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1.
Medicine (Baltimore) ; 100(15): e25416, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847639

RESUMO

ABSTRACT: To study the efficacy of using amniotic membrane, balloon and intrauterine device (IUD) as barrier therapy to prevent re-adhesion after hysteroscopic adhesiolysis.A total of 45 patients diagnosed with intrauterine adhesions in Changzhou Maternal and Child Health Hospital from June 2014 to December 2017 were included in this retrospective case control study. According to different postoperative isolation barrier methods, the patients were divided into group A (Foley balloon + fresh amniotic membrane Day1 + IUD Day7) (22 cases) and group B (Foley balloon Day1 + IUD Day7) (23 cases). Three months after the surgery, the second hysteroscopy was performed to observe the condition of the uterine cavity and the improvement of menstruation, and to monitor the thickness of the endometrium.The efficacy of hysteroscopic procedure in group A was significantly higher than that of group B (P < .05). After 3 months of treatment, the improvement rate of menstruation was significantly higher in group A than in group B (P < .05). Endometrial thickness in both group A and B was significantly increased compared with that before the surgery (P < .05). The postoperative endometrium of group A was significantly thicker than that of group B (P < .05).Amniotic membrane-mediated sequential double-barrier method is clinically feasible for preventing recurrent intrauterine adhesions.


Assuntos
Âmnio , Histeroscopia/métodos , Dispositivos Intrauterinos , Cateterismo Urinário/métodos , Doenças Uterinas/cirurgia , Adulto , Estudos de Casos e Controles , Endométrio/fisiopatologia , Feminino , Humanos , Histeroscopia/efeitos adversos , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Aderências Teciduais
2.
Medicine (Baltimore) ; 100(16): e24097, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879654

RESUMO

RATIONALE: Hysteroscopic morcellation is an alternative approach for the removal of placental remnants, given its advantages of safety, efficiency and good reproductive outcomes. This superiority can be even more obvious for removing persistent placental remnants in the lateral angle of the uterine cavity after repeated dilation and curettage (D&C) of an angular pregnancy, which is rarely reported. PATIENT CONCERNS: Two patients who were both initially misdiagnosed as having missed intrauterine miscarriages underwent repeated suction-assisted D&C procedures and were found to have persistent placental remnants in the lateral angles of the uterine cavity. DIAGNOSES: Ultrasound and hysteroscopy evaluations showed that placental remnants in both cases were in the lateral uterine angles and protruding to the interstitial myometrium around the fallopian tube. We corrected the diagnosis to that of angular pregnancy according to a comprehensive consideration of the ultrasound, hysteroscopy and pathology results. INTERVENTIONS: We performed MyoSure hysteroscopic morcellation for both patients and the placental remnants were removed completely without any complication. OUTCOMES: The patients were both scheduled for a second-look hysteroscopy 1 to 3 months after surgery, which revealed normal morphology of the uterine cavities and tubal ostia. The patients both achieved normal intrauterine pregnancies several months after surgery. LESSONS: Hysteroscopic morcellation is a good alternative approach for the removal of placental remnants and should be considered in cases in which there might be a high risk of incomplete evacuation or a high risk of uterine perforation, especially in cases of angular pregnancy.


Assuntos
Histeroscopia/métodos , Morcelação/métodos , Placenta/cirurgia , Gravidez Angular/cirurgia , Útero/cirurgia , Adulto , Feminino , Humanos , Placenta/diagnóstico por imagem , Gravidez , Gravidez Angular/diagnóstico , Ultrassonografia Pré-Natal , Útero/patologia
3.
Vet Clin North Am Food Anim Pract ; 37(1): 139-147, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33541695

RESUMO

Hysteroscopy in alpacas and llamas allows for the identification of abnormalities on the surface or within the endometrium that cannot be identified with other methods. Hysteroscopy also allows for site-directed endometrial cytology, culture, and biopsy to achieve a definitive diagnosis. Even when no cause for infertility can be found, previously infertile females tend to become pregnant and maintain their pregnancies to term following the hysteroscopic procedure. This therapeutic effect may be a response to pre-hysteroscopy estrogen treatment, dilation of the uterine horns during hysteroscopy, and/or posttreatment uterine lavages. Complications following hysteroscopy have not been reported in camelids.


