Outcomes of surgical hysteroscopy: 25 years of observational study.

The aim of this prospective study was to analyse the complications of operative hysteroscopy over the last 25 years and determine whether such complications were related to patient characteristics, surgery type, surgical time or distension-medium balance. Three thousand and sixty-three operative hysteroscopies were performed; 52.7% were polypectomies and 31.5% were myomectomies. Myectomies had the highest incidence of complications, at 14%, followed by septolysis, at 6.9%. The most common complications were mechanical (52%). Myomectomies had seven times higher risk than polypectomies of distension-medium complications (RR 7.5, p<.001) but three times lower risk of mechanical complications (RR 0.32, p<.001). The highest incidence of complications occurred in type I myomas and those larger than 3 cm. If we define fluid-balance complications as only those patients who absorbed more than 1.5 L and developed related symptoms, our overall complication rate, including all mechanical complications, was 5.6%.Impact StatementWhat is already known on this subject? In recent years, the importance of properly preventing and managing hysteroscopic complications has risen in line with the number of diagnostic and operative hysteroscopies performed. Complications in operative hysteroscopy differ between surgery types, patient characteristics and the distending media used.What do the results of this study add? This study provides data from a high number of patients compared to previously published studies on the complications of operative hysteroscopies, and includes a study of the relationship between type of surgery and type of complication.What are the implications of these findings for clinical practice and/or further research? Our study shows the importance of a good preoperative assessment, since the complications of hysteroscopy differ greatly depending on the indication. Thus, within myomectomies, knowing the exact type, size and location of the myoma will allow the surgeon to carefully plan the procedure to avoid complications.

Resultados obstétricos y perinatales en gestaciones tras técnicas de reproducción asistida / Obstetrical and perinatal outcomes in pregnancies after assisted reproductive techniques

Material y Métodos: estudio observacional retrospectivo que compara 704 gestaciones conseguidas tras técnicas de reproducción asistida en el periodo 2008-2012 (grupo estudio), con 2.507 gestaciones espontaneas (grupo control). Resultados: mayor riesgo de gestaciones múltiples en el grupo estudio 24,3% contra 1% del grupo control p < 0,001 RR 25,5 (17,3-37,6). El parto fue a las 37,79 semanas en grupo estudio y 38,99 grupo control p < 0,001. Manteniéndose las diferencias en gestaciones únicas con una media de 38,5 en grupo estudio y 39 en grupo control p < 0,001. Niños prematuros en grupo estudio 23,2%, contra 6,2% grupo control p < 0,001 RR 4,5 (3,6-5,8). Reduciéndose a la mitad el riesgo relativo cuando solo comparamos gestaciones únicas. Cesarea en 52% gestaciones por técnicas de reproducción asistida, contra 18,6% en gestaciones espontaneas p < 0,001 RR 2,85 (2,56-3,22). Manteniéndose diferencias comparando gestaciones únicas 15,6% en grupo estudio y 18,3% grupo control. No encontramos diferencias en el sexo del recién nacido. La tasa de bajo peso al nacer también fue mayor en grupo estudio 23,8% contra 7,97% grupo control p < 0,001 RR 3,6 (2,8-4,5); manteniéndose diferencias en gestaciones únicas con 11% recién nacido de bajo peso contra 5,8% p < 0,001 RR 2 (1,46-2,8). Malformaciones congénitas mayor en grupo control 9,45% respecto grupo estudio 3,69%. Conclusiones: la gestación tras técnicas de reproducción asistida presenta 25 veces más riesgo de gestación múltiple; las madres son 5 años más añosas; 4,5 veces más riesgo de tener un parto pretérmino; 2 veces mayor si comparamos gestaciones únicas; 3 veces más de tener recién nacido de bajo peso, el doble si comparamos gestaciones únicas; cesárea en más del doble tanto gestaciones únicas como en total gestaciones (AU)

Material and Methods: Retrospective observational study comparing outcomes of 704 pregnancies after assisted reproductive techniques 2008-2012 (study group), with 2507 spontaneous pregnancies (control group). Results: There are difference in outcome between assisted reproductive techniques (study group) and naturally conceived pregnancies (control group). We found differences in increased risk of multiple pregnancies in the study group 24.3% to 1% of control group p < 0.001 RR 25.5 (17.3-37.6). Mean weeks in which the delivery occurred study group was 37.79 and 38.99 in the control group p < 0.001. Maintaining differences when only singleton pregnancies compared with an average of 38.5 in the study group and control group 39 weeks p < 0.001. In the study group are at higher risk of preterm birth with 23.2% versus 6.2% control group, p < 0.001 RR 4.5 (3.6-5.8). Reduced to half the relative risk when compared only single pregnancies. Cesarean was performed in 52% of pregnancies by assisted reproductive techniques, while it was 18.6% incidence of spontaneous pregnancies p < 0.001 RR 2.85 (2.56-3.22). He maintained even comparing differences singleton pregnancies in both groups with 15.6% in the study group and 18.3% control group. Without differences in sex of newborns. The rate low birth weight was also higher in the study group 23.8% vs control group 7.97% p < 0.001 RR 3.6 (2.8-4.5); maintaining differences in single pregnancies with 11% low birth weight against 5.8%, study group against control group, p < 0.001 RR 2 (1.46-2.8); Although increased incidence of congenital malformations in the control group 9.45% from 3.69% in the study group. Conclusions: These results suggest that assisted reproductive techniques is associated with increased risk of multiple pregnancy, delivery preterm, higher risk of low birth weight (< = 2500g), and more cesarean section. The increased risk of preterm, low birth weight, and cesarean persisted in singleton pregnancies (AU)