RESUMO
PURPOSE: To determine the effectiveness, safety, and participant satisfaction with endometrial ablation by bipolar energy (NovaSure®) in the treatment of heavy menstrual bleeding (HMB), and to investigate factors associated with poorer outcomes. METHODS: Multicenter retrospective observational study based on medical record review of the outcomes related to endometrial ablation by the bipolar-energy technique procedure to treat HMB in the setting of three university teaching hospitals in Spain. RESULTS: A total of 333 women were included in the study. Most bipolar-energy ablations were successful (85.12%; n = 269 out of 316), with amenorrhea the most frequent outcome (39.6%, n = 131 out of 316). The majority of participants had no complications (95.5%; n = 317 out of 332), and of those who did, only 2.1% were related to the technique. No further treatment was required for HMB in 82.8% of women (n = 274 out of 331), and surgery was avoided in 91.8%; only 5.9% of women underwent ablation-related hysterectomy. In women with previous transverse cesarean sections (CS), 91.0% avoided subsequent surgical treatment. Eighty-six percent of women (n = 221 out of 257) were satisfied with the procedure. CONCLUSION: Bipolar-energy ablation is very effective and safe for the treatment of HMB and yielded a high rate of participant satisfaction in our setting. The presence of comorbidities or previous CS may slightly reduce the effectiveness of the method, while performing concomitant surgery (mainly curettage) increases the rate of complications. Notably, despite the known increased risk of hysterectomy, most participants with previous CSs who underwent ablation avoided major surgery.
RESUMO
INTRODUCTION: The aim of this study was to test the hypothesis that transperineal ultrasound can be used to decide whether to admit a pregnant woman due to labor. MATERIAL AND METHODS: In this analytical cross-sectional observational study, transperineal ultrasound was performed on pregnant women with intact membranes who came to the hospital due to contractions. A decision was made to admit women due to labor based on the ultrasound measurements. The ultrasound measurements were used to determine cervical dilation, the angle of progression, and fetal head position. The managing midwives were blinded to the results and made the final decision to admit the women based on digital vaginal examination. RESULTS: It was possible to decide whether a woman had to be admitted for delivery or discharged due to the latent phase of labor according to the ultrasound examination in 55 of the 57 cases (96.5%). In four of the 55 cases, the decision based on ultrasound differed from the midwife's decision (7.3%). There was strong agreement between the decision to admit the pregnant women based on ultrasound measurements and the digital vaginal examination (Cohen's kappa: 0.844). It was possible to measure cervical dilation with ultrasound in 52 of the 57 cases (91.2%). The intraclass correlation coefficient for the cervical dilation measurements was 0.736 (95% confidence interval 0.539-0.848). CONCLUSIONS: There was strong agreement between the ultrasound and digital vaginal examination results in the decision to admit singleton pregnant women at term due to labor. A large number of vaginal examinations could be avoided by using intrapartum ultrasound.