Assuntos
Camelídeos Americanos , Infertilidade Feminina/veterinária , Animais , Biópsia/veterinária , Endometrite/diagnóstico , Endometrite/veterinária , Endométrio/diagnóstico por imagem , Feminino , Humanos , Histeroscopia/métodos , Histeroscopia/veterinária , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Infertilidade Feminina/patologia , Gravidez , Útero
5.
Arch Gynecol Obstet ; 301(6): 1485-1492, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32350598

RESUMO

PURPOSE: In this prospective study, endometrial biopsy by pipette was compared with hysteroscopy with curettage in patients with an abnormal uterine bleeding (ABU) (hypermenorrhea, intermediate bleeding, continuous bleeding, postmenopausal bleeding) and patients with a sonographically abnormal endometrium. METHODS: 176 patients were included. The pipette samples were taken during the usual planned procedure under general anaesthesia. Thereafter, the planned hysteroscopy with curettage was completed. The study was performed as a double-blind study. The obtained histologies (of pipelle and curettage) were sent separately to the same pathologist. The pipelle material was encoded by a specific number without any patient data. RESULTS: In 97% of the cases using the biopsy with pipette were obtained an adequate sample. The biopsy with pipette had a sensitivity and specificity of 100% in the diagnosis of endometrial carcinoma and atypical hyperplasia. Pipette showed a significantly lower accuracy with a sensitivity of 28% in the diagnosis of endometrial hyperplasia without atypia. Pipette showed the lowest sensitivity for polyps, myomas and atrophic endometrium. CONCLUSION: The study shows that pipette sampling is a safe, accurate, low-cost ambulatory procedure with high sensitivity for the detection of atypical endometrial hyperplasia and endometrial carcinoma. In the case of sonographically definable findings (polyp, myoma), hysteroscopy with curettage is preferred.


Assuntos
Curetagem/métodos , Hiperplasia Endometrial/cirurgia , Histeroscopia/métodos , Método Duplo-Cego , Feminino , Humanos , Estudos Prospectivos
6.
Gynecol Obstet Invest ; 85(3): 284-289, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396916

RESUMO

INTRODUCTION: Narrow-band imaging (NBI) hysteroscopy by experienced hysteroscopists (EH) is useful for diagnosing endometrial neoplasms. OBJECTIVE: We investigated whether the diagnostic reliability of NBI could be improved by specific professional training. METHODS: Three levels of trainees who were Surgeons at our hospital were selected. Level I: 6 trainees had no prior hysteroscopic experience; level II: 6 trainees had experience with <100 cases; and level III: 6 trainees had <500 cases. The two-hour training program for white light hysteroscopy (WLH) and NBI included information on the classifications of diseases of the uterine cavity and on the features of diagnostic images. Images from 529 patients were evaluated independently by trainees with 3 levels of before and after training, and by EH. Trainees and EHs had to analyze and arrive at a hysteroscopic diagnosis for each image that was compared to the pathological diagnosis for diagnostic accuracy. RESULTS: After training, all levels achieved higher diagnostic accuracy with NBI than was seen with WLH. Level III trainees achieved diagnostic accuracy and kappa values for NBI that were equivalent to those of EH. CONCLUSIONS: Training can increase the diagnostic skill of all trainees using NBI, especially for trainees with prior hysteroscopic experience.


