Post procedural pregnancy occurrence risk after endometrial ablation.

OBJECTIVE: The objective of the study was to analyse the pregnancy rate after curettage, 1G (Endometrial resection) and 2G (Endometrial ablation) procedures in women with abnormal uterine bleeding (AUB-O,E,N) to evaluate the rate of pregnancy following these procedures and to improve pre and post-therapeutic women information. METHODS: This retrospective study analyzed data extracted from the French Hospital medical information database. All hospital stays with a diagnostic code for AUB and an appropriate surgical procedure coded between 2009 and 2015 were identified. A total of 109,884 women were included. Of these, 88,165 were followed up for 18 months, 80,054 for 24 months and 33,251 for 60 months. Outcomes were compared between second generation (2G) procedures, first-generation (1G) procedures (endometrial resection) and curettage. The rate of pregnancy was the primary end point. RESULTS: 7863 women underwent a 2G surgical procedure (7.2%), 39,935 a 1G procedure (36.3%) and 38,923 a curettage (35.4%). The mean age of the women was 46 years (IC.95: 36.7-52.5), with no difference in age between groups. The rate of pregnancy after 2G, 1G and curettage was respectively 13 (1.5%), 617 (10.1%) and 1025 (11.1%). The primary endpoint was significantly different between 2G and 1G and curettage (p<0.0001) CONCLUSION: 2G procedures result in lower risk of pregnancy without requiring specific training for surgeons. However, endometrial ablation cannot be considered as a sterilization method nor an effective contraceptive procedure. In the absence of sterilization of either partner, women should continue to use contraception whatever their age and menstrual status.

The surgical treatment of idiopathic abnormal uterine bleeding: An analysis of 88 000 patients from the French exhaustive national hospital discharge database from 2009 to 2015.

OBJECTIVE: The objective of the study was to compare success rates, complications and management costs of different surgical techniques for abnormal uterine bleeding (AUB). METHODS: This was a retrospective analysis of the French national hospital discharge database. All hospital stays with a diagnostic code for AUB and an appropriate surgical procedure code between 2009 and 2015 inclusive were identified, concerning 109,884 women overall. Outcomes were compared between second generation procedures (2G surgery), first-generation procedures (1G surgery), curettage and hysterectomy. Clinical outcomes were treatment failure and complications during the follow-up period. Costs were attributed using standard French hospital tariffs. RESULTS: 7,863 women underwent a 2G procedure (7.2%), 39,935 a 1G procedure, (36.3%), 38,923 curettage (35.4%) and 23,163 hysterectomy (21.1%). Failure rates at 18 months were 9.9% for 2G surgery, 12.7% for 1G surgery, 20.6% for curettage and 2.8% for hysterectomy. Complication rates at 18 months were 1.9% for 2G surgery, 1.5% for 1G surgery, 1.4% for curettage and 5.3% for hysterectomy. Median 18-month costs were € 1 173 for 2G surgery, € 1 059 for 1G surgery, € 782 for curettage and € 3 090 for hysterectomy. CONCLUSION: Curettage has the highest failure rate. Hysterectomy has the lowest failure rate but the highest complication rate and is also the most expensive. Despite good clinical outcomes and relatively low cost, 1G and 2G procedures are not widely used. Current guidelines for treatment of AUB are not respected, the recommended 2G procedures being only used in <10% of cases.

Successful pregnancy after thermal balloon endometrial ablation followed by in vitro fertilization and embryo transfer.

OBJECTIVE: To describe a case of successful pregnancy after IVF-ET in a patient with previous thermal ablation of the endometrium by uterine balloon therapy (UBT). DESIGN: Case report. SETTING: University hospital. PATIENT(S): Polymorbid patient who received UBT and became pregnant after IVF-ET. INTERVENTION(S): UBT, IVF-ET, and caesarean section. RESULT(S): After UBT, the patient underwent IVF-ET and gave birth to a healthy newborn at 36 weeks' gestation with a birth weight 2900 g and placenta accreta. CONCLUSION(S): Patients who wish to become pregnant after endometrial ablation should undergo preconception consultation and hysteroscopic examination.

Minimally invasive and hysteroscopic diagnosis and treatment of patients after organ transplantation.

AIM: To assess the safety of minimally invasive and hysteroscopic diagnosis and treatment of abnormal uterine bleeding and intrauterine abnormalities in patients after organ transplantation. METHODS: After kidney, pancreas, or liver transplantation, patients who presented with menorrhagia, submucosal myoma or thickened endometrium on ultrasound were diagnosed and treated using a hysteroscopic system Versascope, Bipolar Resectoscopic System and intrauterine system ThermaChoice. RESULTS: Twenty patients were included in this study and were aged 37-63 years (average +/- standard deviation: 48.8 +/- 5.86). The follow up was between 3 and 122 months (44.8 +/- 31.91). All hysteroscopic procedures were performed under general anesthesia, using local anesthetics (paracervical block) or short-term i.v. anesthesia, plus antibiotics. The procedures lasted 5 to 15 min (9.4 +/- 2.44). Five patients presented with minimal blood loss (< or =100 mL) and the rest had no blood loss. The hysteroscopic procedures had no adverse effects on the function of transplanted organs and there were no associated postoperative complications. Uterine bleeding was successfully regulated in all patients. CONCLUSION: Minimally invasive procedures and hysteroscopy of organ-transplanted patients provide a safe solution for the treatment of menorrhagia, submucosal myoma and thick endometrium in postmenopausal patients.

Thermal balloon ablation in patients with multiple morbidity: 3-year follow-up.

STUDY OBJECTIVE: To evaluate the effectiveness of a thermal uterine balloon therapy system in a specific group of patients with multiple morbidity. DESIGN: Retrospective cohort analysis (Canadian Task Force classification II-2). SETTING: Department of Obstetrics and Gynecology in two university teaching hospitals. PATIENTS: Seventy women with severe systemic disease (American Association of Anesthesiologists physical status score >/= III) and severe menorrhagia. INTERVENTION: Uterine balloon therapy under local anesthesia and 3 years of follow-up. MEASUREMENTS AND MAIN RESULTS: The women had a mean age of 44.3 years (range, 24-76). After treatment, 25.7% of the patients had no bleeding, 45.7% hypomenorrhea, and 21.4% normal menstrual flow. The procedure was repeated successfully for one patient, and five failures (7.1%) were observed. The blood count values differed significantly (p <.001) before and after balloon therapy. CONCLUSION: Uterine balloon therapy is a suitable and useful option for women with severe uterine bleeding and concomitant severe systemic nongynecologic disease.

Expression of angiopoietic factors in normal and type-I diabetes human placenta: a pilot study.

OBJECTIVES: Morphological changes of blood vessel wall have been described in placenta from pregnancies complicated by diabetes mellitus type-I. STUDY DESIGN: We measured mRNA expression of vascular endothelial growth factor (VEGF), angiopoietin 1 and 2 (Ang-1 and Ang-2), their receptors VEGFR-1, VEGFR-2, Tie-2, fibroblast growth factor 2 (FGF-2), and its receptor FGF-2R in placental tissue of diabetes type-I patients, in normal term placenta, and endometrium of non-pregnant women by real time reverse transcriptase PCR. RESULTS: The expression of Ang-2 and VEGFR-1 mRNAs was significantly higher in placenta (P