Gynecology, Harper-Hutzel Womens Hospital/Wayne State University, Detroit, Michigan Study Objective: Hysteroscopic sterilization (HS) has become one of the most common permanent contraception methods in the U.S. Essure has been reported by the manufacturer to be 99.97% and 99.83% effective at 1 and 5 years respectively, with Adiana having similar effectiveness. However, concerns exist as recent evidence suggests that the failure rate might not be as low as previously reported. Since 40% of unintended pregnancies in the U.S. end up in abortion and 70% of them are done in abortion clinics we hypothesize that a similar proportion of pregnancies following HS will have a termination in abortion clinics, and therefore these failures would probably be missed and not taken into account on the calculation of the method’s failure rate. Design: Case series of patients with previous HS who presented to an urban abortion clinic for pregnancy termination from October 2012 to January 2014. Patients: Measurements and Main Results: Over a period of 15 months, 8 patients with prior HS had failure of the method and an abortion. 75% underwent sterilization with Essure and 25% with Adiana. Termination of pregnancy occurred in average of 14.25 months following sterilization at a mean gestational age of 10.8 weeks. 62.5% did not have hysterosalpingogram and among those who did 66.6% had no tubal patency. Conclusion: This case series suggests that under-reporting of failures found on abortion clinics poses a significant issue and casts doubt on the exact failure rate reported in clinical trials. The cases here presented, from a single abortion clinic over 15 months, almost match and sometimes surpass the number of failures reported in multicenter case series in the literature. We can only wonder how many cases could be discovered if every abortion clinic in the U.S. reported the terminations performed following HS, thus allowing us to assess the true effectiveness of the method.
S187
661 Hysteroscopic Markers: Endometrial Tuberculosis Versus Chronic Endometritis Kumar A. Hysteroscopic Surgery Division, Women’s Health Centre, Jaipur, Rajasthan, India Study Objective: To demonstrate by way of high resolution images and videos the differences between hysteroscopic markers in chronic endometritis and endometrial tuberculosis. Design: A retrospective study. Setting: A private women’s hospital. Patients: Patients undergoing hysteroscopic surgeries in our hospital between 1993 and 2015. Intervention: High resolution hysteroscopic images were taken in all patients and the images were later analysed in detail especially in context with chronic endometritis and endometrial tuberculosis. Such images are included in this study. Measurements and Main Results: Classical hysteroscopic findings of endometrial tuberculosis is a rough dirty looking bizzare pale looking endometrium with gland openings not seen and with overlying whitish deposits and adhesions, and intraluminal adhesions in the intraluminal part of the interstitial part of the fallopian tube. At times, the whitish deposits do not overly the endometrium and instead they are anchored to flimsy adhesions by being impregnated in the same. In some cases the whitish deposits are seen only afte vital staining with methylene blue staining as hysteroscopy done immediately after chromopertubation, and termed as the Starry Sky appearance. In chronic endometritis the detection of pedunculated micropolyps less than 1 mm in size is a very useful sign. Histologically the micropolyps are small, vascular ingrowths covered by endometrium and characterized by an accumulation of inflammatory cells. Other signs are the presence of red endometrium flushed with a whitish central point, localized or scattered throughout the cavity, homogenous or more frequently non homogenous endometrial thickening and stromal edema in the proliferative phase that causes the endometrial mucosa to appear irregularly thick, pale and edematous. Conclusion: Hysteroscopy is a useful modality of differentiating between chronic endometritis and endometrial tuberculosis.
662 Morphologic and Histologic Changes in Hysterectomies After NovaSure Ablation: A Retrospective Chart Review Ferguson J,1 Kot E,1 Thiel L,2 Karreman E,3 Rattray D,1 Thiel J.1 1 Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, Saskatchewan, Canada; 2College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada; 3Research and Health Information Services, Regina Qu’Appelle Health Region, Regina, Saskatchewan, Canada Study Objective: To quantify number of hysterectomies performed for NovaSure failures and review the indication and underlying pathology in the hysterectomy specimens. Design: Retrospective chart review. Setting: Community based hospital in Canada. Patients: 203 patients underwent Novasure ablation from April 2009-March 2013 with subsequent hysterectomy. Intervention: Hysterectomy after NovaSure ablation. Measurements and Main Results: In the study period 1994 women underwent NovaSure ablation, 203 (10%) subsequently had a hysterectomy The primary indication for hysterectomy was bleeding in 117 (58%). Other indications include pain in 31 (15%), pain and bleeding in 45 (22%), and other in 10 (5%). There were 45 (2%) of the women who had new onset pain following ablation, however only 16 (0.8%) underwent a hysterectomy solely due to new onset pain. Twenty-eight (1.4%) had bleeding and new onset pain.and 1(0.05%). In the 16 patients with new onset pain, 5 had