Assuntos
Competência Clínica/estatística & dados numéricos , Educação Médica Continuada/estatística & dados numéricos , Neoplasias do Endométrio/diagnóstico , Histeroscopia/educação , Imagem de Banda Estreita/métodos , Adulto , Educação Médica Continuada/métodos , Avaliação Educacional/estatística & dados numéricos , Feminino , Humanos , Histeroscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
7.
Niger J Clin Pract ; 23(5): 747-749, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367887

RESUMO

Coronavirus 2, or SARS-CoV-2 disease (COVID-19) is a global public health concern. Although there is a paucity of evidence to advise on the best practice, we recommend postponement of elective gynecological endoscopic surgeries until the pandemic is contained. Emergency surgeries should preferably be done through open surgeries than laparoscopy or hysteroscopy approach. However, if or when laparoscopy or hysteroscopy is considered, health personnel in theatre must wear appropriate personal protective equipment (PPE) and all standard precautions should be observed to prevent COVID-19 infection. When COVID-19 is highly suspected or confirmed, the patient should be referred to centers equipped in taking care of such cases.


Assuntos
Infecções por Coronavirus/prevenção & controle , Coronavirus , Histeroscopia/métodos , Laparoscopia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Aerossóis , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Controle de Infecções , Nigéria/epidemiologia , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Saúde Pública , Sociedades Médicas , Cirurgiões
8.
BMC Womens Health ; 20(1): 75, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32316946

RESUMO

BACKGROUND: Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain. Hysteroscopic resection of diverticula is thought to reduce abnormal uterine bleeding and chronic pelvic pain. In this study, we aim to describe the improvement after hysteroscopic resection of cesarean section diverticula (CSD) in women without childbearing intention, and to explore the variables associated with poor prognosis. METHODS: A retrospective cohort study of women aged 25-48 with CSD diagnosis by transvaginal ultrasonography (TVS) and hysteroscopy that were enrolled at Guangzhou Women and Children's Medical Center between June 2017 and December 2018. A total of 124 women met the inclusion criteria and all patients had undergone hysteroscopic resection and accepted a follow-up interview at the 3rd and 6th months postoperatively to record symptom improvement. RESULT: The mean of intraoperative blood loss and operative time of hysteroscopic resection were (12.94 ± 12.63) ml and (33.63 ± 6.87) min in 124 patients. Overall observed improvement rates of CSD symptom were 47.2 and 65.6% in the first 3 and 6 months, respectively. Multivariable logistic regression models revealed that timing of surgery < 14 days was a good prognostic factor associated with both 3-month improvement (OR, 16.59; 95% CI, 2.62-104.90; P = 0.003) and 6-month improvement (OR, 15.51; 95%CI, 1.63-148.00; P = 0.02); Patients with numbers of cesarean section (CS) ≥2 had a lower rate of improvement after 6 months of CSD repair surgery compared with patients who underwent one CS (OR, 8.29; 95%CI, 1.05-65.75; P = 0.04). CONCLUSIONS: A hysteroscopic repair might be an appropriate method for CSD in women who no childbearing intentions. The timing of surgery and the number of CS seems to be factors influencing the postoperative improvement of CSD.


Assuntos
Cesárea/efeitos adversos , Divertículo/cirurgia , Histeroscopia/métodos , Histeroscopia/estatística & dados numéricos , Doenças Uterinas/cirurgia , Adulto , Criança , China , Cicatriz/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Histeroscopia/efeitos adversos , Pessoa de Meia-Idade , Gravidez , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
9.
Fertil Steril ; 113(4): 704-716, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32228874

