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Hysteroscopic myomectomy in outpatient setting – 38 months experience
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
2000 and 31st December 2014 were studied. The data was obtained from the National Obstetric Information System, Malta. Results: A total of 39,683 mothers were assessed. In the 20–29 years cohort included 31,037 mothers while 8646 patients were 35 years and over. In the 20–29 year age group 67.77% of mother delivered vaginally while 27.73% delivered by caesarean sections. Contrastingly 56.73% of mothers with advanced age delivered vaginally and a significant 40.08% delivered by caesarean sections. The mean birth weight of neonates of mothers aged 20–29 years was 3228.89 g while the mean birth weight of neonates of the elderly mothers was 3208.52 g (p-value: 0.300653). There was also no statistical difference between the two average Apgar scores at 1 min (p-value: 0.748359). Live births and neonatal survival up to 28 days occurred in 99.09% of babies delivered by mothers of 20–29 years and 98.87% of babies delivered by mothers with advanced maternal age. Conclusions: Mothers with advanced maternal age were found to have a significantly higher caesarean rate when compared to younger aged mothers but there was no statistical difference in the neonatal outcomes. http://dx.doi.org/10.1016/j.ejogrb.2016.07.086 Induction of labour No Preference Induction of labour at Mater Dei Hospital, Malta Mandy Caruana ∗ , Tara Giacchino, Marika Borg, Yves Oscar Muscat Baron Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta E-mail address: [email protected] (M. Caruana). Introduction: Induction of labour is a common obstetric procedure which is indicated when the benefits to the mother or the foetus outweigh the benefits of continuing pregnancy. Aim: The aim of this study was to determine the induction rate at Mater Dei Hospital and to analyse the outcomes of induced labour. Method: All cases of induced labour between 1st May 2015 and 31st October 2015 were studied using the labour ward monthly babies’ data books. Results: There were 1949 total deliveries at Mater Dei Hospital between May and October 2015, with an induction rate of 28.9% (564 induced deliveries). The average maternal age was 28.9 years (range 15–44 years). 61.2% (345 mothers) were nulliparous women, 27.5% (155 mothers) were primiparous and 11.4% (64 mothers) were multiparous. Only 11.4% (64 mothers) were induced at 41 weeks of gestation or over; of which 61.9% delivered via normal vaginal delivery, 27.0% delivered via emergency caesarean section and 11.1% had an instrumental delivery. 45.7% (258 mothers) were induced at 40 weeks of gestation; where 74.8% had normal vaginal delivery, 18.6% delivered via caesarean section and 6.6% had instrumental delivery. 42.7% (241 mothers) were induced before the 40 weeks of gestation. 15.4% of these mothers had pregnancy-induced hypertension and 6.6% were induced in view of intra-uterine growth restriction. 86.0% of babies delivered by induced labour had an Apgar score of 9 or more at 1 min and the average birth weight of all babies studied was 3.32 kg (range 1.2–4.67 kg). Conclusion: Our study shows a high rate of induced labour at Mater Dei Hospital, with almost half of these mothers being induced before the 40 weeks of gestation. http://dx.doi.org/10.1016/j.ejogrb.2016.07.087
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Minimally invasive surgery Poster Presentation Hysteroscopic myomectomy in outpatient setting – 38 months experience Rita Simões Carvalh ∗ , M.J. Morais, J. Abreu-Silva, A. Quintas, E. Pinto, J. Gonc¸alves, G. Ramalho Department of Obstetrics and Gynecology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal E-mail address: [email protected] (R.S. Carvalh). Introduction: Uterine leiomyomas are the most common pelvic tumor in women. Abnormal uterine bleeding is the most common symptom associated with fibroids. Submucosal tumors account for approximately 15–20% of fibroids. Hysteroscopic myomectomy replaced hysterectomy in most cases, as a minimally invasive surgical procedure that effectively and safely removes these lesions. Objective: Evaluate de correlation between the pre-operative diagnosis, hysteroscopic findings, and histological analysis, concerning all hysteroscopic myomectomies performed at our Outpatient Surgery Unit during 38 months of activity. Methods: The authors performed a retrospective study based on the review of medical files from patients who underwent hysteroscopic myomectomy at our institution’s Outpatient Surgery Unit from November 1st 2012 to December 31st 2015, in which there was histological evidence of leiomyoma. Results: During the study period 79 hysteroscopic myomectomies were performed, all under sedation. The patients’ average age was 46 years (26–67), 17.7% were post-menopausal and 53% presented co-morbidities. 80% had at least one previous vaginal delivery. The main indication for referral to our centre was abnormal uterine bleeding (67%). All patients had an ultrasound evaluation, 75% at our ultrasound unit (68% with hysterosonography). The main findings were: submucosal leiomyoma (73%) and endometrial polyp (24%). Myomectomy was performed by resectoscope (72%), bipolar energy (20%) or hysteroscopic scissors (8%). There was incomplete resection in eight cases (10%), one of them was later submitted to hysterectomy. There was diagnostic agreement in 65 patients (82.3%). Globally, intra-operative and histological findings were concordant with the presumptive diagnosis by ultrasound in 65 patients (82.3%). 77% of cases, 82% when hysterosonography was previously used. There was not any diagnosed complication. Conclusion: Literature reports a complication rate of 0.8–2.6%. The rate of incomplete myoma resection ranges from 5% to 17% in retrospective series. The wire loop resectoscope technique is the most commonly used for hysteroscopic myomectomy. This technique is efficient for most intracavitary leiomyomas, especially FIGO type 0 or1 (those that protrude entirely or more than 50% of their mass into the uterine cavity. http://dx.doi.org/10.1016/j.ejogrb.2016.07.088
