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Esmya in a Clinical Setting
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S191–S227 Study Objective: To assess whether adhesions formed by laparoscopic myomectomy (LM) influence postoperative spontaneous pregnancy. Design: Retrospective study. Setting: University hospital. Patients: Patients who underwent LM between January 2000 and December 2012. Intervention: Laparoscopy, myomectomy, second-look laparoscopy (SLL). Measurements and Main Results: Adhesions were evaluated by SLL after six months of LM for patients who desired pregnancy in the future. The association between the postoperative status and the spontaneous pregnancy rate was assessed in 591 patients who desired pregnancy immediately after SLL. There were three degree classifications (D0: no adhesion; D1: filmy adhesion; D2: dense to cohesive adhesion), and four extensities (E0: no adhesion; E1: portion of uterine surface; E2: whole posterior or anterior uterine surface)for uterine adhesions. The cumulative pregnancy rate at 24 months after SLL did not significantly differ between patients without and with adhesions (44.1% vs. 33.1%, p=0.14); however, cox regression analysis revealed that the age and extensity of the adhesions were significantly associated with postoperative spontaneous pregnancy (odds ratio: 0.96 and 0.36; p=0.04 and p=0.02). In terms of the extensities, the pregnancy rate of patients with E2 adhesions were significantly lower in comparison with that of patients with E0 and E1 adhesions. According to logistic regression analysis, the E2 adhesion formation was significantly correlated to the number of enucleated myomas, the diameter of the largest myoma, and the coexistence of stage III-IV endometriosis at initial LM (odds ratio: 1.13, 1.02, and 3.96; p\0.001, p=0.04, and p=0.001). Conclusion: Our data suggests that the postoperative spontaneous pregnancy rate potentially declines due to extensive adhesions formed after LM. 624 Hystroscopic Correction of the T-Shaped, Narrow, Infantile and Arcuate Cavities in Infertile Women and Women with Recurrent ICSI/IVF Failure, Significant Results Regarding Both Spontaneous or Assisted Pregnancies Mounir MS,1 Zayed LH,2 Soliman E,1 Fathy AO.1 1Obstetrics and Gynecology, ART, Agial Hospital for Infertility, Endoscopy and Women Health, Alexandria, Roushdy, Egypt; 2Obstetrics and Gynecology, Alexandria University, Alexandria, El Shatby, Egypt Study Objective: Hystroscopic correction of T-shaped, narrow, infantile and arcuate endometrial cavities in women suffering from infertility and IVF/ICSI failure, to develop a chance of pregnancy. Design: Prospective cohort study. Setting: 2D and 3D vaginal U/S revealed narrow endometrial cavity not exceeding 1.2 cm in the maximum transverse diameter in the sagittal scan. Preoperative preparation included laboratory investigations and anaesthesia assessment. Patients: The study was conducted in the period from June 2009 till January 2014 including 200 women suffering from primary infertility for 3-11 years with exclusion of the male factors, their age ranged between 27 and 38 years 120 of them had previous single or more ICSI failure. Intervention: Postmenstrual operative hysteroscope with right angle resectopscope was used in all cases. Hysteroscopic resection of the cavity sides till visualising the osteal orifice from the midcavitary point and resection of the arcuate till the myometrial reserve. Measurements and Main Results: Spontaneous pregnancy: 44 women (22%) had became pregnant within 6 months Spontaneously:, 32 cases (16%) within the next 6 months (76 cases in the first year 38%), 40 women (20%) cases within the 2nd 12 months, Assisted pregnancies: after 1.5-2 years 36 women (18%) had trial of ICSI 21 (58.3% pregnancy rate) of them had success and 11 of them had twin pregnancies. 4 of them had delivered preterm and five full term and the other two are still followed up.
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Lost cases: 11 cases had been lost from the follow up. 43 cases not became pregnant till now. Conclusion: In our study it was clear that, correction of T shaped, narrow infantile and arcuate uterine cavity has marked success in the treatment of infertile women. We recommend hystroscopic assessment preceded by 3D ultrasound should be done for all infertile women either for assisted or for spontaneous pregnancy as a part of the work up. 625 The Use of Ullipristal Acetate/Esmya in a Clinical Setting Powell MC, Chen B. Outpatient Gynaecology, CIRCLE Treatment Centre on the Queens Medical Campus, Nottingham, Nottinghamshire, United Kingdom Study Objective: Esmya is a recently introduced progesterone receptor modulator. This study is one of the first to report the efficacy and side effects of Esmya for the treatment of fibroids in a clinical setting. Design: A questionnaire covering bleeding pattern and pain severity prior and during taking Esmya based on the numeric rating scale was sent after 3 months. Patients were asked whether they would take Esmya long-term and the effect on their surgical intervention. The side effects of Esmya and a modified daily record to score the premenstrual syndrome before and during the Esmya intake were recorded. Setting: The Gynaecology department at the CIRCLE Treatment Centre on the Queens Medical Centre Campus Nottingham. Patients: 86 patients with symptomatic fibroids took Esmya for 3 months. Intervention: Patients referred with symptomatic fibroids requiring interventions in the form of Transcervical resection, Myomectomies, or Uterine Artery Embolisation were offered Esmya to make surgical intervention simpler and safer and reduce symptoms in the interim. Measurements and Main Results: Our preliminary results show that 80% of the patients showed improvement in their bleeding pattern. 