RESUMO

Around 20% of pregnant women undergo cesarean section (CS), and in most regions of the world CS rates continue to grow. There is still no clear definition of what is considered a normal physiologic aspect of a CS scar and what is abnormal. Cesarean scar defects (CSDs) should be suspected in women presenting with spotting, dysmenorrhea, pelvic pain, or infertility and a history of CS. CSDs can be visualized with the use of hysterosalpingography, transvaginal sonography, saline infusion sonohysterography, hysteroscopy, and magnetic resonance imaging. It is reasonable to consider hormone therapy for CSDs as a symptomatic treatment in women who no longer wish to conceive and have no contraindications. In case of failure of or contraindications to medical treatment, surgery should be contemplated according to the severity of symptoms, including infertility, the desire or otherwise to preserve the uterus, the size of the CSD, and residual myometrium thickness (RMT) measurement. Hysteroscopy is considered to be more of a resection than a repair, so women who desire pregnancy should be excluded from this technique if the RMT is <3 mm, in which case repair is essential and can be achieved by only laparoscopic or vaginal approach. Women with CSDs need to be given complete information, including available literature, before any treatment decision is made. Because prevention is better than cure, risk factors should be identified early to ensure appropriate management.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Cicatriz/epidemiologia , Gerenciamento Clínico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Cesárea/tendências , Cicatriz/cirurgia , Feminino , Humanos , Histeroscopia/métodos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Gravidez , Prevalência , Resultado do Tratamento
10.
Fertil Steril ; 113(4): 885-887, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32228882

RESUMO

OBJECTIVE: To describe the diagnosis and the management of hematometra in a patient with unicornuate uterus with noncommunicating functional horn (hemi uterus and rudimentary uterine hemicavity). DESIGN: Video case report. SETTING: Minimally invasive gynaecology unit. PATIENT(S): Sixteen-year-old nulliparous woman admitted to the gynaecologic emergency department with pelvic pain during menses. INTERVENTION(S): Two-dimensional transvaginal ultrasound, magnetic resonance imaging, and laparoscopic rudimentary horn resection. MAIN OUTCOME MEASURE(S): Description of a case of anomaly of the female reproductive tract treated by laparoscopy. RESULT(S): After pain reduction and stabilization of clinical condition, ultrasound and magnetic resonance were performed, which detected a hemi uterus with a right rudimentary uterine hemicavity and a hematosalpinx. The removal of the right rudimentary uterine horn was successfully performed. The patient was in good health at the 3-month follow-up visit. CONCLUSION(S): Laparoscopic amputation of a functional rudimentary horn is considered the basic and traditional surgical option for women with hemiuterus. A detailed diagnostic evaluation should be performed to avoid misdiagnoses of other anomalies with blind hemicavity, which may be treated by hysteroscopy. Laparoscopic surgery with minimally invasive approach could be an essential tool to treat these cases, achieving optimal results with low postsurgical pain and a short hospital stay.


Assuntos
Amputação/métodos , Laparoscopia/métodos , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/cirurgia , Útero/anormalidades , Adolescente , Feminino , Humanos , Histeroscopia/métodos , Útero/cirurgia
12.
Arch Gynecol Obstet ; 301(4): 885-894, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32140807

RESUMO

PURPOSE: The aim of this review is to provide an overview of the literature about the perception and management of anxiety and pain in women undergoing an office hysteroscopic procedure. METHODS: We performed a systematic literature search in Embase, PubMed/MEDLINE, Cochrane Library and Web of Science for original studies written in English (registered in PROSPERO 2019-CRD42019132341), using the terms 'hysteroscopy' AND 'pain' AND 'anxiety' published up to January 2019. Only original articles (randomized, observational and retrospective studies) about management of anxiety and pain related to the hysteroscopic procedure were considered eligible. RESULTS: Our literature search produced 84 records. After exclusions, 11 studies including 2222 patients showed the following results: (a) pain experienced during hysteroscopy is negatively affected by preprocedural anxiety; (b) pharmacological interventions seem to be help in reducing pain during hysteroscopy; (c) waiting time before the procedure is a significant factor affecting patients' anxiety; (d) music during the procedure may be helpful in reducing anxiety. CONCLUSIONS: The utilization of office hysteroscopy is hampered by varying levels of anxiety and pain perceived by women who are candidates for the procedure. For these reasons, it is essential to identify effective pharmacological and non-pharmacological strategies to alleviate these factors. We recommend further studies especially focusing on non-pharmacological interventions to facilitate the dissemination of good clinical practices among hysteroscopists.


