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Hysteroscopic Diagnosis and Management of Infertility Following Miscarriage and Delivery
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S103eS157 Study Objective: To study the factors that play a role in the decision of physicians to choose between Hysteroscopic sterilization (HS)(EssureÒ)and other methods of achieving permanent sterilization. Design: A questionnaire-based survey of attending physicians providing contraceptive services. Setting: Department of Obstetrics and Gynecology at a community hospital. Patients: None Intervention: Paper questionnaire was completed by subjects and their responses analyzed. Measurements and Main Results: Of the 68 physicians surveyed, 35 responded (51.47%). They graduated from residency between 1968 to 2008. 21 (60%) performed HS and 14 (40%) did not. Only 10/35 (28.57%) physicians offered HS as an option to all patients. According to 24/35 (68%) physicians, friends were the most common source of patient knowledge before talking to the doctor. Only 4/21 preferred to perform HS in an office setting, even though 11/21 stated that as the main reason why they prefer HS.19/35 (54.3%) physicians stated that minimally invasive nature of HS was the main reason of their patients’ choice of HS.94.3% (33/35) believed that more training programs in HS will result in more physicians providing HS. Using a Pearson Product Moment Correlation Coefficient calculation, it was seen that the more patients that were offered HS, the higher the percentage of procedures that were done with HS (r 5 .563, p .002) and that the more recently the physician completed his/her residency, the more likely they are to perform HS (r 5 -.307, p .032). Conclusion: Recent graduates are more likely to provide HS than older physicians.The minimally invasive nature of HS is an important reason of patients choice of HS. Increased awareness and training amongst physicians will help in making HS more popular. An increase in sterilizations performed by HS is likely in near future as new graduates enter into practice.
412 Hysteroscopic Diagnosis and Management of Infertility Following Miscarriage and Delivery Argade KV. Gynec Endoscopy Training Center, Argade Hospital, Kolhapur, MS, India Study Objective: To evaluate usefulness of hysteroscopy in treatment of secondary infertility. Design: This was an observational study done at Maher Endoscopy Centre and Laparoscopy Training Centre, Kolhapur, India. Over the period of eight years, 4500 hysteroscopies were performed for primary and secondary infertility. Surgical technique included preoperative introduction of misopristol vaginally to facilitate opening of cervical canal. Gradual introduction of the hysteroscope by opening uterine cavity under hydro pressure inside the cervical canal. Adhesions are stretched and give way to open the uterine cavity, also have used suction curette for sucking adhesions. Setting: N/A Patients: N/A Intervention: N/A Measurements and Main Results: One patient developed secondary amenorrhoea following accidental injection of corrosive/chemicals for uterine artery meant for injecting vescical artery. Two patients had Foetal bones in the uterine cavity. Endometrial cavity was clear except flimsy adhesions. The bone acted like intra uterine device and patient conceived after removal. These bones were easily removed with hysteroscopic foceps. One patient had broken tip of Karmann Cannula in uterine cavity. Three patients had Bony metaplasia due to chronic endometritis following mid-trimester termination. Three cases presented with secondary amenorrhoea following LSCS. Their hormonal profile was normal suggesting uterine cause of amenorrhoea due to accidental inclusion of posterior wall of lower uterine segment. In all the cases intrauterine Foleys catheter was kept for 24 hours and in three cases a repeat hysteroscopy was performed.
S111
Conclusion: Hysteroscopy is an useful tool in diagnosis and management of infertility following miscarriage and delivery.
413 Evaluation of Quality of Life of Women One Year after Ablation of the Endometrium with Thermachoice Avella M,1 Deus A,1 Ayres T.2 1Histeroscopia, Endogin Endoscopia Ginecolo´gica, Sorocaba, Sa˜o Paulo, Brazil; 2Ginecologia, Hospital Evange´lico de Sorocaba, Sorocaba, Sa˜o Paulo, Brazil Study Objective: Evaluate the changes in the quality of life of women one year after thermal balloon endometrial ablation (Thermachoice). Design: By means of SF-36 Quality-of-life Instrument, we evaluated women presenting episodes of metrorrhagia that would be submitted to Thermachoice endometrial ablation. After a one year follow-up the patients were reevaluated following the same criteria of the first questionnaire. Setting: All the patients participating in the pilot project ‘‘Heat treatment with silicone balloon for metrorrhagia under local anesthesia’’ during the year of 2008 were primarily evaluated regarding their quality of life by use of the SF 36 questionnaire a little before the procedure. The patients were followed by phone calls concerning possible complaints and were submitted to the SF 36 again, six months and one year after the procedure.
