Analysis of pain and satisfaction with office-based hysteroscopic sterilization.

OBJECTIVE: To assess pain and patient satisfaction with office-based hysteroscopic sterilization. DESIGN: This prospective, observational study was designed to assess patient pain perception and satisfaction with office-based hysteroscopic sterilization using the Essure device (Conceptus, Mountain View, CA). SETTING: Faculty practice office at an inner-city urban medical center. PATIENT(S): Women seeking hysteroscopic sterilization. INTERVENTION(S): Office hysteroscopic sterilization under local anesthesia. MAIN OUTCOME MEASURE(S): Pain assessed at the time of the procedure by a 0-10 visual scale and satisfaction by a 1-5 scale. RESULT(S): From June 2003 to June 2006, 209 patients were recruited. The mean scores for average procedural pain, most procedural pain, and average menstrual pain were 2.6+/-2.1, 3.3+/-2.5, and 3.6+/-2.6, respectively. Standardized pain scores revealed that 149 subjects (70%) experienced average pain that was less than or equal to the pain experienced with their menses. Mean satisfaction rating for the procedure was 4.7+/-0.71. CONCLUSION(S): Office-based hysteroscopic sterilization performed with local anesthesia alone is well tolerated, and patients are satisfied with this method for permanent sterilization.

Group a Streptococcus causing necrotizing fasciitis and toxic shock syndrome after medical termination of pregnancy.

BACKGROUND: Group A Streptococcus is an aerobic gram-positive bacteria known to cause cutaneous infections. Invasive infections can lead to toxic shock syndrome with multiorgan failure and mortality rates of 25-48%. CASE: A healthy, young woman developed necrotizing fasciitis, myonecrosis, and toxic shock syndrome after an elective medical termination of pregnancy. This patient had confirmed group A Streptococcus on blood cultures and underwent surgical debridement. After aggressive surgical treatment, below-the-knee amputation, and antibiotic therapy, the patient survived. CONCLUSION: This case demonstrates the need for prompt recognition and treatment of necrotizing fasciitis/toxic shock syndrome.

Serum progesterone on the day of human chorionic gonadotropin administration predicts clinical pregnancy of sibling frozen embryos.

OBJECTIVE: To evaluate patient characteristics and fresh in vitro fertilization (IVF) cycle parameters that influence success of sibling frozen-thawed embryo transfer (FET) cycles. DESIGN: Retrospective study. SETTING: Academic infertility practice. PATIENT(S): Infertile women undergoing FET cycles using embryos cryopreserved on day 3 after insemination after an initial fresh IVF cycle. INTERVENTION(S): 90 FET cycles. MAIN OUTCOME MEASURE(S): Clinical pregnancy (CP). RESULT(S): The likelihood of CP after FET was statistically significantly higher in women who had achieved CP in the preceding fresh IVF cycle (71.4% vs. 40.6%). Multivariable logistic regression analysis confirmed that patients achieving CP after the fresh IVF cycle were more likely to achieve CP after FET (OR 5.5; 95% CI, 1.2-25.3) after adjusting for age, number, and cleavage status of embryos transferred. Additionally, higher serum levels of progesterone on the day of human chorionic gonadotropin administration emerged as predictive of CP after FET at a statistically significant level. CONCLUSION(S): The outcome of the fresh embryo transfer cycle is the foremost predictor of CP after FET of the sibling embryos. The relationship between serum progesterone on the day of human chorionic gonadotropin administration in the fresh cycle and the outcome of subsequent FET is noteworthy and merits further investigation.