Reporte de caso: síndrome de absorción intravascular en histeroscopia, intoxicación por glicina / Case report: Intravascular absorption syndrome in hysteroscopy, glycine intoxication

El síndrome de absorción intravascular en histeroscopia se origina por la rápida absorción vascular de soluciones isotónicas e hipotónicas utilizadas en irrigación intrauterina, ocasionando hipervolemia y dilución de electrolitos, especialmente hiponatremia. Cuando este síndrome es debido a intoxicación por glicina al 1,5% causa acidosis severa y neurotoxicidad. La incidencia de este síndrome es baja pero puede aumentar por factores como: falta de control de altura de bolsas de irrigación, ausencia de equilibrio de fluidos de soluciones de irrigación, tejidos altamente vascularizados como miomas uterinos y uso de sistema de electrocirugía monopolar. Se reporta el caso de una paciente con miomas uterinos, programada para resección mediante histeroscopia que cursa con síndrome de absorción intravascular por glicina, el temprano diagnóstico y rápido tratamiento intraoperatorio y postoperatorio permitió una evolución favorable. El manejo se basó en el uso de diuréticos, restricción de fluidos y soluciones hipertónicas de sodio.

Intravascular absorption syndrome in hysteroscopy is caused by rapid vascular absorption of isotonic and hypotonic solutions used in intrauterine irrigation, causing hypervolemia and electrolyte dilution, especially hyponatremia. When this syndrome is due to 1.5% glycine toxicity, it causes severe acidosis and neurotoxicity. The incidence of this syndrome is low but may increase due to factors such as: lack of control of the height of irrigation bags, lack of fluid balance in irrigation solutions, highly vascularized tissues such as uterine myomas and use of a monopolar electrosurgery system. The case of a patient with uterine myomas, scheduled for resection by hysteroscopy, who presents with intravascular glycine absorption syndrome, is reported. Early diagnosis and rapid intraoperative and postoperative treatment allowed a favorable evolution. Management was based on the use of diuretics, fluid restriction, and hypertonic sodium solutions.

SUCCESSFUL HYSTEROSCOPY GUIDED SUCTION & EVACUATION OF PRODUCT OF CONCEPTION ALONG WITH REMOVAL OF UTERINE SEPTUM IN SAME SITTING

Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.

Predictive Factors of Tolerance in Office Hysteroscopy - a 3-Year Analysis from a Tertiary Center

Abstract Objective Pain is the primary limitation to performing hysteroscopy. We aimed to evaluate the predictive factors of low tolerance to office hysteroscopic procedures. Methods Retrospective cohort study of the patients who underwent office hysteroscopy from January 2018 to December 2020 at a tertiary care center. Pain tolerance to office-based hysteroscopy was subjectively assessed by the operator as terrible, poor, moderate, good, or excellent. Categorical variables were compared with the use of the Chi-squared test; an independent-samples t-test was conducted to compare continuous variables. Logistic regression was performed to determine the main factors associated with low procedure tolerance. Results A total of 1,418 office hysteroscopies were performed. The mean age of the patients was 53 ± 13.8 years; 50.8% of women were menopausal, 17.8% were nulliparous, and 68.7% had a previous vaginal delivery. A total of 42.6% of women were submitted to an operative hysteroscopy. Tolerance was categorized as terrible or poor in 14.9% of hysteroscopies and moderate, good, or excellent in 85.1%. A terrible or poor tolerance was more frequently reported in menopausal women (18.1% vs. 11.7% in premenopausal women, p = 0.001) and women with no previous vaginal delivery (18.8% vs. 12.9% in women with at least one vaginal birth, p = 0.007). Low tolerance led more often to scheduling a second hysteroscopic procedure under anesthesia (56.4% vs. 17.5% in reasonable-to-excellent tolerance, p < 0.0005). Conclusion Office hysteroscopy was a well-tolerated procedure in our experience, but menopause and lack of previous vaginal delivery were associated with low tolerance. These patients are more likely to benefit from pain relief measures during office hysteroscopy.

