Hysterosalpingo-foam sonography, a less painful procedure for tubal patency testing during fertility workup compared with (serial) hysterosalpingography: a randomized controlled trial.

OBJECTIVE: To determine whether hysterosalpingo-foam sonography (HyFoSy) is a less painful first line tubal patency test than serial hysterosalpingography (HSG). DESIGN: A two-center, prospective, open-label, randomized, controlled trial. SETTING: University hospital and teaching hospital. PATIENT(S): 40 subfertile women, ages 18 to 41 years, with an indication for tubal patency testing as part of the fertility workup according to the Dutch Nederlandse Vereniging voor Obsteterie & Gynaecologie-guidelines. INTERVENTION(S): Tubal patency testing by HyFoSy versus serial HSG. MAIN OUTCOME MEASURE(S): Visual Analogue Scale (VAS) pain scores during tubal patency testing. RESULT(S): The median VAS score for pain perception during the HyFoSy procedure was 1.7 cm (interquartile range: 2.1) compared with 3.7 cm (interquartile range: 4.2) during HSG. The HyFoSy procedure also had a statistically significantly shorter procedure time compared with HSG, with a median of 5.0 minutes (interquartile range: 3.0) for HyFoSy versus 12.5 minutes (interquartile range: 16.0) for HSG. CONCLUSION(S): The HyFoSy procedure is a less painful and less time-consuming tubal patency test compared with HSG. CLINICAL TRIAL REGISTRATION NUMBER: Netherlands National Trial Register NTR3457.

[Intra-uterine death caused by fetal akinesia]. / Intra-uteriene sterfte door foetale bewegingsarmoede: het belang van diagnostiek na een vruchtdood.

BACKGROUND: When two successive pregnancies end in intra-uterine fetal death (IUFD), the question of whether it is coincidental or if there is an underlying abnormality arises. Although diagnostic investigations into the underlying cause are not always carried out after IUFD, they are recommended by the professional body. CASE DESCRIPTION: A 28-year-old female attended our gynaecology outpatient clinic for a second opinion following two intra-uterine fetal deaths. Her own treating physician was of the opinion that there was no connection between the two IUFDs. After a multidisciplinary evaluation, the phenotype fetal akinesia deformation sequence (FADS) was diagnosed in both cases. This is a rare, clinically and aetiologically heterogeneous group of disorders. Thereafter the patient and her husband were offered specific pre-conception counseling. CONCLUSION: Every IUFD justifies systemic and multidisciplinary investigation to determine any underlying aetiology such as FADS. This may contribute to better pre-conception advice and prenatal individualised diagnostics in a subsequent pregnancy.