Early pregnancy failure as a training tool for chorionic villus sampling.

OBJECTIVES: The goal of this study is to evaluate the success of a training program in chorionic villus sampling (CVS) of early pregnancy failure (EPF) for maternal-fetal medicine (MFM) fellows. METHODS: We conducted a retrospective review of a new training program in CVS for MFM fellows. Women with EPF up to 13 weeks estimated gestational age were offered inclusion in our program and counseled on alternatives. Transcervical CVS was performed for both fellow education and cytogenetic diagnosis. The primary outcome was a successful diagnosis, and the secondary outcome was cell growth by fellow experience. RESULTS: Thirty-nine patients diagnosed with EPF from December 2011 to March 2013 underwent CVS. Villi obtained via CVS yielded a diagnosis in 62% of cases. CVS samples with successful karyotype had more villi but were otherwise similar. CVS by experience showed a trend towards increased success and villi volume after the first five procedures. Abnormal results were obtained in 72% of cases, 15% of which led to changes in care. CONCLUSION: CVS of EPF is an option for the training of MFM fellows as it was acceptable to most patients, and the majority of CVS specimens yielded a karyotype diagnosis.

Novasure as a mechanical endometrial preparation agent in large uteri.

OBJECTIVE: We evaluated Novasure ablation as a mechanical endometrial preparation agent before Roller Ball endometrial ablation in lieu of GnRH agonists in large uteri. METHODS: A retrospective chart review of 20 consecutive patients undergoing Novasure ablation for mechanical endometrial preparation before Roller Ball ablation (RBNovasure group) was conducted and the results compared to that of 23 consecutive patients who received GnRH agonist (Leuprolide acetate) as a medical endometrial preparation before Roller Ball ablation (RB-Lupron group). The postoperative follow-up time frame was divided into immediate (3 mo), intermediate (3 to 12 mo) and long-term (12 to 32 mo). Rates of amenorrhea, heavy bleeding, cramping, and failure (repeat ablation or hysterectomy for heavy bleeding or persistent pain) were compared between the 2 groups. RESULTS: The mean rates of amenorrhea for the patients not lost to follow-up at 3 mo, 3 to 12 mo, and 12 to 32 mo visits were 45.5%, 58.8%, and 44.4% for the RB-Lupron group, and 80%, 86.7%, and 100% for the RB-Novasure group (P = .02, P = .08, and P = .02). Failure rates were 4.8%, 6.2%, and 55.6% for the RB-Lupron group; and 0 (0/20), 12.5% (2/16) and 0 (0/8) for the RB-Novasure group (P = .51, P = .50, and P = .02). The RB-Novasure group had a significantly lower rate of heavy bleeding and cramping. 86.4%, 58.8%, and 33.3% patients reported satisfaction with their treatment in the RB-Lupron group and 100%, 87.5%, and 75% in RB-Novasure group (P = .13, P = .07, and P = .11). CONCLUSION: Novasure ablation, for mechanical endometrial preparation before Roller Ball ablation, appears to be a superior alternative to medical preparation with GnRH agonists in patients with large uteri.