Pain experience during transvaginal aspiration of immature oocytes.

BACKGROUND: We wanted to determine the pain conception prior to, during, and after transvaginal recovery of immature oocytes for in vitro maturation (IVM). MATERIAL AND METHODS: Fifty women received 1 g Paracetamol and 0.125 mg Halcion as preanalgesics. During the oocyte pick-up para-cervical blockage (PCB) with 5 ml Citanest x2 was given, in addition to 1.5-2 ml Raphiphene intravenously. The pain was measured by using a visual analog scale (VAS). The expected pain was recorded just before the oocyte pick-up. Right after the oocyte pick-up the actual pain was measured and again 1/2 hour, and 1-11/2 hour later. Furthermore, the pain was recorded every second hour after discharge and every third hour the next day. RESULTS: Forty-three women experienced less pain than expected (p=0.003). The pain conception was correlated to the number of punctures through the vagina (p=0.012). Fifteen patients received analgesics postoperatively, and all patients were discharged less than 2 hours after the procedure without complaints. None noted any discomfort or pain after 30 hours following the oocyte pick-up. CONCLUSION: Although the IVM oocyte pick-up procedure involved puncture of very small follicles that required numerous punctures through the vagina, the experienced pain was significantly less than the expected pain, and the procedure was well accepted.

Pelvic inflammatory disease: a review with emphasis on antimicrobial therapy.

Pelvic inflammatory disease accounts for 5%-20% of hospital admissions for gynecologic problems and is associated with health care costs of more than 1 billion dollars annually. This article reviews the epidemiology, polymicrobial etiology, and diagnosis of this disease state. Special consideration is given to in vivo and in vitro studies of antimicrobial therapy, including both established regimens and expanded-spectrum beta-lactam antibiotics. The adjunctive modalities reviewed include treatment of sexual contacts, removal of intrauterine devices, use of alternative contraceptive methods associated with a reduced risk of disease, and surgery. Although understanding of pelvic inflammatory disease has increased markedly, investigation of its various aspects is both necessary and ongoing. In particular, well-designed, controlled, comparative clinical trials of new treatment regimens must be performed to verify a true advantage of these therapies.

PIP: This state-of-the-art review focuses on the epidemiology, etiology, diagnosis, and treatment of pelvic inflammatory disease (PID). 5-20% of hospital admissions for gynecologic problems are secondary to PID; the condition itself is associated with health care costs of about $1.25 billion each year in the US. Special consideration is given in this article to in vivo and in vitro studies of antimicrobial therapy, including both established regimens and expanded spectrum beta-lactam antibiotics. Early treatment of PID can reduce the effects of the infection on the fallopian tubes; however, microbe-related inflammation and tubal necrosis can precede the manifestation of symptoms, especially in cases where Chlamydia is the infecting agent. The 2nd-generation cephalosporins seem to offer advantages in the treatment of PID because of an expanded spectrum that includes many of the major pathogens. In vitro tests have demonstrated considerable activity against penicillinase-producing strains of N gonorrhoeae resistant to both penicillin and 1st-generation cephalosporins. Cefoxitin is currently considered the most attractive such cephalosporin and has shown cure rates of 95-100% in the treatment of uncomplicated gonorrhea. Also reviewed in this article are adjunctive methods of treatment, including treatment of sexual contacts, removal of IUDs, use of alternate methods of contraception associated with a reduced risk of disease and surgery. Oral contraceptives are the logical alternative when a switch in contraception is indicated given the lower risk of PID incidence and severity, infertility, and ectopic pregnancy in pill users. There remains a need for well-designed, prospective, comparative studies of new treatment regimens.