Frequency and pattern of intrauterine hysteroscopic lesions among women coming for IVF in the city of Yaoundé

Background: Hysteroscopy is an essential tool to make intrauterine assessment in infertile patients. Diagnosis and appropriate correction of intrauterine anomalies are considered essential in order to increase chances of conception. Ourobjective was to determine the frequency and pattern of intra uterine anomalies identified among women attending hysteroscopy at the Gynaecological Endoscopic Surgery and Human Reproduction Teaching Hospital Paul et Chantal Biya ­Yaoundé (GESHRTH). Methodsand results.Thiswas a cross sectional retrospective study of 96 women attending diagnostic or operative hysteroscopy at the GESHRTH between January 2020 and December 2021.The mean age was 38.7 ±7.6 years. Fifty-nine (61.5%) of the patients were nulliparous. Primary and secondary infertility were found respectively in fifty-two patients (54.2%) and forty-four patients (45.4%). Eleven patients (11.5%) were post-menopausal. Concerning previous surgery, 29 patients (30.2%) have had a myomectomy, 28 patients (29.1%) curettage,16 patients (16.6%) laparoscopy, eight (8.3%) hysteroscopy and one (1%) caesarean section. In all, 92 patients (95.8%) had abnormal intra uterine findings consisting of endometrial polyps (43.7%), sub-mucosal fibroids (42.7%), uterine cavity adhesions (20.8%), endometrial atrophy (4.1%), foetal bone (2%), uterine septum (1%) and non-absorbable suture thread (1%).Conclusion: Abnormal uterine findings were identified in 95.8% of patients attending hysteroscopy at GESHRTH. Most frequent findings were polypsin 43.7%, sub-mucosal fibroids in 42.7% and synechiae in 20.8%. The overall per operatory complication rate was 6.2%.

Introduction. Le recours à l'hystéroscopie constitue une étape indispensable au bilan cavitaire des patientes infertiles. Le diagnostic et la prise en charge adéquate des lésions intra cavitaires permettent d'améliorer les chances de conception.L'objectif de cette étude était de déterminer la fréquence et les caractéristiques des anomalies intra cavitaires chez les patientes opérées d'une hystéroscopie au Centre Hospitalier de Recherche et d'Application en Chirurgie Endoscopique et Reproduction Humaine Paul et Chantal Biya ­Yaoundé (CHRACERH).Méthodes et résultats. Nous avons mené une étude descriptive transversale de Janvier 2020 à Décembre 2021 et recruté 96 patientes. L'âge moyen était de38,7 ±7,6 ans. Soixante-neuf patientes (61,5%) étaient nullipares. Cinquante-deux (54,2%) et quarante-quatre (45,5%) présentaient une infertilité primaire et secondaire respectivement. Onze patientes (11,5%) étaient ménopausées. Concernant les antécédents chirurgicaux,nous avons identifié une myomectomie chez 29 patientes (30,2%), un curetage utérin chez 28 (29,1%), une cœlioscopie chez 16 (16,6%), une hystéroscopie chez huit (8,3%) et une césarienne chez une (1%). Au total, 92 (95,8%) des patientes avaient des anomalies cavitaires objectivées. Il s'agissait de polypes endométriaux (43,7%), fibromes sous-muqueux (42,7%), synéchies utérines (20,8%), atrophie de l'endomètre (4,1%), métaplasie osseuse (2%), cloison utérine (1%) et corps étranger à type de fil de suture nonrésorbable (1%).Conclusion.Les anomalies intra-cavitaires étaient retrouvées chez 95,8% des patientes réalisant une hystéroscopie au CHRACERH. Les anomalies les plus représentées étaient les polypes endométriaux (43,7%), les fibromes sous-muqueux (42,7%) et les synéchies utérines (20,8%). Le taux global de complications opératoires était de 6,2%.

Comparative analysis of clinical diagnosis application of two intrauterine adhesion scoring criteria / 中华妇产科杂志

