Self-Traction During Mechanical Cervical Dilatation, Acceptability, Feasibility and Satisfaction of its Application: A Pilot Study.

This study aims to measure acceptability, feasibility, and satisfaction with self-traction during mechanical cervical dilatation to induce labour and to explore its effects on pain and the process of labour and delivery. 60 parturients were randomly assigned to self-traction or regular traction. Participants completed questionnaires about sociodemographic characteristics, acceptability, and satisfaction. Self-traction participants reported significantly higher acceptability (P = 0.026), and adequacy (P = 0.018). They also reported satisfaction with the procedure. A group comparison regarding feasibility, pain, and the process of labour and delivery showed no significant difference. Self-traction is an acceptable and feasible intervention for full-term parturients.

Women's Experiences of Mechanical Balloon Catheter Induction With Self-Traction.

OBJECTIVE: To explore women's experiences of mechanical labor induction using a balloon catheter with self-traction. DESIGN: Descriptive qualitative. SETTING: Birth unit of an urban hospital in Quebec, Canada. PARTICIPANTS: Fourteen women who experienced labor induction with a balloon catheter using self-traction. METHODS: We conducted individual structured interviews between May 2022 and January 2023 to collect data that we subsequently analyzed using the manifest content analysis approach of Graneheim et al. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). RESULTS: We identified five categories: Expectations, Pain or Comfort Experienced, Emotions Felt, Support From Nursing Staff, and Appreciation of the Procedure. The participants anticipated rapid, effective induction, expressed concerns about potential discomfort, and appreciated control of their experiences. We found a generally positive trend in terms of appreciation for all categories. CONCLUSION: The positive experiences of participants underline the promising potential of the balloon catheter method of labor induction with self-traction. Given the continuing growth in labor induction rates, it becomes necessary to continue efforts to offer services specifically geared to women's needs. Offering an additional option such as self-traction is a step in this direction.

Predictive score for early preterm birth in decisions about emergency cervical cerclage in singleton pregnancies.

OBJECTIVE: To develop a simple score for assessing the risk of early preterm delivery before 32 weeks in women with singleton pregnancies receiving emergency cervical cerclage. DESIGN: Retrospective study. SETTING: French tertiary care center from 1994 to 2006. POPULATION: A total of 134 pregnant women underwent emergency cervical cerclage procedure at 15-26 weeks. The analysis concerned 85 singleton pregnancies after exclusion of women with a dilated cervix without visible membranes, or presenting for revision of failed prophylactic cerclage, or who had either preterm premature rupture of membranes or clinical signs of chorioamnionitis. METHODS: Multivariate logistic regression methods with rounded coefficients were used to develop a score to predict early preterm delivery before 32 weeks. MAIN OUTCOME MEASURES: Early preterm delivery before 32 weeks. RESULTS: The score, ranging from 0 to 15 points, was based on the following four criteria independently associated with early preterm delivery: obstetric history; cervical dilatation; membranes bulging into the vagina; and infection. Each score value was associated with a predicted probability of early preterm birth. CONCLUSIONS: The score and its associated early preterm probabilities may be a valuable tool to help physicians in advising women about the need for emergency cerclage.

Treatment of twenty-two patients with complete uterine and vaginal septum.

STUDY OBJECTIVE: To assess the fertility and obstetric outcome after surgical treatment of complete uterine and vaginal septum. DESIGN: Retrospective study (Canadian Task Force Classification II-2). SETTING: Teaching hospital in France. PATIENTS: Twenty-two women who have experienced infertility, pregnancy losses, dyspareunia, or dysmenorrhea. INTERVENTION: Hysteroscopic section of complete uterine septum and resection of longitudinal vaginal septum. MEASUREMENTS AND MAIN RESULTS: Improvement of dyspareunia or dysmenorrhea and obstetric outcome, focusing on the miscarriage rate, obstetric complications, and the gestational age at delivery were assessed. Overall, 20 women had conceived a total of 37 pregnancies, with 10 and 8 deliveries before and after metroplasty, respectively. Median gestational age at delivery was not significantly different in both groups (36.5 [33-39.5] vs 38.0 weeks' gestation [35-40], respectively). Preterm delivery occurred in 4 cases (25%) before the surgery and in 3 cases (14%) after (p = .44). The live birth rate was also not significantly different before and after surgery (62.5% and 38%, respectively) (p = .19). There was a decrease of caesarean section and significantly fewer breech deliveries after metroplasty (p = .01). A decrease in the prevalence of dyspareunia or dysmenorrhea was observed after metroplasty in the 19 patients originally displaying these symptoms. No perioperative complications were observed in this series. CONCLUSION: Resection of vaginal septum and hysteroscopic metroplasty for complete uterine septum with resection of the cervical septum is a safe procedure that may improve dyspareunia and dysmenorrhea when present. Reproductive and obstetric outcomes after this procedure do not appear to be compromised, even though a relatively high miscarriage rate remains after metroplasty, questioning its systematic practice in symptom-free women without any previous obstetric history.

