Office hysteroscopic myomectomy without myoma extraction: A multicenter prospective study.

OBJECTIVE: To evaluate the feasibility and safety of leaving the submucous myoma (SM) in the uterine cavity after office hysteroscopic enucleation. STUDY DESIGN: Prospective multicenter study including patients who had a single SM diagnosed by transvaginal ultrasounds with surgical indication. Office hysteroscopic enucleation of the SM was performed using a 5 mm continuous flow office hysteroscope with a 2.9 mm rod lens optical system and a 5 Fr operative channel. After the SM was released preserving the pseudo capsule using cold instruments, it was left into the uterine cavity. The primary endpoint was the proportion of patients without evidence of the myoma at the transvaginal ultrasound performed after 90 days from surgery. RESULTS: Between January 1st, 2018, and March 31st, 2020, a total of 204 patients were enrolled. Most patients were nulliparous and reported abnormal uterine bleeding as the leading symptom. 76.5 % of enucleated myomas had a diameter ranging between 1.5 and 2.5 cm, and 81.4 % of SMs were of G0 or G1. Hysteroscopic procedures had a mean duration of 23.2 ± 10.5 min. The operative time was associated with the SM grade and size. All hysteroscopic procedures were completed. A vasovagal reaction was observed in 3 women (1.5 %), and minimal post-operative bleeding was reported after 7 procedures (3.4 %). None reported pelvic pain or vaginal discharges/bleeding during follow-up. The average patient satisfaction from surgery was 4.59 (5-points Likert scale). The level of patient satisfaction was not associated with the grade and the size of the myoma. In 192 (94.12 %; 98 %CI: 89.03-96.93 %) out of 204 patients, the SM was absent at the transvaginal ultrasound performed at the follow-up end. A higher prevalence of G2 SMs and lower prevalence of G1 SMs were observed among patients with evidence of the myoma after 90 days from the surgery. CONCLUSION: Office hysteroscopic myomectomy with SM enucleation without mass extraction appears safe, well-tolerated, and effective in at least 89 % of patients. G2 SMs may be the factor associated with the procedure's failure.

Dysmorphic Uteri: Obstetric Results after Hysteroscopic Office Metroplasty in Infertile and Recurrent Pregnancy Loss Patients. A Prospective Observational Study.

To compare the obstetric results achieved after hysteroscopic office metroplasty (HOME-DU) in infertile and recurrent pregnancy loss (RPL) patients diagnosed with dysmorphic uterus, women hysteroscopically diagnosed with dysmorphic uterus who underwent uterine-enlargement metroplasty were prospectively enrolled from June 2016 until April 2020. Patients were followed up and obstetric outcomes were recorded (pregnancy and live birth rate). Sixty-three women (30 infertile; 33 RPL) were enrolled, of which 48 became pregnant post-HOME-DU, with an overall pregnancy rate of 76.2% (66.7% among infertile participants; 84.9% among those with RPL). Overall, 64.3% (n = 36/63) achieved live birth. Among infertile women, 62.07% (n = 18/29) achieved live birth, as well as 66.7% of women with RPL (n = 18/27). The difference in live birth rates between both cohorts was 4.6% (p > 0.05). The rate of miscarriage amongst infertile patients was 3.3% (n = 1/30) and 12.1% amongst women with RPL (n = 4/33). Office metroplasty via the HOME-DU technique improves obstetric results (namely increasing live birth rate) in patients with dysmorphic uterus and a history of reproductive failure. No significant difference was found in the clinical efficacy of HOME-DU in infertile and RPL patients.

Multiple-parameter screening and prevention of preeclampsia: evaluation of a protocol implemented at Hospital Universitario Puerta de Hierro / Cribado multiparamétrico y prevención de la preeclampsia. Evaluación del protocolo implantado en el Hospital Universitario Puerta de Hierro

