A Randomized Trial of Endometrial Scratching before In Vitro Fertilization.

BACKGROUND: Endometrial scratching (with the use of a pipelle biopsy) is a technique proposed to facilitate embryo implantation and increase the probability of pregnancy in women undergoing in vitro fertilization (IVF). METHODS: We conducted a pragmatic, multicenter, open-label, randomized, controlled trial. Eligible women were undergoing IVF (fresh-embryo or frozen-embryo transfer), with no recent exposure to disruptive intrauterine instrumentation (e.g., hysteroscopy). Participants were randomly assigned in a 1:1 ratio to either endometrial scratching (by pipelle biopsy between day 3 of the cycle preceding the embryo-transfer cycle and day 3 of the embryo-transfer cycle) or no intervention. The primary outcome was live birth. RESULTS: A total of 1364 women underwent randomization. The frequency of live birth was 180 of 690 women (26.1%) in the endometrial-scratch group and 176 of 674 women (26.1%) in the control group (adjusted odds ratio, 1.00; 95% confidence interval, 0.78 to 1.27). There were no significant between-group differences in the rates of ongoing pregnancy, clinical pregnancy, multiple pregnancy, ectopic pregnancy, or miscarriage. The median score for pain from endometrial scratching (on a scale of 0 to 10, with higher scores indicating worse pain) was 3.5 (interquartile range, 1.9 to 6.0). CONCLUSIONS: Endometrial scratching did not result in a higher rate of live birth than no intervention among women undergoing IVF. (Funded by the University of Auckland and others; PIP Australian New Zealand Clinical Trials Registry number, ACTRN12614000626662 .).

Gestational diabetes: development of an early risk prediction tool to facilitate opportunities for prevention.

BACKGROUND AND AIM: In the setting of advancing maternal age, escalating obesity and increasing Gestational Diabetes Mellitus (GDM) rates, we aimed to develop a novel risk prediction tool to identify high-risk women in early pregnancy, specifically to facilitate targeted antenatal prevention of GDM. METHODS: In this retrospective, observational study, first-trimester data collected routinely by midwifery staff in 4276 women attending a large tertiary hospital in 2007/2008 was analysed to examine predictive factors for GDM. GDM was diagnosed with a 28-week oral glucose tolerance test. The data set included a derivation group (n=2880, from 2007 deliveries) and a validation group (n = 1396, from 2008). Multivariate analysis generated a scoring system. RESULTS: GDM was significantly correlated with a number of factors: past history of GDM, increasing maternal age and body mass index, Asian descent and family history of diabetes. Validation group clinical scores achieved a sensitivity of 61.3% and specificity of 71.4% for differentiating women according to their risk of developing GDM. CONCLUSIONS: Risk factors for GDM are easily identified at the first-trimester midwifery hospital booking visit. A risk prediction tool, derived from risk factors in early pregnancy, identifies women at high risk of GDM. This represents a novel approach to facilitate targeted early intervention with the potential to prevent development of, or ameliorate, GDM.

Risk factors for gestational diabetes mellitus: implications for the application of screening guidelines.

BACKGROUND: Recent evidence has shown the importance of ensuring that all pregnancies with gestational diabetes mellitus (GDM) are identified and managed appropriately. However, there remains a lack of consensus as to how to best identify these women. AIM: To review risk profiles of women with GDM and to evaluate international GDM screening recommendations. METHODS: A retrospective observational study was carried out at a tertiary referral hospital (Monash Medical Centre, Victoria). Data of singleton pregnancies in women (without pre-existing diabetes mellitus) giving birth in 2007 from the Birthing Outcomes System were analysed and the performance of the British National Institute for Health and Clinical Excellence (NICE), the American Diabetes Association (ADA) and the Australasian Diabetes in Pregnancy Society (ADIPS) GDM selective screening guidelines were evaluated. Predictors of GDM were identified with logistic regression, and sensitivity and specificity of international screening guidelines were calculated. RESULTS: The strongest independent risk factors for GDM were a past history of GDM (OR = 10.7; 95% CI: 5.4-21.1), maternal age ≥40 years (OR 7.0; 95% CI 2.9-17.2) and BMI ≥35 kg/m(2) (OR 6.1; 95% CI 3.0-12.1). The sensitivity and specificity of the NICE, ADA and ADIPS guidelines were 92.7% and 32.4%, 100% and 3.9% and 98.6% and 13.7%, respectively. CONCLUSIONS: Increasing age and BMI and previous GDM were the most significant risk factors for GDM. Current selective screening guidelines have high sensitivity but low specificity and offer little over universal screening.

Cutaneous endometriosis--Surgical presentations of a gynaecological condition.

Endometriosis is a common gynaecological condition; cutaneous endometriosis is a subtype of endometriosis. Although cutaneous endometriosis involving the abdominal wall is not common, preoperative diagnosis of cutaneous endometriosis can be easily mistaken for a suture granuloma, lipoma, abscess, cyst or hernia. We report two common surgical presentations of this gynaecological condition.