Accuracy of three-dimensional ultrasonography in differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging.

STUDY OBJECTIVE: To estimate the accuracy of 3-dimensional (3-D) ultrasonography in the differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging (MRI). DESIGN: Prospective cohort study (Canadian Task Force Classification II-2). SETTING: University hospital. PATIENTS: Thirty-one patients referred with a suspected diagnosis of septate (n = 20) or bicornuate (n = 11) uterus. INTERVENTIONS: All patients underwent 3-D ultrasonography displaying the rebuilt coronal view of the uterus, office hysteroscopy, and pelvic MRI. Operative hysteroscopic assessment and treatment was performed in case of sonographically diagnosed septate uterus. Bicornuate uterus was confirmed by laparoscopy. MAIN OUTCOMES MEASURES: Concordance between suspected diagnosis with 3-D ultrasonography, hysteroscopy, and pelvic MRI and final diagnosis. RESULTS: A septate uterus was diagnosed with 3-D ultrasonography in 29 patients and bicornuate uterus in 2 patients. Hysteroscopic transcervical section of the uterine septum was achieved in the 29 patients. Bicornuate uterus was laparoscopically confirmed in the 2 patients. Concordance between ultrasonography and operative hysteroscopy or laparoscopy was verified in all 31 cases. Twenty-five uterine septa and 5 bicornuate uteri were diagnosed by hysteroscopy (3 false-positive diagnoses of bicornuate uterus, 1 unfeasible hysteroscopy). Hysteroscopic diagnosis was correct in 27/30 patients. Twenty-four septate uteri and 7 bicornuate uteri were diagnosed by MRI (5 false-positive diagnoses of bicornuate uterus). Two complete septate uteri diagnosed by MRI were finally confirmed as incomplete septate uteri after 3-D ultrasonography and operative hysteroscopy. MRI diagnosis was correct in 24/31 patients. CONCLUSION: Transvaginal 3-D ultrasonography appears to be extremely accurate for the diagnosis and classification of congenital uterine anomalies, more than office hysteroscopy and MRI. It may conveniently become the only mandatory step in the assessment of the uterine cavity in patients with a suspected septate or bicornuate uterus.

Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus.

BACKGROUND: The aim of this study was to describe the surgical approach to, and evaluate the reproductive outcome of, a T-shaped uterus. METHODS: The study included 97 women who were eligible for hysteroscopic surgery, by either monopolar or bipolar electrosurgical instruments. All had diagnostic hysteroscopy 2 months afterwards to assess the success of the procedure and determine whether any synechiae were present. RESULTS: Forty-eight women (49.5%) became pregnant after metroplasty. The overall live birth rate per pregnancy before surgery was 0%; for these patients, it increased to 73%, and their miscarriage rate fell from 78 to 27% (P < 0.05). For all 57 pregnancies in 48 women, the ectopic pregnancy rate was 9% (n = 5), the miscarriage rate 28% (n = 16), the preterm delivery rate 14% (n = 8), the term delivery rate 49% (n = 28) and the live birth rate was 63% (n = 36). CONCLUSIONS: Hysteroscopic metroplasty improves the live birth rate for women with a T-shaped uterus and a history of primary infertility, recurrent abortion or preterm delivery, although it is not a treatment of infertility.

3D ultrasound to assess the position of tubal sterilization microinserts.