Objective: To evaluate the implementation in our center of a preeclampsia risk screening protocol in a low-risk population combined with preventive treatment (aspirin, 100 mg/d) by evaluating the variation in the incidence of preeclampsia. To validate the analysis tool and its predictive strength. Material and methods: We studied 310 patients divided into 2 groups: 138 controls (TR) and 172 patients who had undergone screening and received preventive treatment (CI). We collected demographic data, gestational age at consultation, obstetric history, reproductive method, risk factors for preeclampsia (hypertension, diabetes, BMI, kidney disease, and coagulopathy), use of aspirin as preventive therapy, and data on the outcome of pregnancy (hypertension, proteinuria, diagnosis of preeclampsia, and complications). In the CI group, we also recorded the risk of preeclampsia. This was calculated retrospectively in the TR group. Results: The protocol had 80% sensitivity and 98.4% specificity. The incidence of preeclampsia was 3.62% in the TR group and 0.58% in the CI group (p=0.053), with an OR of 0.155 (0.017-1.34). Among patients with a high risk, 66.7% developed preeclampsia in the TR group and 9.1% in the CI group (p=0.027), with an OR of 0.05 (0.04-0.57) and a number needed to treat of 1.74. Conclusions: The high sensitivity and specificity of the analytical tool make it adequate for screening. The protocol reduces the incidence of preeclampsia in high-risk patients, even if that difference was not significant at the level of the study population

Objetivo: evaluar la implantación, en nuestro centro, de un protocolo de cribado del riesgo de preeclampsia en población de bajo riesgo obstétrico, combinado con tratamiento preventivo con 100 mg diarios de ácido-acetilsalicílico, mediante el análisis de la variación de la incidencia de preeclampsia. Validar la herramienta utilizada, analizando su capacidad predictiva. Material y métodos: se estudiaron 310 pacientes, distribuidas en dos grupos: 138 controles (TR) y 172 con cribado y tratamiento preventivo (CI). Se recogieron datos demográficos, edad gestacional en consulta, historia obstétrica, método reproductivo, factores de riesgo de preeclampsia (hipertensión, diabetes, IMC, nefropatía y coagulopatía), toma de ácido-acetilsalicílico de forma preventiva y datos del final de la gestación (hipertensión, proteinuria, diagnóstico de pree-clampsia y complicaciones). En el grupo CI se recogió el índice de riesgo, y en el grupo TR se calculó de forma retrospectiva. Resultados: la herramienta obtuvo una sensibilidad del 80% y una especificidad del 98,4%. La incidencia de preeclamp-sia resultó del 3,62% en el grupo TR frente al 0,58% en el grupo CI (p=0,053), con una OR de 0,155 [0,017-1,34]. Entre las pacientes con índice de alto riesgo, un 66,7% del grupo TR presentó preeclampsia, frente a un 9,1% del grupo CI (p=0,027), con OR 0,05 [0,04-0,57] y una NNT de 1,74. Conclusiones: la herramienta utilizada tiene elevada sensibilidad y especificidad, resultando útil como cribado. El protocolo implantado reduce la incidencia de preeclampsia en pacientes con índice de alto riesgo, aunque la variación a nivel poblacional no fue significativa

Correction of severe postconization cervical stenosis by means of bipolar office hysteroscopy / Corrección de estenosis cervical posconización grave por medio de energía bipolar en consulta de histeroscopia ambulatoria

Objective: To describe the use of office hysteroscopy as a new tool for the treatment of severe postconization cervical stenosis. Material and methods: Retrospective study (Canadian Task Force classification III) in a Tertiary General Hospital. 18 patients with severe cervical stenosis after cervical conization because of cervical dysplasia. The procedure was performed by means of office hysteroscope. After local anesthesia was administered, the diagnostic hysteroscope was advanced under visual and ultrasonic guidance. Once the uterine cavity was reached, the hysteroscope was withdrawn, and the bipolar electrode resected protrusions and scarring along the endocervical canal. Two months later, patients were scheduled to assess clinical outcome and to repeat hysteroscopy to assess cervical patency. Results: The procedure was successful in 17 of 18 patients (94.4%) in the first trial. The other patient needed a second procedure. The mean operation time was 18.0 (67.4) minutes. Repeat hysteroscopy was successful in all patients. Conclusion: Hysteroscopic cervical resection is a safe and effective treatment for cervical stenosis

