The use of different size-hysteroscope in office hysteroscopy: our experience.

PURPOSE: To evaluate the successful rate and patient acceptance of different-sized hysteroscope in office hysteroscopy. METHODS: We retrospectively evaluated 900 office hysteroscopy performed in ambulatory setting using three different hysteroscopes: 5 mm Hamou II (n = 300), 5 mm Bettocchi (n = 300) and 4 mm Bettocchi (n = 300). Endpoints of our study were the successful rate of hysteroscopy, the eventual side effects/complication and the pain intensity experience from the patients using visual analog scale (VAS). RESULTS: Use of 4 mm Bettocchi leads to a higher rate of successfully performed hysteroscopy (99%, n = 297) and statistically significant when compared to the 5 mm Hamou (95%, n = 285) and to the 5 mm Bettocchi (96%, n = 288) (4 mm Bettocchi vs. 5 mm Bettocchi p < 0.05; 4 mm Bettocchi vs. 5 mm Hamou II p < 0,001; 5 mm Bettocchi vs. 5 mm Hamou II ns). Moreover, the VAS score was higher using 5 mm Hamou II (5.72 ± 1.99) and statistically significant when compared to the 4 mm Bettocchi (3.06 ± 2.14) and to the 5 mm Bettocchi (4.27 ± 1.88) (A vs. B p < 0.05; A vs. C p < 0.001; B vs. C p < 0.001). CONCLUSIONS: Our result suggests that the hysteroscope size plays a pivotal role in the acceptance and for the success of office hysteroscopy.

Is myomectomy always the best choice for infertile women with symptomatic uterine fibroids?

Uterine artery embolization (UAE) is still regarded by most gynaecologists as contraindicated for women with symptomatic fibroids and otherwise unexplained infertility. For such patients, myomectomy is the usual option. We performed UAE as treatment of menorrhagia in an infertile woman with multiple subserosal and intramural fibroids who had previously failed multiple myomectomy. UAE resulted in durable symptom relief and substantial reduction of the uterine and fibroid size. The patient conceived spontaneously 20 months after UAE and progressed through pregnancy uneventfully. At 38 weeks of gestation, she underwent elective cesarean section and delivered a normal, healthy, 3180-g fetus without complications. The present case demonstrates that in symptomatic women with multiple subserosal and intramural fibroids and otherwise unexplained infertility, UAE may have symptomatic and reproductive outcomes superior to those of myomectomy.

Antibiotics Prophylaxis for Operative Hysteroscopy.

OBJECTIVE: To evaluate the incidence of infectious complications and effect of prophylactic antibiotic administration during operative hysteroscopic procedures. METHODS: A multicentric randomized controlled trial was conducted between January 2012 and December 2013. Women (n = 180) affected by endometrial hyperplasia, myomas, or endometrial polyps undergoing operative hysteroscopy were randomized to receive cefazolin 2 g intravenously 30 minutes prior to the procedure (n = 91) and no treatment (n = 89). RESULTS: No statistical difference in terms of postoperative fever (2.4% vs 2.3%, P = .99), endometritis (0% vs 0%), pain (6.0% vs 10.4%, P = .40), cervicitis-vaginitis (0% vs 0%), pelvic abscess (0% vs 0%), pelvic inflammatory disease (0% vs 0%), and bleeding (0% vs 0%) was noticed. No statistical difference in terms of side effects attributable to antibiotic prophylaxis such as allergy (0% vs 4.8%, P = .12), nausea (10.7% vs 17.4%, P = .27), vomiting (3.6% vs 4.6%, P = .99), diarrhea (4.8% vs 5.4%, P = .99), cephalea (9.5% vs 3.5%, P = .13), dizziness (4.8% vs 2.3%, P = .44), and meteorism (5.4% vs 3.4%, P = .99) was noticed. CONCLUSION: The results of the current study support the recommendation not to prescribe routine antibiotic prophylaxis prior to operative hysteroscopy.

Inflammosome in the human endometrium: further step in the evaluation of the "maternal side".

OBJECTIVE: To investigate the expression of inflammosome components (NALP-3, associated speck-like protein containing a CARD [ASC]) and their activation (caspase-1, interleukin [IL]-1ß, and IL-18 secretion) in the human endometrium from fertile and women with history of recurrent pregnancy loss (RPL). DESIGN: Experimental study. SETTING: University hospital. PATIENT(S): Ten fertile women (control group [CTR]) and 30 women with RPL. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Endometrial samples were collected by hysteroscopy during the putative window of implantation and evaluated for chronic endometrial inflammation by hystopathological analysis. Inflammosome expression was analysed by immunohystochemical staining (27 RPL and 10 CTR women). The expression of NALP-3 and ASC protein was quantified by Western blot (30 RPL and 10 CTR women). Caspase-1 activation and IL-1ß and IL-18 secretion was quantified by ELISA (30 RPL and 10 CTR women). RESULT(S): We observed a significantly increased expression of inflammasome NALP-3 and ASC protein, an increased activation of caspase-1, and increased levels of IL-1ß and IL-18 in RPL endometrium compared with CTR. CONCLUSION(S): Abnormal activation of endometrial innate immunity by means of inflammosome, stimulated by pathogen- or damage-associated molecular patterns, may represent an additional mechanism, currently not investigated, negatively interfering with endometrial receptivity. More studies are required [1] to identify the primary trigger of endometrial inflammosome activation and its clinical impact in the occurrence of RPL; and [2] to validate the inflammosome components as a novel family of endometrial biomarkers and promising therapeutic targets in RPL.