Assuntos
Ansiedade/terapia , Histeroscopia/efeitos adversos , Manejo da Dor/métodos , Percepção da Dor/fisiologia , Dor/tratamento farmacológico , Feminino , Humanos , Histeroscopia/métodos , Estudos Retrospectivos
13.
JSLS ; 24(1)2020.
Artigo em Inglês | MEDLINE | ID: mdl-32206011

RESUMO

Study Objective: The objective of the study was to identify factors associated with negative patient experiences with Essure. Design: This was a retrospective cohort study and follow-up survey. Setting: The study was conducted in an academic setting. Patients: Patients included women who had an Essure placed between 2002 and 2017. Methods: The hospitals' database was queried to identify subjects and charts were reviewed to confirm medical information. Subjects were invited by mail, e-mail, or phone call to participate a survey regarding symptoms and satisfaction with Essure. A comparison was made between women who reported a negative experience with Essure versus those who did not. A multivariable logistic regression analysis was performed to identify subject or procedural characteristics associated with any negative experience with Essure sterilization. Results: Two hundred eighty-four women underwent Essure sterilization between 2002 and 2017, 42.3% of whom responded to the follow-up survey. Satisfaction with Essure was reported by 61.9% of respondents. Thirty-three percent of the respondents have undergone removal or desire removal of the device. The most frequent symptoms attributed to Essure were pelvic pain, dyspareunia, and vaginal bleeding. Forty-eight percent of the respondents were identified as having any negative experience with Essure. Factors associated with negative experiences with Essure included young age at placement (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.79-0.94; P < .001), high gravidity (OR 1.39; 95% CI 1.14-1.71; P = .002), and absent history of abdominal surgery (OR 0.35; 95% CI 0.12-1.00; P = .049). Conclusion: Young age at placement, high gravidity, and absent history of abdominal surgery are factors associated with negative patient experiences following Essure sterilization. A negative experience with Essure is common, although dissatisfaction with the device is not always attributable to symptoms. This information could be considered when counseling women who plan removal of Essure. Implications Statement: Our study provides new follow-up data with respect to hysteroscopic sterilization. This research is the first to examine any cause for negative patient experiences with Essure. Understanding factors associated with negative patient experiences could improve patient counseling regarding the extent to which symptoms could be attributed to Essure as well as counseling women who want to undergo removal of the device. These factors could in turn prove to be predictors for successful resolution of symptoms after removal of Essure. Results of this study could also be used for developing future hysteroscopic sterilization techniques.


Assuntos
Histeroscopia/instrumentação , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Esterilização Tubária/instrumentação , Adulto , Estudos de Coortes , Feminino , Humanos , Histeroscopia/efeitos adversos , Histeroscopia/métodos , Pessoa de Meia-Idade , Esterilização Tubária/efeitos adversos , Esterilização Tubária/métodos , Inquéritos e Questionários
14.
West Afr J Med ; 37(2): 178-182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150637

RESUMO

Hysteroscopy involves the visualization of the endometrial cavity with the aid of a hysteroscope (Telescope) inserted through the cervix. Hysteroscopy can be performed in an office setting and minor pathologies managed. A distension medium is necessary for proper visualization. These media include gaseous media such as carbon dioxide, used for diagnostic hysteroscopy, and liquid based media such as normal saline and 1.5% glycine, used for both diagnostic and operative hysteroscopy. Complications following hysteroscopy are few. A hysteroscope should become part of the armamentarium of every gynaecologist.


