NovaSure endometrial ablation under local anaesthesia in an outpatient setting: An observational study.

The use of NovaSure under local anaesthesia (LA) has been described as part of efficacy trials, but its use in an outpatient setting has not previously been explored. This prospective study was conducted to determine feasibility and efficacy of NovaSure in the outpatient setting under LA. The study included all women with menorrhagia unresponsive to medical management and were agreeable for treatment under LA (n = 50). The mean duration of procedure was 100 s. A total of 47 (94%) patients were discharged home the same day. Simple analgesics controlled postoperative pain in 44 (88%) patients. Seven (14%) patients gave preference for general anaesthesia for future treatment. The mean pain scores at 30, 60 and 90 min were 4.18, 4.38 and 3.85, respectively on the visual analogue scale. At follow-up, the improvement in menstrual symptoms was seen in 47 (94%) and the satisfaction rate was 43 (86%) and 47 (94%) at 4 and 6 months, respectively.

Knowledge and use of secondary contraception among patients requesting termination of pregnancy.

PIP: The results of a survey of 769 patients attending the St. James's University Fertility Control Clinic, England, for abortion services showed that patients seeing general practitioners were less knowledgeable than those attending specialist clinics. There was a demonstrated need for counseling on pill and condom use and protection against sexually transmitted diseases. Knowledge of postcoital methods was also found to be lacking. The survey was conducted between April 1, 1991, and January 31, 1992. Respondents included minorities such as Afro-Caribbean (8%) and Asian (9%). 307 of the cases were using a less effective form of contraception at the time of conception, usually a change from the pill to condoms. Of the 171 people reporting failure of contraception, 93 noted a split or leaking condom; 13, a condom falling off during intercourse; 32, inconsistent use of condoms;l 32, forgetting to take contraceptive pills or using antibiotics with the pill; and 1, a late injection of medroxyprogesterone acetate. 45 of the 309 people who had conceived while using condoms recognized a potential condom failure, and only 20 attempted any emergency contraceptive method such as the postcoital pill. Only 30% of the 171 patients with recognized condom failure and 12% of the 210 who had not used any contraception had adequate knowledge of the existence, timing, and source of postcoital pills; i.e., 20% of 381. Only 2% of the 171 nd 2% of the 381 patients, had knowledge of postcoital insertion of an intrauterine contraceptive device. Given the choice between and unplanned pregnancy and postcoital contraceptive, most (718 out of 769) preferred using postcoital contraception. Contraceptive information was given to 501 by a general practitioner, to 102 by a community family planning clinic, and 163 had no medical advice. There was a range of knowledge of postcoital contraceptive methods. Knowledge of how to deal with forgotten pills, severe vomiting, severe diarrhea, and concurrent antibiotic treatment among the 422 patients who had ever used the combined pill also was variable. 19% of the 372 patients treated by general practitioners knew 4 correct answers, but 50% of the 50 patients in community family planning clinics answered correctly 4 times. Differences could not be explained by other demographic characteristics.^ieng

Effect of presentation of partogram information on obstetric decision-making.

The way in which medical information is presented may affect doctors' decision-making. We have assessed whether changing the appearance of the same information on the partogram affects clinical decisions during labour. Sixteen junior obstetricians were asked about how they would manage six hypothetical cases of difficult labour. Information was given by partogram, in which we varied either the relative scales of the x and y axes or whether the latent phase of labour had been included. Doctors were more likely to intervene and to intervene more actively if the progress of labour curve appeared flat and if the latent phase was included. The shape and point of origin of the partogram probably influence intervention rates in practice and may partly explain the low rates of caesarean section in some hospitals.

Fetal movements; factors affecting their perception.

We prospectively recorded placental site, maternal weight and parity in 182 patients reporting decreased fetal movements and compared these with controls. Reports of decreased fetal movements were 2.10 times (95% CI 1.51-2.92) as likely in association with an anterior placenta and 1.81 times (95% CI 1.20-2.93) and 2.61 times (95% CI 1.26-5.40) as likely in mothers weighing over 80 and 90 kg, respectively, but there was no association with parity. Decreased perception of fetal movements is more likely to have serious implications in thin women with a posterior placenta. Our findings also suggest that the sensation of fetal movements arises from pressure against body wall structures rather than the uterus or peritoneum.

Clinical experience with the triple test for Down's syndrome screening.

The introduction of maternal serological screening for chromosome disorders in pregnancy in women aged over 30 years at the estimated date of delivery was monitored in two hospitals. The test used involved measurement of three substances in maternal serum combined with maternal age (the triple test). This is the first report of such screening applied to an unselected antenatal clinic population. Test uptake was high but there was no overall increase in amniocentesis numbers because the increase in younger mothers was compensated for by a decrease in older women who previously, without serological testing, might have gone directly to amniocentesis. It is anticipated that widespread introduction of such testing will lead to improved detection of Down's syndrome as predicted from retrospective studies.