Objective:To explore the similarities and differences of China Society of Gynecology Endoscopy (CSGE) and American Fertility Society (AFS) intrauterine adhesion (IUA) scoring criteria on IUA grading and their predictive value of reproductive prognosis.Methods:From January 2016 to January 2019, a total of 1 249 patients were diagnosed with IUA by hysteroscopy at Beijing Obstetrics and Gynecology Hospital. Totally, 378 patients with complete clinical data were enrolled, and the results diagnosed by CSGT and AFS scoring criteria were compared and analyzed.And follow-up for 2 years, the pregnancy rate and live birth rate were statistical analysis.Results:(1) The grade of IUA according to AFS and CSGE scoring criteria was less consistent ( κ=0.295, P<0.001). Compared with AFS, the proportion of severe IUA cases diagnosed by CSGE was significantly lower [45.8% (173/378) vs 15.1% (57/378); RR=0.22, 95% CI: 0.15-0.30, P<0.01); the proportions of both mild and moderate IUA cases were significantly higher ( RR=4.16, 95% CI: 2.38-7.14; RR=2.38, 95% CI: 1.75-3.23; both P<0.01). (2) The pregnancy rates of mild, moderate and severe IUA diagnosed according to CSGE were 11/13, 64.5% (147/228), 31.8% (7/22), live birth rates were 11/13, 54.8% (125/228) and 22.7% (5/22), respectively; there were statistically significant differences between the groups (all P<0.01). The pregnancy rates of mild, moderate and severe IUA diagnosed based on AFS were 3/3, 66.9% (97/145) and 56.5% (65/115), respectively, with no statistically significant difference between the groups ( P>0.05). (3) IUA grades based on both CSGE and AFS criteria were significantly negatively correlated with pregnancy rates and live birth rates (CSGE: r=-0.210, r=-0.226; AFS: r=-0.130, r=-0.147; all P<0.05). Univariate logistic regression analysis showed that CSGE had higher OR for both pregnancy rates and live birth rates compared to AFS (3.889 vs 1.657, 3.983 vs 1.554, respectrvely). Conclusions:Compared with AFS, the IUA grade based on CSGE is better related with reproductive prognosis, suggesting that the CSGE standard might be more objective and comprehensive and has better predictive value for reproductive prognosis, thus avoiding overdiagnosis and overtreatment.

Misoprostol Administration Before Hysteroscopy Procedures - A Retrospective Analysis / O uso do misoprostol prévio aos procedimentos histeroscópicos - Um estudo retrospectivo

Abstract Objective To evaluate the use of misoprostol prior to hysteroscopy procedures regarding technical ease, the presence of side effects, and the occurrence of complications. Methods This is a retrospective, observational, analytical, case-control study, with the review of medical records of 266 patients followed-up at the Gynecological Videoendoscopy Sector of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto of the Universidade de São Paulo (HCFMRP - USP, in the Portuguese acronym) from 2014 to 2019, comparing 133 patients who used the drug before the procedure with 133 patients who did not. Results The occurrence of postmenopausal uterine bleeding was the main indication for hysteroscopy and revealed a statistical difference between groups (p < 0.001), being present in 93.23% of the patients in the study group and in 69.7% of the patients in the control group. Only 2 patients (1.5%) in the study group reported adverse effects. Although no statistical differences were observed regarding the occurrence of complications during the procedure (p = 0.0662), a higher total number of complications was noted in the group that used misoprostol (n = 7; 5.26%) compared with the group that did not use the drug (n = 1; 0.75%), a fact that is clinically relevant. When evaluating the ease of the technique (measured by the complete performance of all steps of the hysteroscopy procedure), it was verified that although there was no difference between groups (p = 0.0586), the control group had more than twice as many incompletely performed procedures (n = 17) when compared with the group that used misoprostol previously (n = 8), which is also clinically relevant. Conclusion The use of misoprostol prior to hysteroscopy in our service indicated that the drug can facilitate the performance of the procedure, but not without side effects and presenting higher complication rates.

Resumo Objetivo Avaliação do misoprostol prévio à histeroscopia quanto à facilidade técnica, efeitos colaterais e a ocorrência de complicações durante o procedimento. Métodos Estudo analítico observacional retrospectivo tipo caso controle com revisão de prontuários de 266 pacientes do Setor de Videoendoscopia Ginecológica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (HCFMRP - USP), de 2014 a 2019, sendo comparadas 133 pacientes que utilizaram o medicamento prévio ao procedimento com 133 pacientes que não o utilizaram. Resultados Sangramento uterino após a menopausa foi a principal indicação de histeroscopia, apresentando diferença estatística (p < 0,001), estando presente em 93,23% das pacientes do grupo de estudo e em 69,17% das pacientes do grupo controle. Apenas 2 pacientes (1,5%) do grupo de estudo relataram efeitos adversos. Não foram observadas diferenças quanto à presença de complicações durante o procedimento (p = 0,0662), mas observamos um número total de complicações maior no grupo de estudo (n = 7; 5,26%) do que no grupo controle (n = 1; 0,75%), o que é clinicamente relevante. Não houve diferença entre os grupos quanto à facilidade técnica (p = 0,0586), mas o grupo controle apresentou mais do que o dobro de procedimentos não completamente realizados (n = 17) quando comparado com o grupo de estudo (n = 8), o que é clinicamente relevante. Conclusão O uso de misoprostol prévio à histeroscopia no nosso serviço demonstrou que ele pode facilitar a realização do procedimento, mas não é isento de efeitos colaterais e apresenta maiores taxas de complicações.

