The use of dinoprostone versus evening primrose oil for cervical ripening in women who will undergo hysteroscopy: A randomized controlled trial

Objective@#To compare the efficacy of Dinoprostone gel versus intravaginal evening primrose oil capsule as cervical ripening agents for operative hysteroscopy…. and to compare the length of time to achieve a 10mm cervical dilatation prior to operative hysteroscopy.@*Methods@#This is a two-arm randomized controlled trial done in a tertiary training institution. Group A and B received Dinoprostone gel and EPO for cervical ripening, respectively. Population consisted of women admitted for operative hysteroscopy, aged between 19-56 years old, and with closed cervix. @*Results@#Thirty-eight (38) patients mostly pre-menopausal with mean age of 41, without history of uterine surgery, and presented with abnormal uterine bleeding, were included. Significant difference was observed in initial cervical dilatation between Dinoprostone gel(5.63 mm) versus EPO(4.21mm). Most patients in EPO group were pain-free while Dinoprostone group experienced tolerable pain. Use of Dinoprostone was 4x more expensive versus EPO. @*Conclusion@#Both agents were effective in dilating the cervix prior to operative hysteroscopy. Nevertheless, EPO may be superior and acceptable due to reduced cost, patient convenience and acceptability, and ease of administration.

Operative Hysteroscopy in Infertility Patients and Its Complications.

The problem of infertility is increasing over the years and so are the couples seekingmedical help for it. Estimates of infertility in India goes to around 10 - 15 percent.Hence evaluation of the couple with the help of history and accompanyinginvestigations are foremost required. Various modalities are available foridentifying the cause. One such cause is abnormalities in the uterine cavity. Thisstep is important because its inner layer, called endometrium is responsible forimplantation of the embryo in the blastocyst stage. For such assessment of theuterine cavity, the gold standard procedure is the diagnostic hysteroscopy. Itinvolves direct visualization of the cavity and simultaneous correction of theintrauterine pathology. Hysteroscopy is a simple procedure with low risk ofcomplication; moreover, complications occur with operative procedures mostcommonly. This study aims to evaluate these complications and critically appraisethe changes in trend of complications.METHODSThis is an observational study. Study included 32 patients with infertilityundergoing operative hysteroscopy at obstetrics and gynaecology department inour hospital.RESULTSAmong the 32 patients, the most common hysteroscopic procedure was lateral wallmetroplasty (40.6%) followed by septal resection (25%). Polypectomy, adhesiolysisand tubal cannulation. Complication rate was 6.25 percent, among which post-opinfection and bleeding per vaginum were the most important

Experience of hysteroscopy in a rural tertiary care center of Haryana, India

Background: During the last few decades hysteroscopy has become a tool of choice for evaluation of uterine cavity due to its “see and treat “benefits. It is more accurate and less invasive. Introduction of hysteroscopy in gynecological practice is the need of time. Aim of our study is to share the experience of hysteroscopy, its learning curve and limitations in a rural tertiary care center of Haryana.Methods: We retrospectively analyzed all the hysteroscopy procedure done from January 2016 to December 2018 from the hospital records.Results: Total 118 hysteroscopy were done but record of only 110 was available. Out of 110, 37(33%) were operative and 73(67%) were diagnostic. 36% were done for AUB, 33%  for infertility, 15% for misplaced cu t, 6% for amenorrhea, 2% in cases of RPL and rest for some less common indications. Out of operative hysteroscopy major procedures done were polypectomy and removal of misplaced Cu-T. Septal resection was also done in 3 cases. Number of operative hysteroscopy has increased over the time period of study.Conclusions: Hysteroscopic evaluation of uterine cavity is a reliable method for both diagnostic and treatment purpose. Proportion of hysteroscopy procedures and its learning curve will improve with persistent effort.

Operative hysteroscopy in a jamaican cohort / Histeroscopia operatoria en una cohorte jamaicana

OBJECTIVE: The objective of this study is to determine the indications, success, and complications of operative hysteroscopy performed at The University of the West Indies (UWI). METHODS: A five-year retrospective cohort study was done of women undergoing operative hysteroscopy at the Hugh Wynter Fertility Management Unit (HWFMU) of the University of the West Indies from January 1, 2001 to December 31, 2005. The demographics of the patients, indications, complications of the procedure and postoperative follow-up were assessed. Patient's post-procedural quality of life was assessed by a questionnaire. RESULTS: During this period, 92 operative hysteroscopies were performed on 87 patients, with repeat procedures being performed in three patients. The mean age of patients undergoing operative hysteros-copy was 36.65 years with a range of 23 to 50 years. The main indications for operative hysteroscopy at the HWFMU were submucosal fibroids (50%), intrauterine synechiae (26%) and removal of an intrauterine contraceptive device (11%). There were four procedure-related complications, all of which occurred during myomectomy and required hospitalization. CONCLUSION: Operative hysteroscopy is a safe and highly effective therapy for carefully selected women. As a consequence of technological advancements, an increasing number of gynaecological conditions, traditionally treated by laparotomy, can now be treated safely and effectively using outpatient operative hysteroscopy.

OBJETIVO: El objetivo de este estudio es determinar las indicaciones, éxito, y complicaciones de las histeroscopías operatorias realizadas en la Universidad de West Indies (UWI). MÉTODOS: Se realizó un estudio de cohorte retrospectivo de cinco años con mujeres sometidas a Histeroscopia operatoria en la Unidad de Fertilidad "Hugo Wynter", en la Universidad de West Indies (HWFMU), del 1ero de enero de 2001 al 31 de diciembre de 2005. Se evaluaron los datos demográficos de los pacientes, así como las indicaciones, las complicaciones del procedimiento y el seguimiento post-operatorio. Se aplicó un cuestionario para evaluar la calidad de vida del paciente luego del procedimiento. RESULTADOS: Durante este período se realizaron 92 histeroscopías operatorias a 87 pacientes, repitiéndose los procedimientos en tres pacientes. La edad promedio de los pacientes sometidos a Histeroscopia operatoria fue 36.65 años, con una rango de 23 a 50 años. Las indicaciones principales para la histeroscopía operatoria en la Unidad HWFMU fueron los miomas submucosos (50%), las sinéquias intrauterinas (26%) y la extracción del dispositivo anticonceptivo intrauterino (11%). Hubo cuatro complicaciones relacionadas con los procedimientos, todas las cuales tuvieron lugar durante la miomectomía y requirieron hospitalización. CONCLUSIÓN: La histeroscopía operatoria es una terapia segura y altamente efectiva para mujeres cuidadosamente seleccionadas. Como consecuencia de los avances tecnológicos, un número creciente de condiciones ginecológicas, tradicionalmente tratadas mediante laparotomía, pueden ahora ser tratadas con seguridad y efectividad mediante histeroscopía operatoria ambulatoria.