Performance of outpatient transvaginal hydrolaparoscopy.

STUDY QUESTION: What is the feasibility of performing transvaginal hydrolaparoscopy (THL) in an outpatient setting? SUMMARY ANSWER: It is feasible to perform THL in an outpatient setting, reflected by a low complication and failure rate and a high patients' satisfaction. WHAT IS KNOWN ALREADY: THL is a safe method to investigate tubal patency and exploring the pelvis in subfertile women. STUDY DESIGN, SIZE, DURATION: Retrospective cohort study of 1127 subfertile women who underwent THL as primary diagnostic method for testing tubal patency in an outpatient setting. PARTICIPANTS/MATERIALS, SETTING, METHODS: We studied all THL procedures performed as a primary diagnostic tubal patency test in an outpatient setting in subfertile women starting from the initial THL in four large hospitals. Baseline characteristics were obtained, as well as the outcome of the procedures in terms of success, complications and findings by examining medical records. We used a uniform visual analogue scale (VAS) score document to collect data on pain and acceptability prospectively and compared two methods of pain relief. MAIN RESULTS AND THE ROLE OF CHANCE: We studied a total of 1103 women who underwent THL. Successful access to the pouch of Douglas was achieved in 1028 women (93.2%), and 1017 women had a complete evaluation (92.2%). Double-sided tubal patency was found in 844 women (83%), unilateral tubal patency in 127 women (12.5%), while in 46 women (4.5%) bilateral occluded tubes were diagnosed. Endometriosis alone was seen in 64 women (6.3%), adhesions alone in 87 women (8.6%) and both endometriosis and adhesions in 42 women (4.1%).Complications occurred in 29 (2.6%) women, including 10 perforations of the rectum (0.9%), 8 perforations of the posterior uterine wall (0.7%) and 5 infections/pelvic inflammatory diseases (PIDs) (0.5%). Bleeding of the vaginal wall requiring intervention and hospital admissions due to pain was seen in 4 (0.4%) and 2 women, respectively (0.2%). The average pain score was rated 4.0 (±2.4 SD) on a VAS from 0 to 10 with 0 meaning no pain at all with no difference in different types of pain relief. Acceptability was rated 1.5 (±2.1 SD). LIMITATIONS, REASONS FOR CAUTION: The main limitation of the study is its retrospective character and the fact that only a fourth of the women were asked for pain and acceptability scores. WIDER IMPLICATIONS OF THE FINDINGS: THL can be used as a primary method for tubal assessment in an outpatient setting. Further randomized studies are needed to assess whether THL is superior to other methods and strategies for tubal assessment in terms of prognostic capacity and cost-effectiveness. STUDY FUNDING/COMPETING INTEREST: No external funding was either sought or obtained for this study. The authors have no competing interests to declare.

Is the correlation between fetal oxygen saturation and blood pH sufficient for the use of fetal pulse oximetry?

OBJECTIVES: Fetal pulse oximetry was performed during labor in high-risk cases for fetal distress to determine the diagnostic value of this method. METHODS: The fetal SpO2 values were blinded from the obstetrician so that these values did not influence clinical decisions. Mean and lowest SpO2 measurements for the last 30 min prior to either fetal scalp blood sampling or delivery were correlated with scalp pH or pH from the umbilical artery. RESULTS: No significant correlation was found between pH and mean fetal oxygen saturation (correlation coefficient -0.02, p = 0.9). There was no significant correlation between pH and lowest fetal oxygen saturation (correlation coefficient 0.04, p = 0.84). Concerning the feasibility of the method, we found that only 23 of 65 included patients were suitable for analysis; in 20% of cases, we were not able to perform a SpO2 measurement. CONCLUSIONS: None of three cases with pH below 7.05 would have been detected using mean SpO2 over the last 30 min prior to fetal scalp blood sampling or delivery. Only one case would have been detected using the lowest SpO2 measurement over this period. We conclude that fetal SpO2 measurements during labor are of poor diagnostic value, with a disappointing feasibility and therefore are not ready for implementing into daily clinical practice.