Diagnostic accuracy of hysteroscopy in relation to histopathology in patients with abnormal uterine bleeding at a tertiary care centre

Background: : Judicious use of hysteroscopy to manage abnormal uterine bleeding (AUB) adds a new dimension in handling this perplexing problem. Hysteroscopy combined with histological examination is the new “Gold Standard” for evaluating a case of abnormal uterine bleeding Objectives: To study Diagnostic accuracy of hysteroscopy in relation to histopathology in patients with abnormal uterine bleeding Methods: A hospital based diagnostic accuracy study was carried out among 100 women with abnormal uterine bleeding. All patients underwent the procedure of hysteroscopy. Samples were collected in all patients for histopathology confirmation of the hysteroscopy findings. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for hysteroscopy in comparison to gold standard histopathology. Results: Majority of the women belonged to 40-49 years (41%). Majority (37%) reported after one year of occurrence of the symptoms. Majority (54%) had menorrhagia. Hysteroscopy was found to be having good sensitivity and specificity in comparison to gold standard histopathology. Sensitivity=97.7%; specificity=78.5%, positive predictive value=78.1%; negative predictive value=97.7%; diagnostic accuracy=87% for hysteroscopy in comparison to histopathology. Conclusion: Hysteroscopy is simple to perform and provides direct visualization of the uterus cavity and the endo-cervical canal. In abnormal uterine bleeding, quick and safe diagnosis is possible by hysteroscopy. In cases of endometrial polyp and sub mucous myoma which are pedunculated structures, diagnostic accuracy is greater with hysteroscopy and can be treated during the procedure itself. Thus, Hysteroscopic guided biopsy and histopathology is considered as new “Gold Standard” in diagnosis and often treatment of abnormal uterine bleeding.

Noncardiogenic Pulmonary Edema As Sequel Of Venous Air Embolism In A Case Of Operative Hysteroscopy - A Case Report.

Hysteroscopy is minimally invasive procedure performed widely for diagnosis and treatment of intrauterine and endocervical pathologies.Venous air embolism, though rare complication, is catastrophic if encountered.We report one such case of venous air embolism leading to non-cardiogenic pulmonary edema encountered by us during hysteroscopic uterine septum resection done for infertility under general anaesthesia. Quick identification, preventing further gas entry and timely intervention saved our patient.

Diagnostic Hysteroscopy and Saline Infusion Sonography in Abnormal Uterine Bleeding

One of the commonest reasons for women seeking gynecological advice is Abnormal uterine bleeding (AUB). Most common anatomical causes of abnormal uterine bleeding in women are endometrial polyps, sub mucosal fibroids and endometrial hyperplasia. Hysteroscopy is an effective procedure but is more expensive than Saline Infusion Sonography (SIS). Direct visualization of uterine cavity is possible by hysteroscopy, but it does not give any information about myometrium and adnexa. Saline infusion sonography is effortlessly accepted by most patients as it can be an outpatient procedure. This article present summary of salient features of the procedure which will help the practitioner to take informed decision.

Power Doppler sonography – A supplement to hysteroscopy in abnormal uterine bleeding: Redefining diagnostic strategies

Background: Abnormal Uterine Bleeding (AUB) is a very frequent cause of gynecological visits in women of all age groups. Ultrasound pelvis with or without endometrial sampling have been conventionally used to make diagnosis. Power Doppler is a comparatively recent modality which can be used to screen patients who will need endometrial biopsy/ curretage. We hereby conducted a study to compare the diagnostic accuracy of power Doppler sonography and hysteroscopy with histopathology associated with abnormal uterine bleeding. We also calculated the incidence of uterine pathology in AUB by power Doppler ultrasound and hysteroscopy and compared it with histopathology. Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University. After excluding 42 women, a total of 100 women fulfilling the inclusion criteria contributed to our study. Selected women underwent power Doppler ultrasound and hysteroscopy with guided biopsy. Results were compared with histopathology as per the gold standard. Evaluation of sensitivity, specificity, positive and negative predictive values were performed for each modality. All statistical analyses were performed using the SPSS 11.0 statistical package. P value ?0.05 was considered statistically significant for all tests used. Results: Sensitivity and specificity of power Doppler are 75% and 100% for carcinoma endometrium, 72.72% and 98.9% for endometrial hyperplasia, and 81.81% and 100% for endometrial polyp, respectively. Conclusion: Power Doppler sonography can be used to screen outpatients who do not need an endometrial biopsy for abnormal uterine bleeding. This will avoid unnecessary hysteroscopy in definitive benign cases, and watchful hysteroscopy in suspected premalignant and malignant cases. Irregular branching vessels and color splashes were found to be the best parameters for diagnosing endometrial carcinoma. Power Doppler should be done along with transvaginal sonography in all cases of abnormal uterine bleeding