2000 and 31st December 2014 were studied. The data was obtained from the National Obstetric Information System, Malta. Results: A total of 39,683 mothers were assessed. In the 20–29 years cohort included 31,037 mothers while 8646 patients were 35 years and over. In the 20–29 year age group 67.77% of mother delivered vaginally while 27.73% delivered by caesarean sections. Contrastingly 56.73% of mothers with advanced age delivered vaginally and a significant 40.08% delivered by caesarean sections. The mean birth weight of neonates of mothers aged 20–29 years was 3228.89 g while the mean birth weight of neonates of the elderly mothers was 3208.52 g (p-value: 0.300653). There was also no statistical difference between the two average Apgar scores at 1 min (p-value: 0.748359). Live births and neonatal survival up to 28 days occurred in 99.09% of babies delivered by mothers of 20–29 years and 98.87% of babies delivered by mothers with advanced maternal age. Conclusions: Mothers with advanced maternal age were found to have a significantly higher caesarean rate when compared to younger aged mothers but there was no statistical difference in the neonatal outcomes. http://dx.doi.org/10.1016/j.ejogrb.2016.07.086 Induction of labour No Preference Induction of labour at Mater Dei Hospital, Malta Mandy Caruana ∗ , Tara Giacchino, Marika Borg, Yves Oscar Muscat Baron Department of Obstetrics and Gynaecology, Mater Dei Hospital, Malta E-mail address: [email protected] (M. Caruana). Introduction: Induction of labour is a common obstetric procedure which is indicated when the benefits to the mother or the foetus outweigh the benefits of continuing pregnancy. Aim: The aim of this study was to determine the induction rate at Mater Dei Hospital and to analyse the outcomes of induced labour. Method: All cases of induced labour between 1st May 2015 and 31st October 2015 were studied using the labour ward monthly babies’ data books. Results: There were 1949 total deliveries at Mater Dei Hospital between May and October 2015, with an induction rate of 28.9% (564 induced deliveries). The average maternal age was 28.9 years (range 15–44 years). 61.2% (345 mothers) were nulliparous women, 27.5% (155 mothers) were primiparous and 11.4% (64 mothers) were multiparous. Only 11.4% (64 mothers) were induced at 41 weeks of gestation or over; of which 61.9% delivered via normal vaginal delivery, 27.0% delivered via emergency caesarean section and 11.1% had an instrumental delivery. 45.7% (258 mothers) were induced at 40 weeks of gestation; where 74.8% had normal vaginal delivery, 18.6% delivered via caesarean section and 6.6% had instrumental delivery. 42.7% (241 mothers) were induced before the 40 weeks of gestation. 15.4% of these mothers had pregnancy-induced hypertension and 6.6% were induced in view of intra-uterine growth restriction. 86.0% of babies delivered by induced labour had an Apgar score of 9 or more at 1 min and the average birth weight of all babies studied was 3.32 kg (range 1.2–4.67 kg). Conclusion: Our study shows a high rate of induced labour at Mater Dei Hospital, with almost half of these mothers being induced before the 40 weeks of gestation. http://dx.doi.org/10.1016/j.ejogrb.2016.07.087
e23
Minimally invasive surgery Poster Presentation Hysteroscopic myomectomy in outpatient setting – 38 months experience Rita Simões Carvalh ∗ , M.J. Morais, J. Abreu-Silva, A. Quintas, E. Pinto, J. Gonc¸alves, G. Ramalho Department of Obstetrics and Gynecology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal E-mail address: [email protected] (R.S. Carvalh). Introduction: Uterine leiomyomas are the most common pelvic tumor in women. Abnormal uterine bleeding is the most common symptom associated with fibroids. Submucosal tumors account for approximately 15–20% of fibroids. Hysteroscopic myomectomy replaced hysterectomy in most cases, as a minimally invasive surgical procedure that effectively and safely removes these lesions. Objective: Evaluate de correlation between the pre-operative diagnosis, hysteroscopic findings, and histological analysis, concerning all hysteroscopic myomectomies performed at our Outpatient Surgery Unit during 38 months of activity. Methods: The authors performed a retrospective study based on the review of medical files from patients who underwent hysteroscopic myomectomy at our institution’s Outpatient Surgery Unit from November 1st 2012 to December 31st 2015, in which there was histological evidence of leiomyoma. Results: During the study period 79 hysteroscopic myomectomies were performed, all under sedation. The patients’ average age was 46 years (26–67), 17.7% were post-menopausal and 53% presented co-morbidities. 80% had at least one previous vaginal delivery. The main indication for referral to our centre was abnormal uterine bleeding (67%). All patients had an ultrasound evaluation, 75% at our ultrasound unit (68% with hysterosonography). The main findings were: submucosal leiomyoma (73%) and endometrial polyp (24%). Myomectomy was performed by resectoscope (72%), bipolar energy (20%) or hysteroscopic scissors (8%). There was incomplete resection in eight cases (10%), one of them was later submitted to hysterectomy. There was diagnostic agreement in 65 patients (82.3%). Globally, intra-operative and histological findings were concordant with the presumptive diagnosis by ultrasound in 65 patients (82.3%). 77% of cases, 82% when hysterosonography was previously used. There was not any diagnosed complication. Conclusion: Literature reports a complication rate of 0.8–2.6%. The rate of incomplete myoma resection ranges from 5% to 17% in retrospective series. The wire loop resectoscope technique is the most commonly used for hysteroscopic myomectomy. This technique is efficient for most intracavitary leiomyomas, especially FIGO type 0 or1 (those that protrude entirely or more than 50% of their mass into the uterine cavity. http://dx.doi.org/10.1016/j.ejogrb.2016.07.088