BACKGROUND: The aim of this study was to assess the diagnostic accuracy of three-dimensional ultrasound (3D-US) for determining the position of Essure microinserts and the success of sterilization by the Essure method. METHODS: This retrospective observational study examined the case records of 311 women who underwent hysteroscopic sterilization from October 2002 through October 2008. Imaging with 3D-US or pelvic X-radiography or both was performed 3 months after the procedure to verify device position. Hysterosalpingography (HSG) was performed when a bilateral procedure was not completed because of a history of salpingectomy or blocked tube, when doubt persisted after 3D-US or pelvic radiography, or for comparative purposes in a prospective study. The positions seen on 3D-US were classified in four categories according to a specific scale we devised. RESULTS: The insertion procedure was completed in 94.2% patients. Only 90.5% underwent imaging verification of the device 3 months afterwards. In all, 227 3D-US, 175 pelvic radiography and 64 HSG imaging procedures were performed. Visualization of the device was possible in 99.6% of the 3D-US images. According to our classification, 3D-US was appropriate for assessing device position for 195 (85.9%) patients. The need for HSG confirmation was significantly lower with 3D-US than radiographic imaging (14.1 versus 26.8%, P = 0.001). 3D-US examinations, compared with the results of HSG as the reference test, had a sensitivity of 100% and a specificity of 76.6%. Neither pregnancy nor early expulsion occurred when 3D-US found that the devices were correctly placed. CONCLUSIONS: 3D-US is a simple technique for assessing the position of Essure(®) microinserts, even after concomitant endometrial surgery. The 3D-US classification presented here appears to make it possible to use HSG for back-up confirmation only when the microinsert is found in a very distal position on 3D-US and thus to protect the majority of women from the negative effects of pelvic radiography and HSG.

Ovarian drilling for surgical treatment of polycystic ovarian syndrome: a comprehensive review.

This systematic literature review is intended to clarify and evaluate the results obtained by ovarian drilling as surgical treatment for polycystic ovarian syndrome (PCOS). Four databases were consulted (Medline at the National Library of Medicine, USA; Cochrane Library, UK; National Guideline Clearinghouse, USA; and the Health Technology Assessment Database, Sweden) and searched for 'polycystic ovary syndrome' plus 'drilling' in the title or abstract. The assessment criteria used to define the efficacy of the procedure were the rates of ovulation, clinical pregnancy and early miscarriage. Alternatives to surgical ovarian drilling were evaluated. This search produced 147 references, 81 of which met the selection criteria. This review of infertility management in women with PCOS indicates that ovarian drilling is a second-line treatment when treatment with clomiphene citrate fails to lead to conception. The benefits of ovarian drilling are that it does not induce either hyperstimulation syndrome or multiple pregnancies. It is concluded that ovarian drilling is an option in the management of female infertility associated with PCOS, especially as a second-line treatment after the failure of clomiphene citrate treatment.

Transvaginal cervicoisthmic cerclage using a polypropylene sling: pregnancy outcome.

AIM: To report pregnancy outcome following prophylactic transvaginal cervicoisthmic cerclage using a polypropylene sling in a population of high-risk pregnant women. MATERIALS AND METHODS: A retrospective study with a continuous series of 57 women presenting with prior failure of McDonald cerclage (n = 47) and/or absent portio-vaginalis of the cervix (n = 10). RESULTS: Cervicoisthmic cerclage was performed between 12 and 16 weeks of gestation (median 14 weeks' gestation). No intraoperative complication occurred. Preterm labor treated with parenteral tocolysis occurred in 14 women (24%). Cesarean delivery was systematically performed. Median gestational age at delivery was 37.2 weeks' gestation (interquartile range: 36.5-38.0). Overall neonatal survival rate was 94%. CONCLUSION: Transvaginal cervicoisthmic cerclage using a polypropylene sling may be considered as an effective alternative to the transabdominal cervicoisthmic cerclage in women presenting with previous cerclage failure.

Tubal anastomosis after tubal sterilization: a review.

PURPOSE: To evaluate various techniques for restoring tubal patency after sterilisation. METHODS: A search strategy was designed, and for each subject either thesaurus terms (MeSH descriptors) or terms from the title or summary were used. RESULTS: Mean length of hospital stay following laparoscopy seems to be shorter in comparison with laparotomy (3.3 vs. 6.1 days, P < 0.05). Rate of conversion to laparotomy is 5%. Pregnancy rates observed are between 54 and 88% for laparotomy and 31-85% for laparoscopy. Mean time to conception was between 2 and 9.6 months. Most pregnancies occurred in the 2 years following restoration of tubal patency (cumulative conception rate 80% at 12 months). Young age (<35 years), type of ligature (rings), how recently the ligature was done (<8 years), the anastomosis site (in the middle of the tube) and a good length of remaining tube (>7 cm) are the factors that govern whether there can be good restoration of tubal patency. Ectopic pregnancy rates observed are between 1.7 and 12% for laparotomy and 0-7% for laparoscopy. There are no randomised or quasi-randomised studies comparing tubal anastomosis and in vitro fertilization. CONCLUSIONS: There are few good-quality controlled studies in this area. Results of restoration of tubal patency seem to be comparable, regardless of the route of approach (laparotomy or laparoscopy).

