Feasibility of resectoscopic operative hysteroscopy in a UK outpatient clinic using local anesthetic and traditional reusable equipment, with patient experiences and comparative cost analysis.

STUDY OBJECTIVE: To assess procedural success, patient acceptability, and cost-saving potential of operative hysteroscopy using conventional equipment and local anesthetic in an outpatient clinic. DESIGN: Feasibility study/service evaluation (Canadian Task Force classification II-3). SETTING: Outpatient (office) clinic in a large UK teaching hospital. PATIENTS: One hundred eighteen women with diagnosed or suspected intrauterine myomas or polyps. INTERVENTIONS: Operative hysteroscopy (122 monopolar resection procedures using 8- or 10-mm diameter rigid resectoscopes with glycine solution for uterine irrigation) with the patient under local anesthesia in an outpatient (office) clinic. MEASUREMENTS AND MAIN RESULTS: Procedural success, duration of procedure, pathologic measurements, glycine irrigant deficit, patient pain scores and satisfaction, and comparative costs were recorded. Success of outpatient procedures was 90% (110 of 122 attempted), with a significantly reduced median procedure duration compared with a surgical setting using local (-7 minutes; p = .009) or general (-12.5 minutes; p < .001) anesthetic. Glycine irrigant absorption was low (median deficit, 0 mL), and no deficit was observed in 81% of patients. Mean (SD) estimated disease volume was comparable to that of hysteroscopic resection procedures in a surgical setting (3.38 [5.09] cm(3)), and weight was 1.8 (1.84) g. Patients tolerated the procedure well and reported low pain scores (highest median periprocedure pain measurement was 1.25 of 10), and 7-day follow-up satisfaction responses were positive. Retrospective cost analysis demonstrated that operative resection in an outpatient clinic was less expensive than in a surgical setting using general anesthetic (-$1003) or local anaesthetic (-$234). Reduced staff costs were the primary reason for this saving. CONCLUSIONS: Operative hysteroscopic resection of myomas and polyps is feasible and well tolerated by patients in an outpatient/office setting using local anaesthetic and conventional equipment. The outpatient procedure is less expensive and its duration is shorter than in a surgical setting.

Second trimester amniotic fluid endothelin-1 concentrations and subsequent development of intrauterine growth restriction.

OBJECTIVE: The purpose of this prospective study was to record endothelin-1 (ET-1) concentrations in the second trimester amniotic fluid and compare these values in women who developed intrauterine growth restriction (IUGR) later in pregnancy with those with uneventful pregnancies. METHOD: Amniotic fluid was retrieved by amniocentesis from 125 women in the second trimester of pregnancy. The levels of ET1 were measured by a sensitive and specific radioimmunoassay. RESULTS: From the 125 women included in the study 12 had pregnancies that later developed IUGR and 88 had uneventful pregnancies. The ET1 concentration was significantly higher (P<0.005) in women who later developed IUGR than in normal pregnancy (106 pg/ml versus 64.7 pg/ml). CONCLUSION: The amniotic fluid concentration of ET1 is elevated by the second trimester in women who later develop IUGR.

Perifollicular blood flow and pregnancy in superovulated intrauterine insemination (IUI) cycles: an observational comparison of recombinant follicle-stimulating hormone (FSH) and urinary gonadotropins.

The group of patients who received urinary gonadotropins (n = 117) for follicular stimulation had a significantly higher incidence of high perifollicular blood flow compared with that of the group who received recombinant FSH (n = 114; 46.3% vs. 22.7%). The overall clinical pregnancy rate in patients stimulated with recombinant FSH was 10.91%, compared with 22.22% in the group stimulated with urinary gonadotropins.

Induction to delivery time interval in patients with and without preeclampsia: a retrospective analysis.

BACKGROUND: Anecdotally, it is suggested that patients with preeclampsia have a shorter induction to delivery interval than patients without preeclampsia, despite there being no good objective evidence. METHODS: A retrospective analysis of 136 primiparous, singleton, cephalic, nonassisted vaginal deliveries between January 1997 and January 2000. Sixty-eight women had induction of labor for preeclampsia and 68 women without preeclampsia had induction of labor for other reasons. The two groups were already case-matched for maternal and gestational age. The following details were recorded from the case notes: maternal age, gestation at delivery, initial Bishop score, total dose of prostaglandin administered, induction to delivery interval, duration of second-stage labor, birthweight, and the percentage of Apgar scores < 7 at 5 min. Statistical analysis was carried out with a Mann-Whitney U-test, with the aid of SPSS version 9, Microsoft Windows RESULTS: The women with preeclampsia had a statistically significant longer induction to delivery interval than those without preeclampsia. The mean induction to delivery interval of women with and without preeclampsia was 1049.5 min and 762.5 min, respectively (p < 0.001) CONCLUSION: Women with preeclampsia had a longer induction to delivery interval than patients without preeclampsia. This fact must be considered when deciding upon the mode of delivery in preeclamptic patients.

Fluid within the endometrial cavity in an IVF cycle--a novel approach to its management.

Fluid within the endometrial cavity before embryo transfer in IVF cycles is associated with failure of implantation. The etiology of endometrial fluid is surrounded in controversy but it is associated with hydrosalpinges, polycystic ovarian disease, and subclinical uterine infections. The current treatment consists of postponing embryo transfer. This of course has biological and psychological disadvantages; a decreased implantation rate from frozen embryo transfer, and frustration and disappointment for the couple. Removing the fluid with an embryo transfer catheter immediately before embryo transfer may be a successful method of treatment.