Assuntos
Doenças dos Genitais Femininos/diagnóstico , Histeroscopia/métodos , Útero/diagnóstico por imagem , Assistência Ambulatorial , Dióxido de Carbono , Colo do Útero , Dilatação , Feminino , Glicinérgicos , Humanos , Gravidez , Cloreto de Sódio
15.
Arch Gynecol Obstet ; 301(4): 1081-1088, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32170409

RESUMO

PURPOSE: This study was undertaken to evaluate the prevalence of endometriosis in infertile women of couples with non-male factor infertility. METHODS: A retrospective validation analysis was carried out of consecutive women of infertile couples with non-male factor infertility who received combined diagnostic hysteroscopy and laparoscopy, in the period from January 2017 to August 2019 in the Department for Gynecology and Reproductive Medicine (n = 300). Type, stage and site of endometriosis were assessed and matched with the occurrence of tubal stenosis. Binary regression analysis was used to estimate the prevalence of endometriosis. RESULTS: Endometriosis was diagnosed in 67% (n = 201). Primary infertility (OR 1.76; p = 0.036), dysmenorrhea (OR 2.47; p = 0.002), and a shorter cycle length (OR 0.972; p = 0.036) were independent risk factors for detection of endometriosis in diagnostic hystero-laparoscopy. The most frequent endometriosis sites were pelvic side wall (53.2%) and uterosacral ligaments (41.8%). Patients with endometriosis showed less often a tubal occlusion (34.32% vs. 41.4%; p = 0.205) and presented a lower rate of bilateral obstruction (9.5% vs. 18.8.%, p = 0.024). Women with endometriosis of a Fallopian tube showed a higher rate of tubal occlusion on the same side (right side p = 0.002; left side p = 0.001). Patients with rASRM score III showed the highest rate of tubal obstruction. CONCLUSIONS: The prevalence of endometriosis in infertile women was higher than expected. The indication for operative infertility diagnostics by minimal invasive techniques should be made much more generous as well as the complete clarification of the causes of female infertility.


Assuntos
Endometriose/complicações , Doenças das Tubas Uterinas/diagnóstico , Histeroscopia/métodos , Infertilidade Feminina/etiologia , Laparoscopia/métodos , Esterilização Tubária/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Gravidez , Estudos Retrospectivos
16.
Taiwan J Obstet Gynecol ; 59(1): 85-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039807

RESUMO

OBJECTIVE: To evaluate differences in hysteroscopic findings between benign endometrial polyps and endometrial cancer. MATERIALS AND METHODS: From January 2012 to December 2016, we extracted 179 cases with endometrial polyps from 3066 women who underwent hysteroscopy followed by dilatation and curettage or transcervical resection, with 154 and 25 cases of benign and malignant endometrial polyps, respectively. Clinical characteristics, histopathological and hysteroscopic findings of the women were evaluated retrospectively. RESULTS: The hysteroscopic findings of malignant polyps were hyper-vascular (72%, 18/25), ulcerative (64%, 16/25) and polyps with irregular surfaces (24%, 6/25). In contrast, pedunculate small growths with smooth surfaces were usually seen in the benign endometrial polyps (38.3%, 59/154). Hyper-vascular (OR: 142.6, 95% CI: 25.98-783.4) and polyps with irregular surfaces (OR: 12.02, 95% CI: 1.765-81.83) in hysteroscopic findings were significant strong predictors of endometrial polyps with endometrial cancer. Hysteroscopic findings of ulcerative changes were most strongly associated with a diagnosis of malignant polyps, with sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of 64.0%, 100%, 94.5%, and 100%, respectively. CONCLUSION: Women with hysteroscopic findings of endometrial polyps with hyper-vascular, ulcerative, and polyps with irregular surfaces had a high likelihood of endometrial cancer. A target biopsy of the polyps with these specific appearances should be performed to exclude malignant lesions.


