Hysteroscopy in pregnancy-related conditions: descriptive analysis in 273 patients.

STUDY OBJECTIVE: To describe the feasibility of office hysteroscopy in patients with pregnancy-related problems such as retained trophoblastic tissue, persistent molar tissue, pregnancy with in situ intrauterine device (IUD), isthmocele, embryoscopy, and osseous metaplasia. DESIGN: Retrospective cohort chart review of use of hysteroscopy in 273 patients with pregnancy-related conditions (Canadian Task Force classification II-2). SETTING: University tertiary-care hospital. PATIENTS: Office hysteroscopy with the indication of pregnancy-related conditions such as retained trophoblastic tissue, pregnancy with IUD, molar pregnancy, cesarean scar defects, and fetal death were studied. The study included 273 patients: 185 with retained trophoblastic tissue, 14 with persistent molar tissue, 7 with an in situ IUD, 22 with symptomatic isthmocele, 41 with embryoscopy, and 4 with osseous metaplasia. INTERVENTION: Diagnostic and operative office hysteroscopy. MEASUREMENTS AND MAIN RESULTS: Variables studied included resolution of abnormal uterine bleeding in patients with persistent trophoblastic tissue, normalization of ß-human chorionic gonadotropin levels in patients with persistent molar tissue, continuation of pregnancy after retrieval of lost IUDs, resolution of postmenstrual bleeding in patients with symptomatic isthmocele, rate of uncontaminated embryonic tissue after embryoscopic biopsy, and successful extraction of bony tissue in patients with osseous metaplasia. Office hysteroscopy enabled resolution of most cases of retained trophoblastic tissue (91.8%) and all 14 cases of persistent molar tissue. 7 IUDs were extracted from pregnant patients. Fifteen isthmoceles resolved with office hysteroscopy, and 7 were resected in the operating room. A normal karyotype was obtained in 37 embryoscopies (90.2%). Four osseous metaplasia cases resolved with either office hysteroscopy (75%) or resectoscopy in the operating room (25%). CONCLUSION: Office hysteroscopy is a safe and minimally invasive treatment for pregnancy-related conditions, with good clinical and functional results.

Follow-up in women with vaginal agenesis after laparoscopic creation of neovagina.

STUDY OBJECTIVE: To compare 2 different methods to create a neovagina in patients with Rokitansky syndrome and to describe their functional results during the follow-up. DESIGN: Descriptive study on functional outcome in 32 patients with Rokitansky syndrome (Canadian Task Classification Force II-2). SETTING: University tertiary Hospital. DESIGN AND PATIENTS: 18 patients (group 1) underwent our original technique. 14 patients (group 2) were operated on with the modified technique. INTERVENTION: Comparison between 2 different techniques of laparoscopic approach. RESULTS: Both groups had excellent surgical outcomes. The modified technique (group 2) obtained an optimal vaginal depth in fewer days than in the first group (p < .001). Consequently, the hospital stay was shorter in the second group (p < .001). Follow-up was 85 months for group 1 and 17.2 months for group 2. Functional outcome was excellent during the follow-up in both groups. CONCLUSION: Laparoscopic creation of a neovagina is a safe, minimally invasive treatment with good functional and sexual results.