Pain Management During Office Hysteroscopy: A Survey of Hysteroscopists.

OBJECTIVE: Outpatient hysteroscopy can be a painful procedure for some patients and there is still no consensus regarding analgesia use. We evaluated which types and modalities of analgesia are most commonly used in a select group of hysteroscopists. STUDY DESIGN: A 15-item questionnaire was created to assess the use of routine analgesia during office hysteroscopy. The SurveyMonkey portal (https://www.surveymonkey.com/) was used to administer the questionnaire. Of the 400 hysteroscopists who were approached, 229 replied. RESULTS: Routine pre-procedural or intra-procedural analgesia was used by 34% of hysteroscopists (67% of these reported using NSAIDs, 12% paracetamol, 7% opioids 13.5% other). Among hysteroscopists who routinely used intra-procedural analgesia, 46.1% reported using a paracervical block, 15.4% used an intracervical blockage, 15.4% had the patient listen to music during the procedure, 3.8% used local anesthetics, as in a spray or gel on the surface of the cervix, and 19.2% used some other method. Regarding misoprostol use, 75% of hysteroscopists reported not using it routinely. CONCLUSION: Our results are consistent with poor evidence from published studies that there is a low prevalence of routine analgesia use during outpatient hysteroscopy.

Prophylaxis of peripartum haemorrhage using recombinant factor VIIa (rfVIIa) in pregnant women with congenital factor VII deficiency: A case report and literature review.

Congenital factor VII deficiency is a rare autosomal recessive disorder associated to different haemorrhagic manifestations. Labour and delivery may cause bleeding risk in patients with this coagulation deficit, thus it is appropriate to clarify whether prophylaxis of peripartum haemorrhage is necessary. To date, there are very few cases in scientific literature which report the management of women with congenital factor VII deficiency during labour, and a consensus for prophylaxis does not exist. In this manuscript we present the management of a 35 years old woman with factor VII deficiency, treated with recombinant factor VIIa before delivery, without haemorrhagic complications either for the woman and for the infant. Therefore, we present a review of similar cases managed with a peripartum prophylaxis with recombinant factor VIIa, and discuss its usefulness and effectiveness, in view of the severity of the deficit and the doses used.