Opciones e indicaciones en el manejo del istmocele / Options and indications in the management of isthmocele

INTRODUCCIÓN: El istmocele es un defecto en la cicatrización del sitio de una histerotomía, que puede cursar con sangrado posmenstrual, dolor pélvico, dismenorrea, dispareunia e infertilidad secundaria. Esta patología ha ido incrementando su prevalencia dado el aumento de la tasa de cesáreas en todo el mundo. OBJETIVO: Se realizó una revisión sobre el istmocele y su manejo, presentando sus indicaciones específicas y las complicaciones asociadas a esta patología. MÉTODO: Se llevó a cabo una búsqueda en PubMed, Embase, Scopus y Google Scholar, en la que se encontraron 868 artículos, de los cuales se revisaron 30 al aplicar los criterios de inclusión y exclusión. DISCUSIÓN: El istmocele es cada vez más frecuente. Tiene una prevalencia cercana al 60% posterior a la realización de una cesárea y aumenta hasta valores del 100% con tres de ellas. Los métodos diagnósticos más utilizados son la ecografía transvaginal y la histerosonografía. Su abordaje es habitualmente quirúrgico, aunque existe la posibilidad de intentar tratamiento médico en algunos casos. CONCLUSIONES: Es necesario determinar el grosor miometrial para poder establecer un plan de manejo adecuado. Además, se ameritan estudios que realicen un seguimiento a largo plazo y que aporten mayor evidencia para la realización de cada procedimiento. Después de clasificar el tipo de defecto, el tratamiento quirúrgico del istmocele se debe ofrecer a pacientes sintomáticas y a aquellas con defectos grandes y que desean mantener la fertilidad.

INTRODUCTION: The isthmocele is a defect in the healing of the site of a hysterotomy, which can present with post-menstrual bleeding, pelvic pain, dysmenorrhea, dyspareunia and secondary infertility. This pathology has been increasing its prevalence given the increase in the rate of cesarean sections worldwide. OBJECTIVE: A review will be carried out of the isthmocele and its management, presenting its specific indications and the complications associated with this pathology. METHOD: A search was carried out in databases such as PubMed, Embase, Scopus and Google Scholar, finding a total of 868 articles, of which 30 of them were reviewed when applying the inclusion and exclusion criteria. DISCUSSION: Isthmocele is an increasingly frequent pathology, having a prevalence of 60% after performing a cesarean section and increasing to 100% with 3 of them. There are multiple diagnostic methods, mainly transvaginal ultrasound and sono-hysterosonography. The approach to this pathology is usually surgical, although there is the possibility of trying medical treatment in some cases. CONCLUSIONS: It is necessary to determine the myometrial thickness in order to establish an adequate management plan. Additionally, long-term follow-up studies are warranted and provide more evidence for the performance of each procedure. After classifying the type of defect, surgical treatment of the isthmocele should be offered to symptomatic patients or those with large defects and who desire future fertility.

Hysteroscopic Evaluation Of Abnormal Uterine Bleeding In A Tertiary Care Institute — An Observational Study

Objectives:To assess the feasibility of diagnos?c hysteroscopy in the diagnosis of abnormal structure and pathological lesions in the uterine cavi?es of women presen?ng abnormal bleeding of the uterus. Methods: This is a Prospec?ve Cross-sec?onal study conducted in the Department of Gynaecology at Prathima Ins?tute Of Medical Sciences, Karimnagar: one hundred women presen?ng with Abnormal Uterine Bleeding, over a period of one year from December 2020 to November 2021, were subjected to the procedure. Results: The results of our study show that hysteroscopy has high accuracy for detec?ng the pathology in women with abnormal uterine bleeding, especially in benign lesions such as endometrial polyp and submucosal fibroid and it can be used as the first line diagnos?c method for these abnormali?es. Conclusion:Hysteroscopy provides a more accurate diagnosis than dilata?on and cure?age or ultrasonography alone to diagnose pathology in women with abnormal bleeding of the uterus. It is very sensi?ve for diagnosing intracavitary lesions like submucous myoma and endometrial polyp

Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352­4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.

