The quality of operative consenting against RCOG advice as standard.

Clinical Governance Advice published by the RCOG states that 'before seeking a women's consent ... you should ensure that she understands the nature of the condition for which treatment is being proposed, its prognosis, likely consequences and risks of receiving no treatment at all'. The importance of obtaining informed consent within obstetrics and gynaecology is highlighted by the litigious nature of our specialty, with CNST data, demonstrating that it makes up 21% of all claims and incur highest cost of any other specialty. We present an audit of the quality of operative consenting for 120 procedures over a 3-month period for five procedures (diagnostic hysteroscopy and laparoscopy, total abdominal hysterectomy, vaginal repair/hysterectomy and lower segment caesarean section) for which we have RCOG advice (Numbers 1, 2, 4, 5, 7, respectively). The quality of consent was also assessed by grade of clinicians. The results identify significant deficiencies when various gynaecological and obstetric procedures are being consented for, and we have discussed various options recommended for improvement.

Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in women with normal hysterosalpingography?

The advantage of hysteroscopy (HSC) over hysterosalpingography (HSG) in the accuracy of the diagnosis of uterine cavity abnormalities that may cause or contribute to infertility has been shown by numerous studies. The aim of this study was to analyse the results obtained from diagnostic HSC performed routinely during diagnostic laparoscopy in the investigation of the infertile women, to evaluate the effectiveness of the procedure in the diagnosis of uterine causes of female infertility. Ninety-three infertile patients with normal uterine cavity as demonstrated in HSG underwent diagnostic laparoscopy and hysteroscopy in this infertility unit. The hysteroscopy showed a normal cavity in 80 cases (88%), giving a false-negative rate of 12% for HSG. The pathologies found included small adhesions (two cases), an arcuate fundus (two cases), an endometrial polyp (three cases), and endometrial hyperplasia was diagnosed in four cases. In the absence of a positive history or a radiographical suggestion of endometrial abnormalities, or both, HSC made little diagnostic contribution towards elucidating the cause of female infertility or to finding a pathology that could affect the chances of achieving a normal pregnancy. However, in view of the low complication rates, minimal time requirement, and a negligible effect on the post-operative course, HSC could be performed on all infertile patients undergoing diagnostic laparoscopy.