Assuntos
Neoplasias do Endométrio/diagnóstico , Histeroscopia/estatística & dados numéricos , Pólipos/diagnóstico , Doenças Uterinas/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Dilatação e Curetagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
17.
Artigo em Inglês | MEDLINE | ID: mdl-32044621

RESUMO

OBJECTIVE: to compare the effect of administering diclofenac sodium and/or oral hyoscine in pain perception during and after outpatient diagnostic hysteroscopy without anesthesia. STUDY DESIGN: a randomized, double-blind placebo-controlled clinical trial was performed in an University Hospital. We included 217 patients submitted to office hysteroscopy for the following indications: diagnosis of abnormal uterine bleeding, endometrial polyps, submucous myomas, infertility and recurrent miscarriage. Patients were allocated into 3 groups: (Group 1) placebo, (Group 2) diclofenac sodium 50 mg and (Group 3) diclofenac sodium 50 mg plus Hyoscine-N-Butylbromide 10 mg. The primary outcome was the visual analogue score immediately after the procedure. The secondary outcomes included Likert acceptance scale, the need for extra analgesia after the procedure, need to stay in the observation room and the occurrence of vagal symptoms. RESULTS: Groups were similar according to age, color, age of menarche, gravity, c-section, abortion, presence of pelvic pain, presence of uterine scar, height and body mass index. Patients in all three groups demonstrated similar visual pain scores when submitted to office hysteroscopy (Group 1: 4.18 ± 3.1, Group 2: 4.68 ± 2.9, group 3: 4.45 ± 2.9, P = 0.59). Moreover, patients presented high acceptance scores of the procedure, similar between groups. We performed a subgroup analysis in patients in treatment for chronic pelvic pain and, in this subgroup, prior medication with diclofenac sodium isolated or associated with hyoscine were both effective in decreasing pain levels when compared to placebo (Group 1: 6.0 ± 1.9, Group 2: 3.6 ± 2.1, group 3: 4.2 ± 1.5, P = 0.04). CONCLUSION(S): Office hysteroscopy is a well tolerated procedure and prior use of analgesic medication was not effective in decreasing pain. In selected patients with chronic pelvic pain the use prior analgesic medication may be beneficial.


Assuntos
Analgésicos/administração & dosagem , Brometo de Butilescopolamônio/administração & dosagem , Diclofenaco/administração & dosagem , Histeroscopia/métodos , Manejo da Dor/métodos , Administração Oral , Adulto , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor/efeitos dos fármacos , Período Pré-Operatório
18.
Int J Gynaecol Obstet ; 149(2): 192-196, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32012261

RESUMO

OBJECTIVE: To investigate the effect of early second-look office hysteroscopy combined with intrauterine balloon dilatation on prognosis and pregnancy rate for women with intrauterine adhesions. METHODS: A retrospective analysis of 156 women diagnosed with intrauterine adhesions by hysteroscopy at Shenyang Women's and Children's Hospital, China, from April 2017 to January 2019. The study women underwent intrauterine balloon dilatation 10 days after transcervical resection of adhesion (TCRA) and hysteroscopy 20 days after TCRA (n=81). The control women underwent hysteroscopy 3 months after TCRA (n=75). Estrogen and aspirin were routinely administered postoperatively to all women. Data, including American Fertility Society (AFS) scores assessed by hysteroscopy, endometrial thickness measured by ultrasound, and menstruation and pregnancy outcomes assessed by interview, were compared between the two groups. RESULTS: The degree of intrauterine adhesions, menstrual status, and endometrial thickness were improved in both groups after TCRA. Greater improvement in AFS score, menstruation, and endometrial thickness was observed in the study group than in the control group. After follow-up, more women in the study group achieved pregnancy (48.1% vs 30.7%, P<0.05). CONCLUSION: Early second-look of hysteroscopy combined with intrauterine balloon dilatation after hysteroscopic TRCA might improve the prognosis and postoperative pregnancy rate for women with intrauterine adhesions.