Objetivo: describir la utilidad de la histeroscopia en consulta para el tratamiento de la estenosis cervical grave posconización. Material y métodos: se trata de un estudio retrospectivo realizado en un hospital terciario. Se analizan 18 pacientes con estenosis cervical grave tras haber sido sometidas a una conización por displasia cervical. La técnica fue realizada por histeroscopia en la consulta. Tras aplicar anestesia local paracervical, el histeroscopio se introducía en el cérvix con guía ecográfica. Una vez que se alcanzaba la cavidad uterina, el histeroscopio se retiraba hasta colocarlo en el canal endocervical desde donde el electrodo bipolar iba resecando los tejidos cicatriciales y necróticos a lo largo de este canal. Dos meses más tarde las pacientes eran citadas para realizar una histeroscopia diagnóstica de comprobar el paso del canal cervical. Resultados: de las 18 pacientes incluidas en el análisis, en 17 este resultó efectivo en el primer intento (94,4%). La otra paciente necesitó una segunda intervención. El tiempo medio de intervención fue de 18.0 (SD 67,4) minutos. La histeroscopia de revisión fue exitosa en todas las pacientes. Conclusión: la resección cervical histeroscópica es un medio seguro y efectivo para tratar la estenosis cervical posconización

Hysteroscopy in pregnancy-related conditions: descriptive analysis in 273 patients.

STUDY OBJECTIVE: To describe the feasibility of office hysteroscopy in patients with pregnancy-related problems such as retained trophoblastic tissue, persistent molar tissue, pregnancy with in situ intrauterine device (IUD), isthmocele, embryoscopy, and osseous metaplasia. DESIGN: Retrospective cohort chart review of use of hysteroscopy in 273 patients with pregnancy-related conditions (Canadian Task Force classification II-2). SETTING: University tertiary-care hospital. PATIENTS: Office hysteroscopy with the indication of pregnancy-related conditions such as retained trophoblastic tissue, pregnancy with IUD, molar pregnancy, cesarean scar defects, and fetal death were studied. The study included 273 patients: 185 with retained trophoblastic tissue, 14 with persistent molar tissue, 7 with an in situ IUD, 22 with symptomatic isthmocele, 41 with embryoscopy, and 4 with osseous metaplasia. INTERVENTION: Diagnostic and operative office hysteroscopy. MEASUREMENTS AND MAIN RESULTS: Variables studied included resolution of abnormal uterine bleeding in patients with persistent trophoblastic tissue, normalization of ß-human chorionic gonadotropin levels in patients with persistent molar tissue, continuation of pregnancy after retrieval of lost IUDs, resolution of postmenstrual bleeding in patients with symptomatic isthmocele, rate of uncontaminated embryonic tissue after embryoscopic biopsy, and successful extraction of bony tissue in patients with osseous metaplasia. Office hysteroscopy enabled resolution of most cases of retained trophoblastic tissue (91.8%) and all 14 cases of persistent molar tissue. 7 IUDs were extracted from pregnant patients. Fifteen isthmoceles resolved with office hysteroscopy, and 7 were resected in the operating room. A normal karyotype was obtained in 37 embryoscopies (90.2%). Four osseous metaplasia cases resolved with either office hysteroscopy (75%) or resectoscopy in the operating room (25%). CONCLUSION: Office hysteroscopy is a safe and minimally invasive treatment for pregnancy-related conditions, with good clinical and functional results.

Hysteroscopic dynamic assessment of the endometrium in patients treated with long-term tamoxifen.

STUDY OBJECTIVE: To describe the evolutive endometrial hysteroscopic patterns in patients undergoing long-term tamoxifen treatment. DESIGN: Prospective analysis. Analysis of variance test with post hoc Bonferroni test and homogeneity test of percentages were used for hypothesis contrast between the groups. DESIGN CLASSIFICATION: Canadian task force II-2. SETTING: Four Spanish tertiary care hospitals. PATIENTS: A total of 278 patients with breast cancer diagnosed between 2002 and 2004, which completed 5-years adjuvant therapy with tamoxifen. INTERVENTIONS: Ultrasonography and hysteroscopic explorations were performed before starting the treatment and then at yearly intervals during the 5 years of adjuvant treatment. MEASUREMENTS AND MAIN RESULTS: Hysteroscopic endometrial changes were significant throughout the years of treatment. Tamoxifen-exposed endometria present five different patterns: atrophic, cystic, hypervascularized, endometrial polyp, and suspicious of malignancy. Endometrial carcinoma appeared in four patients (1.5%) that bled during the follow-up. CONCLUSION: Tamoxifen produces five different endometrial patterns that evolve dynamically throughout the 5 years of treatment.