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Genital Tuberculosis in Female Infertility: An Enigma
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
to determine whether there are differences in rates or trends across important socio-demographic, clinical, and hospital-levels characteristics. Design: A cross-sectional analysis of the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (HCUP-NIS), the largest all-payer inpatient database in the United States, was conducted for all patients who underwent surgical management of ectopic pregnancy. Joinpoint regression was used to estimate temporal trends (including the annual percent change [APC]) in salpingectomy versus salpingostomy during the study period and to evaluate whether trends were different across individual and hospital-level characteristics. Setting: All community hospitals in the US participating in HCUP, excluding rehabilitation and long-term acute care hospitals. Patients: The study includes all inpatient hospitalizations for women receiving treatment for ectopic pregnancy as identified using ICD-9-CM codes. Measurements and Main Results: During the study period, the number of inpatient discharges for ectopic pregnancy decreased from 36,574 in 1998 to 21,426 in 2011. Among tubal ectopic pregnancies, which is the most common type, the rate of salpingectomy increased steadily during the study period (APC=1.2%; 95%CI: 1.0, 1.3). Conversely, the rate of salpingostomy decreased moderately from 1998-2004 (APC= -3.7%; 95%CI: -6.3, -1.1), and then more drastically from 2004-2011 with a 10% annual decline (95%CI: -12.5, -6.6). There were no statistically significant changes in the rate of other adnexal surgery for ectopic pregnancy, or for medical management without surgical treatment. Conclusion: The rate of inpatient hospitalization for ectopic pregnancy has decreased in the US over the past 15 years. When hospitalization occurs, there is an increasing tendency to perform salpingectomy as oppose to salpingostomy as surgical management approach of ectopic pregnancy. There is no significant change in the trends for non-surgical management.
36 Reproductive Outcomes of 10 Years Asherman’s Surgery Hanstede M, Emanuel MH. Ob/Gyn, Spaarne Gasthuis, Hoofddorp/ Haarlem, Noord Holland, Netherlands Study Objective: To identify succes rates of hysterscopic adhesiolysis in women with Asherman Syndrome and to study pregnancy rates, life birth and obstetrie outcomes. Design: Retrospective Cohort study and prospective follow up study. Setting: University teaching hospital ‘Spaarne Ziekenhuis’. All women with Asherman Syndromen were operated in this centre using conventional instruments for hysterscopic adhesiolysis with fluoroscopic guidance. After succesfull adhesiolysis an IUD was placed and adjudant progesterone and oestrogen was given. Two months after surgery a second look hysterscopy was performed. Patients: Women who were diagnosed with Asherman Syndrome. Confirmation of intrauterine adhesions was done by hysteroscopy.
All women underwend hysterscopic adhesiolysis with fluoroscopic guidance. In 10 years from 2003-2013 638 women were identified. Data was collected from operation and second look hysteriscopy from the hospital database. Patients were contacted by phone to get information on reproductive outcomes. Measurements and Main Results: More 55% of the patientes had severe intra uterine adhesions. Most of them had an amenorroe. Succes rate was defined as a normal uterine cavity with restore of normal menstrual bloodflow after adhesiolysis. This succeded in 95%. Spontaneous recurrence of inta uterine adhesions occurred in almost 30%. The follow up rate was 80%. Pregnancy rate was 75% and life birth was 68% after succesfull adhesiolysis. There was a five time increased change of a placental problem post partum. Conclusion: Patientes with Asherman Syndrome have a good chance of restoration of the intra uterine anatomy after adhesiolysis but have a high chance of recurrence of adhesions. If adhesiolysis is succesful the chance of a life birth is 68%. The chance of post partum placental problems is 5 times increased.
37 Genital Tuberculosis in Female Infertility: An Enigma A.M. Luthra. Luthra Hospitals, Dehradun, Uttarakhand, India Study Objective: Mycobacterial infection of the genital tract is a common etiology for female infertility in developing countries. Aim of this study is to evaluate plethora of laparoscopic and hysteroscopic appearances of tuberculosis, to correlate them with Endometrial TB PCR and BACTEC culture . Design: Retrospective case series. Setting: Tertiary care hospital in Northern India. Patients: 100 infertile women in the reproductive age group (25-38 years) were included in the study between January 2000 to January 2014. Laparohysteroscopic assessment of female pelvis was done along with endometrium sampling for PCR and BACTEC Cultures. The results were retrospectively correlated with endoscopic appearance and treatment options were offered accordingly. Intervention: Patients were called for follow up one week post surgery for PCR results, and 4 weeks later for Bactec culture reports. Measurements and Main Results: Out of hundred women, 24 women had endoscopic abnormalities suggestive of tuberculosis. 18 of these women with positive endoscopic findings were PCR positive. Sensitivity and specificity of endoscopic evaluation was 75% and 28% respectively. Laparoscopic findings of caseous material. beading of fallopian tubes, cornual block, thick omental adhesions, tubo-ovarian adhesions and hydrosalpinx were strongly suggestive of tubercular infection. Hysteroscopic appearance of peri-ostial fibrosis, intra- uterine synechiae and Asherman’’s syndrome were correlated with old tubercular infection. Conclusion: Endoscopic evaluation is a valuable tool to diagnose genital Tuberculosis; and to assess the extent of the disease process. In addition,the routine application of endometrium bacteriological PCR assay and BACTEC cultures carries a great potential in improving the diagnosis of genital tuberculosis. 38 Does the Mode of Surgery for Hydrosalpinges Affect Outcome in In-Vitro-Fertilization (IVF) Cycles? A Randomized Trial Comparing Laparoscopic Salpingectomy and Proximal Tubal Occlusion (PTO) Malhotra N, Vignarajan CP. Art Centre, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