Patients: The patients selected were the ones who presented dysfunctional uterine bleeding diagnosed in basic health care units and who were referred to surgical treatment. They were submitted to interview (SF 36 questionnaire applied) and underwent careful physical examination followed by ultrasonography in the patients who were apt to the procedure. The inclusion criteria are described below. Criteria for inclusion: Documental diagnosis of menorragias for benign causes Complete offspring Normal Pap smear Uterine cavity anatomically normal proven by ultrasound Uterine cavity between 4-12 cm Drug therapy on the treatment of menorragia has failed or against indicated Intervention: Patients were requested, through phone contact, to come for a new interview in which the SF 36 was once more applied by the same interviewer for data collection. Measurements and Main Results: Important improve was observed in the quality of life of these women in all the evaluation criteria with the exception of the general health and social aspects. Conclusion: According to this study the thermachoice treatment of metrorrhagias showed significant improve in the quality of life of the patients with one-year follow-up. 414 Hysteroscopic Evaluation of Different Types of Healing of the Uterine Incision for Caesarean Section Ceci O, Scioscia M, Pinto L, Laera AF, Achilarre MT, Camporeale AL, Vimercati A, Bettocchi S. Department of Obstetrics, Gynecology and Neonatology, University of Bari, Bari, BA, Italy Study Objective: To evaluate by hysteroscopy the different types of healing of the uterine incision for low segment caesarean section.
412 Hysteroscopic Diagnosis and Management of Infertility Following Miscarriage and Delivery Argade KV. Gynec Endoscopy Training Center, Argade Hospital, Kolhapur, MS, India Study Objective: To evaluate usefulness of hysteroscopy in treatment of secondary infertility. Design: This was an observational study done at Maher Endoscopy Centre and Laparoscopy Training Centre, Kolhapur, India. Over the period of eight years, 4500 hysteroscopies were performed for primary and secondary infertility. Surgical technique included preoperative introduction of misopristol vaginally to facilitate opening of cervical canal. Gradual introduction of the hysteroscope by opening uterine cavity under hydro pressure inside the cervical canal. Adhesions are stretched and give way to open the uterine cavity, also have used suction curette for sucking adhesions. Setting: N/A Patients: N/A Intervention: N/A Measurements and Main Results: One patient developed secondary amenorrhoea following accidental injection of corrosive/chemicals for uterine artery meant for injecting vescical artery. Two patients had Foetal bones in the uterine cavity. Endometrial cavity was clear except flimsy adhesions. The bone acted like intra uterine device and patient conceived after removal. These bones were easily removed with hysteroscopic foceps. One patient had broken tip of Karmann Cannula in uterine cavity. Three patients had Bony metaplasia due to chronic endometritis following mid-trimester termination. Three cases presented with secondary amenorrhoea following LSCS. Their hormonal profile was normal suggesting uterine cause of amenorrhoea due to accidental inclusion of posterior wall of lower uterine segment. In all the cases intrauterine Foleys catheter was kept for 24 hours and in three cases a repeat hysteroscopy was performed.
S111
Conclusion: Hysteroscopy is an useful tool in diagnosis and management of infertility following miscarriage and delivery.
413 Evaluation of Quality of Life of Women One Year after Ablation of the Endometrium with Thermachoice Avella M,1 Deus A,1 Ayres T.2 1Histeroscopia, Endogin Endoscopia Ginecolo´gica, Sorocaba, Sa˜o Paulo, Brazil; 2Ginecologia, Hospital Evange´lico de Sorocaba, Sorocaba, Sa˜o Paulo, Brazil Study Objective: Evaluate the changes in the quality of life of women one year after thermal balloon endometrial ablation (Thermachoice). Design: By means of SF-36 Quality-of-life Instrument, we evaluated women presenting episodes of metrorrhagia that would be submitted to Thermachoice endometrial ablation. After a one year follow-up the patients were reevaluated following the same criteria of the first questionnaire. Setting: All the patients participating in the pilot project ‘‘Heat treatment with silicone balloon for metrorrhagia under local anesthesia’’ during the year of 2008 were primarily evaluated regarding their quality of life by use of the SF 36 questionnaire a little before the procedure. The patients were followed by phone calls concerning possible complaints and were submitted to the SF 36 again, six months and one year after the procedure.
Patients: The patients selected were the ones who presented dysfunctional uterine bleeding diagnosed in basic health care units and who were referred to surgical treatment. They were submitted to interview (SF 36 questionnaire applied) and underwent careful physical examination followed by ultrasonography in the patients who were apt to the procedure. The inclusion criteria are described below. Criteria for inclusion: Documental diagnosis of menorragias for benign causes Complete offspring Normal Pap smear Uterine cavity anatomically normal proven by ultrasound Uterine cavity between 4-12 cm Drug therapy on the treatment of menorragia has failed or against indicated Intervention: Patients were requested, through phone contact, to come for a new interview in which the SF 36 was once more applied by the same interviewer for data collection. Measurements and Main Results: Important improve was observed in the quality of life of these women in all the evaluation criteria with the exception of the general health and social aspects. Conclusion: According to this study the thermachoice treatment of metrorrhagias showed significant improve in the quality of life of the patients with one-year follow-up. 414 Hysteroscopic Evaluation of Different Types of Healing of the Uterine Incision for Caesarean Section Ceci O, Scioscia M, Pinto L, Laera AF, Achilarre MT, Camporeale AL, Vimercati A, Bettocchi S. Department of Obstetrics, Gynecology and Neonatology, University of Bari, Bari, BA, Italy Study Objective: To evaluate by hysteroscopy the different types of healing of the uterine incision for low segment caesarean section.