Esterilização tubária histeroscópica: uma atualização sobre o dispositivo Essure® / Hysteroscopic tubal sterilization: update on the Essure® device

No intuito de oferecer para a laqueadura tubária uma alternativa menos invasiva e com menos complicações, foi desenvolvido o dispositivo Essure®, aplicado ao método da esterilização histeroscópica, além de ter utilidade nos quadros de hidrossalpinge com indicação de fertilização in vitro (FIV). Este artigo, por meio de uma revisão de literatura, teve como objetivo reunir dados acerca do uso do Essure®, incluindo resultados obtidos com o dispositivo, bem como comparações em diversos aspectos com outras metodologias de esterilização. Foram utilizados os bancos de dados PubMed, Lilacs e Scielo, no período entre 1970 e 2016. Foram pesquisados os termos "hysteroscopic contraception"; "Essure"; "definitive tubal sterilization; "sterilization"; "contraception". A literatura demonstrou se tratar de um dispositivo de fácil e rápida inserção, e com bons resultados para anticoncepção. Porém, devido a complicações como perfuração tubária, implante peritoneal e aborto, bem como para avaliar seu custo financeiro ao sistema de Saúde, mais estudos prospectivos são necessários.(AU)

In order to provide a less invasive and harmful technique compared to the tubal ligation, the Essure® device was developed, applied to the hysteroscopic sterilization method. It is also used in cases of hydrosalpinus and indication of in vitro fertilization (IVF). This article, through a literature review, aimed to gather data about the use of Essure®, including results obtained with the device, comparing different aspects with other methods of sterilization. For this purpose, PubMed, Lilacs and Scielo databases were used, with results from 1970 to 2016. The keywords searched were "hysteroscopic contraception", "Essure", "definitive tubal sterilization". The literature has shown that it is a quickly and easily inserted device with good results for contraception. However, due to complications such as tubal perforation, peritoneal implantation and abortion, as well as to evaluate its financial cost to the health system, more prospective studies are needed.(AU)

Reproducibility of placental maturity grade classification using a dynamic ultrasonography.

OBJECTIVE: To evaluate the agreement between ultrasonographers in classifying placental maturity grade using examination videos. METHODS: A prospective, cross-sectional study was conducted using 25 videos of ultrasonographic examinations of single, healthy pregnancies ≥ 34 + 0 weeks. The Grannum (grades 0, I, II and III) and Julio (grades 0, 1, 2A, 2B and 3) classifications were used for placental maturity grade. The videos were evaluated on two occasions by 10 experienced ultrasonographers. Intra- and inter-observer agreements were evaluated using the Kappa (k) coefficient of agreement. RESULTS: According to the Grannum classification, the inter-observer agreement coefficients were good for grades III and 0 (k = 0.69 and 0.738, respectively) and moderate for grades I and II (k = 0.401 and 0.593, respectively) placentas. According to the Julio classification, the inter-observer agreement coefficients were good for grades 0 and 3 (k = 0.738 and 0.651, respectively), moderate for grades 1 and 2A (0.401 and 0.413, respectively) and poor for grade 2B (k = 0.161). Intra-observer coefficients for the Grannum and Julio classifications ranged from 0.567 to 0.890 and from 0.446 to 0.790, respectively. CONCLUSION: Placental maturity grading using the Grannum and Julio classifications demonstrated moderate/good intra- and inter-observer agreements on examination videos evaluation.