[Thermal balloon endometrial ablation for dysfunctional uterine bleeding: technical aspects and results. A prospective cohort study of 152 cases]. / Thermoablation de l'endometre par ballonnet pour menometrorragies fonctionnelles. Etude prospective d'une cohorte de 152 cas.

BACKGROUND: Thermal balloon endometrial ablation is a new operative technique recently proposed in the treatment of dysfunctional uterine bleeding. AIM: To evaluate the efficacy of thermal balloon endometrial ablation in the treatment of dysfunctional uterine bleeding, and to identify the possible predictive factors for a successful outcome. METHODS: A prospective study was conducted including 152 patients with chronic abnormal uterine bleeding refractory to medical treatment. All patients were treated by thermal balloon endometrial ablation (Thermachoice, Gynecare) between January 1, 1996 and December 31, 2003. patients were included if their uterine cavities sounded to less than 12 cm and had undergone hysteroscopy, pelvic ultrasound and endometrial biopsie showing no structural or (pre) malignant endometrial abnormalities. INTERVENTION: A balloon catheter was placed through the cervix and after inflation in the endometrial cavity with 5% dextrose in water, was heated to 87 +/- 5 degrees C. No one required cervical dilatation. Balloon pressures were 160 to 170 mm Hg. All patients underwent 8 minutes of therapy. RESULTS: The average patient was 47 years (range: 30-62 years) and was followed for a mean of 3 years and 7 months (range: 6 months - 8 years). 31.6% of women reported amennorhea, 16.5% hypomenorrhea and 21% eumenorrhea. Menorrhagea persisted in 11.2% of patients. No intraoperative complications and minor postoperative morbidity occured in 10.5% of patients. Three prgnancy complicated by spontaneous abortions were reported after the treatment. A total of 78% of women reported overall satisfaction with the endometrial ablation procedure and 18% were dissatisfied. 17.8% of patients underwent hysterectomy within 1 to 5 years of balloon endometrial ablation. Increasing age and menopause were significantly associated with increased odds of success (p < 0.05). CONCLUSION: Thermal balloon endometrial ablation is a simple, easy, effective, and minimally invasive procedure in menhorragic women with no desire for further childbearing. The chance of successful treatment is thightly depinding of several factors such as increased age and menopause, that shows the importance of patients selection. Although rare, pregnancy after endometrial ablation is possible. Women of reproductive age should have a post operative contraception method.

Is vaginal hysterectomy a risk factor for urinary incontinence at long-term follow-up?

OBJECTIVE: The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. STUDY DESIGN: One hundred and seventeen patients, who had a vaginal hysterectomy for menorrhagia, from January 1991 to December 2001, answered to a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. RESULTS: Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the two groups. Mean follow-up was 4.6+/-2.2 years (range 1.5-11) after vaginal hysterectomy and 4+/-1.8 years (range 1.5-7) after conservative treatment. The prevalence of urinary symptoms, included urge and stress incontinence, were statistically similar in the two groups. CONCLUSION: This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.

Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse.

OBJECTIVE: To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France). STUDY DESIGN: A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using polypropylene mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The polypropylene mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system. RESULTS: Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the mesh (8.3%); 4 necessitated a second procedure for partial excision of the mesh. CONCLUSION: Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.

Reproductive outcome after methotrexate treatment of tubal pregnancies.