Comparison of volume therapy guided by inferior vena cava ultrasound and lung ultrasound at different sites in patients undergoing grade four hysteroscopic surgery / 中华麻醉学杂志

Objective:To compare the efficacy of volume therapy guided by inferior vena cava ultrasound and lung ultrasound at different sites in patients undergoing grade four hysteroscopic surgery.Methods:A total of 90 patients, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ, undergoing elective grade four hysteroscopic surgery under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: conventional group (C group), ultrasound at the subcostal area group (S group) and ultrasound at right mid-axillary line group (R group). When the inferior vena cava distensibility index<15% or pulmonary ultrasound B-line score>8.5 or arterial blood gas Na + concentrations <125 mmol/L, surgeons were advised to speed up the process of surgery and decrease the pressure of uterine distention, furosemide 10-20 mg was intravenously injected, and the speed of infusion was adjusted at the same time.On admission to the operating room (T 0), at 20 min after induction (T 1), 40 min after induction (T 2), and at the end of operation (T 3), the B-line score of lung ultrasound, concentrations of Lac and Na + and PaO 2/FiO 2 were recorded, and the postoperative complications, amount of uterine distention fluid, volume of fluid infused and time of laryngeal mask airway removal were recorded. Results:Compared with group C, the pulmonary ultrasound B-line score was significantly decreased, the concentrations of Na + and PaO 2/FiO 2 were increased, the time of laryngeal mask airway removal was shortened, and the amount of uterine distention fluid was decreased in S and R groups, and the total incidence of complications was significantly decreased in group R ( P<0.05). Compared with group S, the lung ultrasound B-line score was significantly decreased, PaO 2/FiO 2 was increased, and the amount of uterine distention fluid was decreased in group R ( P<0.05). Conclusions:Compared with subxiphoid process, the volume therapy guided by inferior vena cava ultrasound on the right mid-axillary line and lung ultrasound has more advantages in the patients undergoing grade four hysteroscopic surgery.

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.

Clinical study of hysteroscopical electroresection of FIGO type 3 myoma / 中华妇产科杂志

Objective:To analyze the clinical application and to evaluate the efficiency of hysteroscopical electroresection of International Federation of Gynecology and Obstetrics (FIGO) type 3 myoma.Methods:The clinical data of patients who underwent hysteroscopical electroresection single FIGO type 3 myoma in Obstetrics and Gynecology Hospital of Fudan University from January 2019 to October 2021 were collected retrospectively. The clinical symptoms, myoma size, location, operation time, intraoperative bleeding, surgical complications and postoperative follow-up were recorded, and the subsequent pregnancy outcomes were followed-up.Results:Totally 35 patients with FIGO type 3 myoma were included in this study. The average age was (36.6±4.7) years old, the diameter of myoma was (4.0±1.2) cm (range: 2.0-5.8 cm). The rate of complete resection of myoma in one operation was 86% (30/35), the average operation time was (41±15) minutes (range: 20-65 minutes), and the average intraoperative bleeding was (24±18) ml (range: 5-150 ml). No complications such as uterine perforation, massive hemorrhage, hyperhyderation syndrome and infection occurred in all patients perioperation. There were 20 cases with significant increase of menstruation before operation, the cure rate and effective rate of hysteroscopical electroresection of FIGO type 3 myoma were 75% (15/20) and 95% (19/20). There were 24 patients with fertility requirements, their average follow-up time was (14.5±6.8) months, the pregnancy rate within 1 year after operation was 79% (19/24), and the average postoperative pregnancy time was (5.8±3.4) months. There were 15 cases who had completed delivery after operation, including 10 cases of vaginal delivery and 5 cases of cesarean section, and none of them had uterine rupture.Conclusions:Hysteroscopy could effectively resect FIGO type 3 myoma. Hysteroscopical electroresection of FIGO type 3 myoma is minimally invasive with rapid postoperative recovery and could achieve pregnancy in a short time, which is not only helpful to reduce the amount of menstruation, but also beneficial for the prognosis of fertility. It should be carried out by the experienced hysteroscopists.