56% became amenorrhoeic within 10 days. Menses returned within 4 weeks of stopping the esmya. 16% had noimprovement at all. 56% improved their pain scores but in 70% the pain had returned within 4 weeks. Hot flushes occurred in 28% compared to 3% in clinical trials. 76% of the patients demonstrated improvement in PMS. However one patient had a worsening PMS with suicidal thoughts despite lower bleeding and pain. 50% would have carried on the Esmya and 25% would change their mind about surgery if allowed to continue with this drug. 2 patients stopped prematurely due to increased bleeding and headaches. Conclusion: Treatment with Esmya is effective to control excessive bleeding and pain with tolerated side effects. This data also showed new evidence of improvements in PMS. 626 Obstetric Outcomes after Robotic-Assisted Laparoscopic Repair of Cesarean Scar Defect Sangha R. Henry Ford Hospital, Detroit, Michigan Study Objective: To describe Obstetric Outcomes after robotic-assisted repair of cesarean scar defect. Design: Case Series-Prospective, consecutive. Setting: Henry Ford Hospital (Detroit, MI), University-affiliated Hospital. Patients: Three consectuive women undergoing robotic-assisted repair of cesarean scar defect. Intervention: Robotic-assisted repair of Cesarean Scar Defect. Measurements and Main Results: A common complication of multiple cesarean deliveries is uterine scar dehiscence. This gives rise to the serious complication of future uterine rupture in pregnancy. Three consecutive cases from 2009-2011 are presented here. Case 1 and 2 were diagnosed by a saline sonogram done prior to embryo transfer during an IVF cycle. This was then confirmed by an MRI. They underwent roboticassisted laparoscopic repair of the uterus with scar revision and diagnostic hysteroscopy. They subsequently became pregnant with embryo transfer 3 months later . They had uncomplicated pregnancies and delivered via repeat c-section at term. Case 3 was diagnosed one week after a VBAC
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Lost cases: 11 cases had been lost from the follow up. 43 cases not became pregnant till now. Conclusion: In our study it was clear that, correction of T shaped, narrow infantile and arcuate uterine cavity has marked success in the treatment of infertile women. We recommend hystroscopic assessment preceded by 3D ultrasound should be done for all infertile women either for assisted or for spontaneous pregnancy as a part of the work up. 625 The Use of Ullipristal Acetate/Esmya in a Clinical Setting Powell MC, Chen B. Outpatient Gynaecology, CIRCLE Treatment Centre on the Queens Medical Campus, Nottingham, Nottinghamshire, United Kingdom Study Objective: Esmya is a recently introduced progesterone receptor modulator. This study is one of the first to report the efficacy and side effects of Esmya for the treatment of fibroids in a clinical setting. Design: A questionnaire covering bleeding pattern and pain severity prior and during taking Esmya based on the numeric rating scale was sent after 3 months. Patients were asked whether they would take Esmya long-term and the effect on their surgical intervention. The side effects of Esmya and a modified daily record to score the premenstrual syndrome before and during the Esmya intake were recorded. Setting: The Gynaecology department at the CIRCLE Treatment Centre on the Queens Medical Centre Campus Nottingham. Patients: 86 patients with symptomatic fibroids took Esmya for 3 months. Intervention: Patients referred with symptomatic fibroids requiring interventions in the form of Transcervical resection, Myomectomies, or Uterine Artery Embolisation were offered Esmya to make surgical intervention simpler and safer and reduce symptoms in the interim. Measurements and Main Results: Our preliminary results show that 80% of the patients showed improvement in their bleeding pattern. 56% became amenorrhoeic within 10 days. Menses returned within 4 weeks of stopping the esmya. 16% had noimprovement at all. 56% improved their pain scores but in 70% the pain had returned within 4 weeks. Hot flushes occurred in 28% compared to 3% in clinical trials. 76% of the patients demonstrated improvement in PMS. However one patient had a worsening PMS with suicidal thoughts despite lower bleeding and pain. 50% would have carried on the Esmya and 25% would change their mind about surgery if allowed to continue with this drug. 2 patients stopped prematurely due to increased bleeding and headaches. Conclusion: Treatment with Esmya is effective to control excessive bleeding and pain with tolerated side effects. This data also showed new evidence of improvements in PMS. 626 Obstetric Outcomes after Robotic-Assisted Laparoscopic Repair of Cesarean Scar Defect Sangha R. Henry Ford Hospital, Detroit, Michigan Study Objective: To describe Obstetric Outcomes after robotic-assisted repair of cesarean scar defect. Design: Case Series-Prospective, consecutive. Setting: Henry Ford Hospital (Detroit, MI), University-affiliated Hospital. Patients: Three consectuive women undergoing robotic-assisted repair of cesarean scar defect. Intervention: Robotic-assisted repair of Cesarean Scar Defect. Measurements and Main Results: A common complication of multiple cesarean deliveries is uterine scar dehiscence. This gives rise to the serious complication of future uterine rupture in pregnancy. Three consecutive cases from 2009-2011 are presented here. Case 1 and 2 were diagnosed by a saline sonogram done prior to embryo transfer during an IVF cycle. This was then confirmed by an MRI. They underwent roboticassisted laparoscopic repair of the uterus with scar revision and diagnostic hysteroscopy. They subsequently became pregnant with embryo transfer 3 months later . They had uncomplicated pregnancies and delivered via repeat c-section at term. Case 3 was diagnosed one week after a VBAC