OBJECTIVE: To evaluate reproductive outcome after ectopic pregnancy (EP) treated with methotrexate (MTX) and to assess the relative contribution of various risk factors to future fertility. DESIGN: Telephone follow-up interviews in a cohort of patients treated for EP. SETTING: University hospital. PATIENT(S): A cohort of 158 patients treated with MTX for tubal pregnancies between April 1991 and March 1999. INTERVENTION(S): Assessment of fertility outcomes. MAIN OUTCOME MEASURE(S): Cumulative pregnancy rates for intrauterine and ectopic pregnancies. RESULT(S): Thirty-two patients (20.2%) were lost to follow-up. Of 126 patients, 93 (73.8%) sought to become pregnant, and of these 93 women, 76 (81.7%) did. Sixty-four pregnancies were spontaneous, and 12 resulted from in vitro fertilization (IVF). No pregnancies occurred in the group not trying to become pregnant. Of the 64 spontaneous pregnancies, 52 (81.2%) were intrauterine, with 12 (18.7%) resulting in miscarriages, and 12 (18.7%) were recurrent ectopic pregnancies. The cumulative intrauterine pregnancy rate was 57.5% after 1 year and 66.9% after 2 years. The cumulative ectopic pregnancy rate was 15.4% after 1 year and 23.7% after 2 years. After adjusting for factors associated with fertility with a Cox regression, only one factor was associated with poor reproductive performance: previous history of infertility. CONCLUSION(S): Within 1 year of seeking to become pregnant, more than half the women previously treated medically for EP conceived and had ongoing pregnancies. Our analysis indicates that fertility depends more on the patients' previous medical history than on her treatment for EP.

Total hysterectomy for a nonprolapsed, benign uterus in women without vaginal deliveries.

OBJECTIVE: To compare the different techniques of hysterectomy for a nonprolapsed, benign uterus in women without vaginal deliveries. STUDY DESIGN: A retrospective study in a university hospital analyzed 148 total hysterectomies in women without vaginal deliveries performed from August 1991 to June 2000. Forty-four patients had had cesarean sections (29.7%), and 104 (70.3%) were nulliparous. Twenty-four patients had had abdominal myomectomies (16.2%). The vaginal route (group 1) was used for 77 patients (52%), 56 (37.8%) had laparotomies (group 2), and 15 (10.2%) had laparoscopically assisted vaginal hysterectomies (group 3). RESULTS: The uterine weight was 275 (+/- SD 140) g in group 1, 830 (+/- SD 1620) in group 2 and 331 (+/- SD 160) in group 3. Mean operation time was 87 (+/- SD 76) minutes in group 1, 96 (+/- SD 41) in group 2 and 112 (+/- SD 56) in group 3. There was one serious complication with the vaginal route (sigmoid injury). The hospital stay was 4 (+/- SD 3.1) days in group 1, 7.1 (+/- SD 3.8) in group 2 and 4.3 (+/- SD 1.5) in group 3. CONCLUSION: Vaginal hysterectomy for a nonprolapsed, benign uterus is indicated for women without vaginal deliveries and is feasible in 72% of cases in our recent experience, with a low complication rate. Training in vaginal surgery should allow safe performance of the procedure at most centers.

Methotrexate for the treatment of unruptured tubal pregnancy: a prospective nonrandomized study.

BACKGROUND AND OBJECTIVES: The aim of this study was to compare in a prospective nonrandomized study, the efficacy of 2 methods of administering methotrexate (MTX) in the treatment of ectopic pregnancy (EP): transvaginal injection under sonographic control or intramuscular injection (IM). METHODS: Patients with EP who met specific inclusion criteria for medical treatment were treated with MTX: 63 patients (group 1) were treated by IM and 47 patients (group 2) by transvaginal local injection. In group 1, 50 mg/m2 of MTX was injected intramuscularly; in group 2, transvaginal injection of 1 mg/kg of MTX was injected into the ectopic sac under sonographic control. When an additional dose of MTX was required, it was administrated IM at the dosage of 50 mg/m2 in both groups. RESULTS: The overall success rate, defined by a posttreatment normal hCG level (< 10 mUI/mL) was 71.4% in group 1 versus 91.5% in group 2 (P < 0.01); for patients with hCG levels < 2000 mUI/mL, 83% and 96%, respectively (not significant); for patients with hCG > or = 2000 mUI/mL, 37.5% and 86.4%, respectively (P < 0.01). CONCLUSION: In the medical treatment of EP, the efficacy of MTX is greater when administered by local transvaginal injection than by IM injection. We propose local treatment every time EP can be punctured, especially when hCG levels are > or = 2000 mUI/mL.

[Maternal-fetal transmission of HIV: preventive measures and prenatal care]. / La transmission materno-foetale du VIH: mesures préventives et prise en charge périnatale.