to determine whether there are differences in rates or trends across important socio-demographic, clinical, and hospital-levels characteristics. Design: A cross-sectional analysis of the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (HCUP-NIS), the largest all-payer inpatient database in the United States, was conducted for all patients who underwent surgical management of ectopic pregnancy. Joinpoint regression was used to estimate temporal trends (including the annual percent change [APC]) in salpingectomy versus salpingostomy during the study period and to evaluate whether trends were different across individual and hospital-level characteristics. Setting: All community hospitals in the US participating in HCUP, excluding rehabilitation and long-term acute care hospitals. Patients: The study includes all inpatient hospitalizations for women receiving treatment for ectopic pregnancy as identified using ICD-9-CM codes. Measurements and Main Results: During the study period, the number of inpatient discharges for ectopic pregnancy decreased from 36,574 in 1998 to 21,426 in 2011. Among tubal ectopic pregnancies, which is the most common type, the rate of salpingectomy increased steadily during the study period (APC=1.2%; 95%CI: 1.0, 1.3). Conversely, the rate of salpingostomy decreased moderately from 1998-2004 (APC= -3.7%; 95%CI: -6.3, -1.1), and then more drastically from 2004-2011 with a 10% annual decline (95%CI: -12.5, -6.6). There were no statistically significant changes in the rate of other adnexal surgery for ectopic pregnancy, or for medical management without surgical treatment. Conclusion: The rate of inpatient hospitalization for ectopic pregnancy has decreased in the US over the past 15 years. When hospitalization occurs, there is an increasing tendency to perform salpingectomy as oppose to salpingostomy as surgical management approach of ectopic pregnancy. There is no significant change in the trends for non-surgical management.
36 Reproductive Outcomes of 10 Years Asherman’s Surgery Hanstede M, Emanuel MH. Ob/Gyn, Spaarne Gasthuis, Hoofddorp/ Haarlem, Noord Holland, Netherlands Study Objective: To identify succes rates of hysterscopic adhesiolysis in women with Asherman Syndrome and to study pregnancy rates, life birth and obstetrie outcomes. Design: Retrospective Cohort study and prospective follow up study. Setting: University teaching hospital ‘Spaarne Ziekenhuis’. All women with Asherman Syndromen were operated in this centre using conventional instruments for hysterscopic adhesiolysis with fluoroscopic guidance. After succesfull adhesiolysis an IUD was placed and adjudant progesterone and oestrogen was given. Two months after surgery a second look hysterscopy was performed. Patients: Women who were diagnosed with Asherman Syndrome. Confirmation of intrauterine adhesions was done by hysteroscopy.
All women underwend hysterscopic adhesiolysis with fluoroscopic guidance. In 10 years from 2003-2013 638 women were identified. Data was collected from operation and second look hysteriscopy from the hospital database. Patients were contacted by phone to get information on reproductive outcomes. Measurements and Main Results: More 55% of the patientes had severe intra uterine adhesions. Most of them had an amenorroe. Succes rate was defined as a normal uterine cavity with restore of normal menstrual bloodflow after adhesiolysis. This succeded in 95%. Spontaneous recurrence of inta uterine adhesions occurred in almost 30%. The follow up rate was 80%. Pregnancy rate was 75% and life birth was 68% after succesfull adhesiolysis. There was a five time increased change of a placental problem post partum. Conclusion: Patientes with Asherman Syndrome have a good chance of restoration of the intra uterine anatomy after adhesiolysis but have a high chance of recurrence of adhesions. If adhesiolysis is succesful the chance of a life birth is 68%. The chance of post partum placental problems is 5 times increased.
37 Genital Tuberculosis in Female Infertility: An Enigma A.M. Luthra. Luthra Hospitals, Dehradun, Uttarakhand, India Study Objective: Mycobacterial infection of the genital tract is a common etiology for female infertility in developing countries. Aim of this study is to evaluate plethora of laparoscopic and hysteroscopic appearances of tuberculosis, to correlate them with Endometrial TB PCR and BACTEC culture . Design: Retrospective case series. Setting: Tertiary care hospital in Northern India. Patients: 100 infertile women in the reproductive age group (25-38 years) were included in the study between January 2000 to January 2014. Laparohysteroscopic assessment of female pelvis was done along with endometrium sampling for PCR and BACTEC Cultures. The results were retrospectively correlated with endoscopic appearance and treatment options were offered accordingly. Intervention: Patients were called for follow up one week post surgery for PCR results, and 4 weeks later for Bactec culture reports. Measurements and Main Results: Out of hundred women, 24 women had endoscopic abnormalities suggestive of tuberculosis. 18 of these women with positive endoscopic findings were PCR positive. Sensitivity and specificity of endoscopic evaluation was 75% and 28% respectively. Laparoscopic findings of caseous material. beading of fallopian tubes, cornual block, thick omental adhesions, tubo-ovarian adhesions and hydrosalpinx were strongly suggestive of tubercular infection. Hysteroscopic appearance of peri-ostial fibrosis, intra- uterine synechiae and Asherman’’s syndrome were correlated with old tubercular infection. Conclusion: Endoscopic evaluation is a valuable tool to diagnose genital Tuberculosis; and to assess the extent of the disease process. In addition,the routine application of endometrium bacteriological PCR assay and BACTEC cultures carries a great potential in improving the diagnosis of genital tuberculosis. 38 Does the Mode of Surgery for Hydrosalpinges Affect Outcome in In-Vitro-Fertilization (IVF) Cycles? A Randomized Trial Comparing Laparoscopic Salpingectomy and Proximal Tubal Occlusion (PTO) Malhotra N, Vignarajan CP. Art Centre, Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India