High risk factors for endometrial polyps in 304 cases / 中国基层医药

Objective:To investigate the high risk factors for endometrial polyps (EP).Methods:The clinical data of 669 cases who underwent hysteroscopic examination due to abnormal vaginal bleeding and ultrasonic indications in Binzhou Medical University Hospital from October 2019 to September 2020 were retrospectively analyzed. According to postoperative pathological results, these patients were divided into an EP group ( n = 304) and a non-EP group ( n = 365). The clinical data of these patients were subjected to univariate and multivariate analysis using SPSS 22.0 software. Results:Univariate analysis showed that age (median age: 45 years in the EP group and 47 years in the non-EP group), number of pregnancies (median number of pregnancies: 2 in the EP group and 3 in the non-EP group), number of births (median number of births: 1 in the EP group and 2 in the non-EP group), menopause [49 cases (16.12%) in the EP group and 83 cases (22.74%) in the non-EP group], chronic endometritis [111 cases (36.51%) in the EP group and 174 patients (47.67%) in the non-EP group], cervical polyps [58 cases (19.08%) in the EP group and 46 cases (12.06%) in the non-EP group], hypertension [48 cases (15.79%) in the EP group and 88 cases (24.11%) in the non-EP group], diabetes mellitus [14 cases (4.61%) in the EP group and 31 cases (8.49%) in the non-EP group] were the risk factors of EP ( Z =-3.71, -4.30, -2.50, χ2 = 4.59, 8.44, 0.02, 0.01, 0.04, all P < 0.05). Multivariate analysis showed that age, number of pregnancies, chronic endometritis and cervical polyps had significant effects on the incidence of EP ( OR = 0.97, 95% CI 0.95-0.99, OR = 0.80, 95% CI 0.72-0.90, OR = 0.53, 95% CI 0.38-0.74, OR = 1.73, 95% CI 1.10-2.72, all P < 0.05). Conclusion:Age, number of pregnancies, chronic endometritis and cervical polyps are all risk factors for the development of endometrial polyps.

Malformación arteriovenosa posterior a la retención de productos de la concepción / Arteriovenous malformation after retention of products of conception

Resumen OBJETIVO: Plantear un procedimiento para pacientes con retención de restos corioplacentarios y riesgo de formación de fístulas arteriovenosas que sea efectivo, seguro y ambulatorio. MATERIALES Y MÉTODOS: Estudio de serie de casos, retrospectivo, de pacientes atendidas en el Hospital Gea González de enero a mayo de 2022. Se empleó un equipo de Bettocchi, de flujo continuo de 5 mm, lente cilíndrico de 2.9 mm y 30°. En casos específicos se programó un procedimiento quirúrgico con resectoscopio Richard Wolf Princess, con diámetro exterior de 7 mm, sistema óptico de 2.7 mm, dirección visual de 30°. RESULTADOS: Se revisaron 642 expedientes de los que se obtuvo una serie de 31 casos que se incluyeron conforme a la clasificación de Gutenberg, con biopsia por protocolo posaborto y resección con Grasper para los tipos 0 y 1; dos pacientes se enviaron a Urgencias por sangrado abundante para aspiración mecánica endouterina inmediata; dos pacientes se catalogaron con tipo 3; en la primera se optó por el tratamiento médico con metotrexato con lo que se consiguió la resolución completa y la segunda finalizó el embarazo con histerectomía laparoscópica. CONCLUSIONES: En pacientes con imágenes ecográficas sugerentes de retención de restos corioplacentarios o malformación arteriovenosa, los procedimientos con visión directa evitan las complicaciones inmediatas y futuras. El diagnóstico mediante la clasificación de Gutenberg permite definir el tipo de acceso con extracción en frío con pinza Grasper para los tipos 0 y 1, o la aplicación de una prueba farmacológica con metotrexato y resección histeroscópica para los tipos 2 y 3 en pacientes hemodinámicamente estables.

Abstract OBJECTIVE: To propose an effective, safe and outpatient procedure for patients with retained chorioplacental remnants and risk of arteriovenous fistula formation. MATERIALS AND METHODS: Retrospective case series study of patients attended at the Gea González Hospital from January to May 2022. A Bettocchi equipment was used, 5 mm continuous flow, 2.9 mm cylindrical lens and 30°. In specific cases a surgical procedure was scheduled with a Richard Wolf Princess resectoscope, 7 mm outer diameter, 2.7 mm optical system, 30° visual direction. RESULTS: We reviewed 642 files from which we obtained a series of 31 cases that were included according to the Gutenberg classification, with biopsy by postabortion protocol and resection with Grasper for types 0 and 1; two patients were sent to the ER for heavy bleeding for immediate MVA; two patients were categorized as type 3; in the first one we opted for medical treatment with methotrexate with which we achieved complete resolution and the second one ended the pregnancy with laparoscopic hysterectomy. CONCLUSIONS: In patients with ultrasound images suggestive of retained chorioplacental debris or arteriovenous malformation, direct vision procedures avoid immediate and future complications. Diagnosis by Gutenberg classification allows to define the type of access with cold extraction with Grasper forceps for types 0 and 1, or the application of a pharmacological test with methotrexate and hysteroscopic resection for types 2 and 3 in hemodynamically stable patients.