Assuntos
Histeroscopia/métodos , Aderências Teciduais/cirurgia , Tamponamento com Balão Uterino/métodos , Doenças Uterinas/cirurgia , Adulto , Estudos de Casos e Controles , China , Feminino , Humanos , Menstruação/fisiologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Cirurgia de Second-Look/instrumentação
19.
J Obstet Gynaecol Res ; 46(2): 279-285, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31960535

RESUMO

AIM: This study was conducted to evaluate comparative clinical outcomes of hysteroscopy-assisted transvaginal repair in the treatment of cesarean scar defect (CSD) in patients desirous of conceiving again. METHODS: We retrospectively enrolled 63 patients with CSD who were treated at Beijing Hospital between January 2014 and January 2016. Patients were divided into the hysteroscopic electrocauterization group (electrocauterization group, n = 28) and hysteroscopy-assisted transvaginal repair group (transvaginal group, n = 35). Perioperative parameters including operation time, intraoperative blood loss, time to passage of flatus, hospitalization duration, duration of postoperative vaginal bleeding, pre- and postoperative myometrial thickness, rate of full-term births and surgical complications were compared between the two groups. RESULTS: At the 6-month follow-up, myometrial thickness was significantly greater in the transvaginal group (9.8 ± 1.0 mm) compared to the electrocauterization group (3.3 ± 0.7 mm, P < 0.05). One patient in the transvaginal group required intraoperative conversion to laparotomy because of surgical complications. The transvaginal group had a significantly higher rate of full-term live birth compared to the electrocauterization group (92% vs 46%, P < 0.05). There were no significant between-group differences in the other pre-, intra-, and postoperative parameters. The maximum postoperative diameter of the CSD in the transvaginal and electrocauterization groups was 1.6 ± 0.8 and 17 ± 2.0 mm, respectively. CONCLUSION: Compared to hysteroscopic electrocauterization, hysteroscopy-assisted transvaginal repair of CSD was associated with better clinical outcomes and higher rate of full-term live births.


Assuntos
Cesárea/efeitos adversos , Cicatriz/cirurgia , Histeroscopia/métodos , Infertilidade Feminina/cirurgia , Adulto , Cicatriz/etiologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Estudos Retrospectivos , Adulto Jovem
20.
Arch Gynecol Obstet ; 301(1): 33-52, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31989288

RESUMO

PURPOSE: To investigate the effectiveness and risks of different surgical therapies for isthmocele in symptomatic women with abnormal uterine bleeding, infertility, or for the prevention of obstetric complications, considering safety and surgical complications. METHODS: PubMed/MEDLINE, Scopus, Embase, Science Direct, and Cochrane Library were systematically searched (n° CRD4201912035) for original articles on the surgical treatment of isthmocele published between 1950 and 2018. Data synthesis was completed using MedCalc 16.4.3. The body of evidence was assessed using the GRADE methodology. RESULTS: We retrieved 33 publications: 28 focused on a single surgical technique, and five comparing different techniques. Meta-analysis showed an improvement of symptoms in 85.00% (75.05-92.76%) of women after hysteroscopic correction, 92.77% (85.53-97.64%) after laparoscopic/robotic correction, and 82.52% (67.53-93.57%) after vaginal correction. Hysteroscopic surgery was associated with the lowest risk of complications (0.76%, 0.20-1.66%). CONCLUSIONS: We found adequate evidence supporting the use of surgery for the treatment of symptomatic isthmocele, as it was found to improve the bleeding symptoms in more than 80% of patients. Differently, we found a lack of evidence regarding the role of surgery with the purpose of improving fertility or reducing the risk of obstetric complications in women with asymptomatic isthmocele. The hysteroscopic correction of isthmocele may be the safest and most effective strategy in those patients with adequate residual myometrial thickness overlying the isthmocele. Laparoscopic and vaginal surgeries may be the preferred options for patients with a thinner residual myometrium over the defect (< 2.5 mm) and when hysteroscopic treatment is inconclusive.


Assuntos
Cicatriz/cirurgia , Doenças Uterinas/cirurgia , Cicatriz/patologia , Feminino , Humanos , Histeroscopia/métodos , Laparoscopia/métodos
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