1. Vaginal breech birth--the phoenix arising from the ashes.

Vaginal breech birth all but disappeared from UK maternity units after the publication of the Term Breech Trial (Hannah et al 2000). However, mounting evidence does not support caesarean section as the safest mode of birth for the baby or the mother when the baby is presenting breech. But the intervening years have depleted the attending professional's skills. We describe our personal journey to regaining them, learning better ones and introducing safe choice for women. This article is the first in a series which examines the practice and evidence base for the care of women and babies aspiring to experience a safe breech birth.

Patient satisfaction with outpatient hysteroscopy performed by nurse hysteroscopists.

OBJECTIVE: To investigate the effect of the introduction of nurse hysteroscopists on patient satisfaction at an outpatient hysteroscopy clinic in the United Kingdom. METHODS: Satisfaction with outpatient hysteroscopy performed in a University Teaching Hospital was measured using an anonymous structured questionnaire in 2000 and 2005. The unpaired t test, Mann-Whitney U test, or chi(2) test was used depending on the level of measurement. RESULTS: A total of 102 women surveyed in 2005 were compared with 139 women surveyed in 2000. Age, ethnicity, perceived health status, previous satisfaction with outpatient appointments, and expectations of the appointment did not differ between the groups. Waiting time for an appointment and once at the clinic fell during the study period (P<0.001); satisfaction increased with the former (P<0.001), but not the latter (P=0.25). Satisfaction with the professional skills of healthcare providers and overall satisfaction was 95% or greater in both years. CONCLUSION: High levels of patient satisfaction with outpatient hysteroscopy were maintained after the introduction of nurse hysteroscopists.

An in vitro uterine perfusion model for investigating endometrial cryoablation.

STUDY OBJECTIVES: To build a simple in vitro uterine perfusion model for investigating the clinical effectiveness of endometrial ablation. DESIGN: Comparative laboratory and in vivo study (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: Women undergoing hysterectomy for menorrhagia with uteri of normal shape and size. INTERVENTIONS: A single 5-minute freeze, followed by an active thaw was applied to the endometrial cavity of uteri in vivo and in the in vitro perfusion model. MEASUREMENTS AND MAIN RESULTS: Endometrial/myometrial temperature change was measured continuously during the cryosurgical procedure. Depth of cell death was measured using nicotinamide adenine dinucleotide diaphorase enzyme assay. There was no significant difference in temperature change and depth of cell death in endometrial/myometrial tissue between in vivo and in vitro perfusion experiments. CONCLUSIONS: The in vitro perfusion model described is a useful tool for investigating endometrial cryoablation and has potential for investigating and developing other intrauterine surgical modalities.

Susceptibility of uterine myomas and endometrium to cryosurgery using a carbon dioxide cryosurgical probe in vitro.

STUDY OBJECTIVE: To determine the effect of a 9-mm diameter carbon dioxide cryoprobe, the Endocryo, on myomas and endometrial/myometrial tissue in vitro. DESIGN: Comparative laboratory study (Canadian Task Force classification II-2). SETTING: University laboratory. PATIENTS: Women with and without myomas, undergoing hysterectomy. INTERVENTION: A single 5-minute freeze followed by an active thaw was applied to uterine myomas and endometrial/myometrial tissue in vitro. MEASUREMENTS AND MAIN RESULTS: Endometrial/myometrial and uterine myoma temperature change was measured continuously during the cryosurgical procedure. Depth of cell death was measured using nicotinamide adenine dinucleotide diaphorase enzyme assay. There was no significant difference in temperature change and depth of cell death between myomas and endometrial/myometrial tissue in vitro. CONCLUSIONS: The Endocryo produces the same cryosurgical effect on both uterine myomas and endometrial/myometrial tissue in vitro, an important principal for future development of a clinically effective cryosurgical device for the treatment of menorrhagia in the presence of submucous myomas.