Métodos de estudio de pacientes con sangrado uterino posmenopáusico: recomendaciones prácticas / Study methods of patients with postmenopausal uterine bleeding: practical recommendations

Resumen El sangrado uterino posmenopáusico se define como aquel sangrado que ocurre después del cese definitivo de la menstruación en la etapa reproductiva de la mujer como consecuencia de la claudicación biológica de los ovarios, o como un sangrado no esperado en mujeres con terapia de reposición hormonal sistémica de la menopausia. Representa el 5% de las consultas ginecológicas y, si bien su origen suele ser por causas benignas, puede requerir una evaluación minuciosa para descartar patologías malignas del endometrio. El objetivo de este trabajo es establecer un flujograma diagnóstico basado en la evidencia para la evaluación de las pacientes con sangrado uterino posmenopáusico.

Abstract Postmenopausal uterine bleeding is defined as the bleeding that occurs after the last menstruation due to loss of ovarian function, or a non-scheduled bleeding in patients with hormonal therapy. It represents 5% of the gynecologic visits, and even though its origin is often benign, it requires a thorough evaluation to discard malignant diseases. The objective of these review is to propose a diagnostic algorithm based on the available evidence for the evaluation of patients with postmenopausal uterine bleeding.

Evaluación de la efectividad y satisfacción de las pacientes tras miomectomía histeroscópica en consulta / Evaluation of effectiveness and patient satisfaction of hysteroscopic myomectomy in office

OBJETIVO: Analizar la efectividad de las miomectomías histeroscópicas en consulta realizadas con minirresector y conocer si hay factores relacionados con el grado de satisfacción de las pacientes. MÉTODO: Estudio observacional, transversal y prospectivo, de mujeres sometidas a miomectomía histeroscópica en consulta durante el año 2018. Las pacientes recibieron medicación para la preparación cervical, analgesia oral y anestesia paracervical. La miomectomía se realizó con un minirresector de 5.8 mm. Se registraron el tiempo y el dolor en una escala visual analógica (EVA) durante la entrada y la resección, así como la satisfacción de las pacientes a los 3 meses con el cuestionario validado CSQ-8. RESULTADOS: El estudio incluyó 59 pacientes. El tiempo medio de entrada fue menor de 1 minuto (47,93 segundos) y el de resección fue de 13,51 minutos. El dolor referido por las pacientes en la EVA durante la entrada y la resección puntuó en torno a 3 y 4, respectivamente. Se consiguió un 74.6% de resecciones completas de los miomas y la puntuación media de satisfacción de las pacientes fue de 27.17. La resección completa del mioma se asoció con una mayor satisfacción total de las pacientes. CONCLUSIONES: La miomectomía histeroscópica en consulta llevada a cabo con un minirresector de 5.8 mm con analgesia paracervical obtiene buenos resultados clínicos, con buena satisfacción de las pacientes. Esta última se relaciona con una resección completa del mioma, sin que influyan el tiempo necesario para su exéresis ni el dolor.

OBJECTIVE: To analyze the effectiveness of hysteroscopic myomectomy in office performed with mini-resectoscope, and to know if there is any variable related with patient satisfaction. METHOD: Observational and prospective transversal study, which included all women who underwent a hysteroscopic myomectomy in office in 2018. Patients received drugs for cervical preparation and pain management, as well as paracervical block. We used the 5.8 mm mini-resectoscope. We kept record of time and AVS pain during entrance and resection, as well as patient satisfaction 3 months after the procedure using the CSQ-8. RESULTS: The study included 59 patients. Mean entrance time was less than 1 minute (47.93 seconds), while mean resection time was 13.51 minutes. AVS pain during entrance and resection was around 3 and 4, respectively. We achieved 74.6% rate of complete resection. Mean patient satisfaction rate was 27.17 points. We found that a complete myoma resection is related to higher patient satisfaction. CONCLUSIONS: Hysteroscopic myomectomy in office performed with the 5.8 mm mini-resectoscope, using cervical block, achieves good clinical results and a good patient satisfaction. Patient satisfaction is associated with a complete resection of the myoma, without any influence of pain experienced or time required.