Pain experienced using two different methods of endometrial biopsy: a randomized controlled trial.

OBJECTIVE: To compare patient-reported pain, provider- reported ease of use, and tissue sampling adequacy between endometrial biopsy instruments. METHODS: Women presenting for endometrial biopsy were randomized to either Pipelle or Explora curette. The primary outcome was patient-reported pain with biopsy as measured by a 100-mm visual analog scale. Secondary outcomes included the adequacy of biopsy sample and provider-reported ease of instrument use. RESULTS: Groups were similar in respect to age, parity, ethnicity, level of dysmenorrhea, menopausal status, and biopsy indication. The most common indication for biopsy was abnormal uterine bleeding. Subject reported pain with biopsy was similar between groups (Pipelle, 6.21 ± 2.41 cm; Explora, 6.91 ± 2.88 cm; P=.14), as was provider-reported ease of use. Although procedure length was significantly shorter for patients in the Pipelle group (4.05 ± 1.48 minutes compared with 5.27 ± 2.53 minutes; P=.007), 38% of Pipelle procedures required two or more passes to obtain a sample compared with only 9% using the Explora (P=.004). The Explora group had a higher proportion of adequate samples (97% compared with 91%; P=.33). CONCLUSION: Women's pain during endometrial biopsy does not differ by type of biopsy instrument used. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov NCT00613925.

Using the Brink score to predict postpartum anal incontinence.

OBJECTIVE: To evaluate whether antepartum pelvic floor muscle strength, as measured by the Brink scale, predicts postpartum anal incontinence. STUDY DESIGN: This prospective cohort study of primigravid women used validated questionnaires and standardized pelvic examinations to evaluate subjects during the third trimester and at 2 postpartum time points. RESULTS: Of the initial 129 subjects, 102 and 81 completed 2 week and 6 month postpartum visits. 35% had cesarean deliveries. The antepartum prevalence of fecal incontinence (14%) did not differ significantly from the postpartum (17% at 2 weeks, 11% at 6 months). However, the prevalence of flatal incontinence fell from antepartum (65%) to postpartum (47% at 2 weeks, P = .001; 49% at 6 months, P = .012). Mean Brink score decreased postpartum; no correlations were found between Brink score and questionnaire scores. CONCLUSION: Anal incontinence symptoms are common in the third trimester of a first pregnancy and may regress or resolve after delivery. Brink score did not predict postpartum anal incontinence.