HIV can be transmitted to foetus during pregnancy, labour, and breastfeeding. An estimated 600,000 newborns acquired HIV each year through mother to fetus transmission. Without preventive interventions, approximately 25% of infants born to HIV positive mothers contract the virus. Elective delivery by caesarean section at 38th weeks, before labor and rupture of membrane, decreased the fetal risk. Anniotomy and long-standing rupture of the membranes should be avoided, as should breastfeeding. As well based on the review of literature the authors provide an overview of vertically acquired of HIV infection, preventive measures and perinatal car are discussed.

Surgical management of infertility due to polycystic ovarian syndrome after failure of medical management.

OBJECTIVES: To evaluate surgical management and fertility and pregnancy outcome in women with polycystic ovarian syndrome (PCOS). STUDY DESIGN: Retrospective file review and follow-up of 74 consecutive women with PCOS resistant to citrate clomiphene (CC) who underwent ovarian drilling by fertiloscopy with bipolar energy, together with hysteroscopic surgery when indicated (Canadian TASK FORCE II-2). RESULTS: Of 77 files, only 3 women were lost to follow-up. Mean age was 30.2 years (SD 5.3) [29.0-31.4 CI 95%], and mean BMI 25.6kg/m(2) (SD 6.2) [24.2-27.0 CI 95%]. Pregnancy occurred after drilling in 47 cases (63%), spontaneously in 20 (27%), after ovarian stimulation in 5 (6.7%) and after in vitro fertilization in 22 (29.7%). Laparoscopic conversion was required in 5 cases (6.7%), due to failure to visualize the adnexa (n=3), or pelvic adhesions (n=1), or uterine hemorrhage (n=1). Hysteroscopy detected and simultaneously treated a uterine anomaly in 18 of 74 patients: uterine septum (n=10, 13%), T-shaped uterine cavity (n=3, 4%), endometrial polyp (n=2, 2.7%), endometrial hypertrophy (n=2, 2.7%), and synechiae (n=1, 1.3%). The mean overall delay to pregnancy was 11.1 months (SD 8.5) [8.7-13.5 CI 95%] and to spontaneous pregnancy, 7 months (SD 7.6) [3.7-10.3 CI 95%]. The mean follow-up was 23.4 months (SD 16.5) [18.1-28.7 CI 95%]. After multivariate analysis, the likelihood of pregnancy was significantly associated with previous ovarian stimulation by FSH (OR=2.28, 95% CI=1.08-4.83) and initial FSH level (OR=0.52, 95% CI=0.29-0.93). CONCLUSION: Ovarian drilling by hydrolaparoscopy is an effective treatment for CC-resistant PCOS. The high rate of associated uterine anomalies justifies simultaneous hysteroscopic surgery.

Laparoscopic ovarian drilling using a 5-French bipolar energy probe.

OBJECTIVE: To report a new technique of laparoscopic ovarian drilling using a 5-Fr bipolar electrode. DESIGN: Retrospective study (case series). SETTING: University hospital. PATIENT(S): Patients presenting with polycystic ovarian syndrome. INTERVENTION(S): Laparoscopic ovarian drilling using a 5-Fr bipolar probe. MAIN OUTCOME MEASURE(S): Feasibility of operative technique. RESULT(S): No perioperative complication was noted. CONCLUSION(S): We describe a new technique of laparoscopic ovarian drilling using a bipolar electrosurgical probe.

Fertility outcome following transvaginal cervicoisthmic cerclage using a polypropylene sling.

OBJECTIVE: To report fertility and pregnancy outcomes following transvaginal cervicoisthmic cerclage with a polypropylene sling during a previous pregnancy. METHODS: A continuous series of 57 women who underwent prophylactic cervicoisthmic cerclage during a previous (reference) pregnancy were enrolled. Telephone interviews were carried out to evaluate each patient's subsequent fertility. RESULTS: Among the 57 women interviewed, 8 had an inadequate follow-up, 13 women were lost to follow-up, 1 woman required a hemostatic hysterectomy, and 2 women required removal of the sling. Nineteen women did not desire a subsequent pregnancy. Of the 14 women who did desire a subsequent pregnancy, 1 woman had previously known tubal infertility. Of the 13 remaining women, 7 subsequently became pregnant. One woman had a spontaneous abortion (11 weeks of pregnancy); 1 woman delivered at 22 weeks of pregnancy, after a spontaneous premature membrane rupture; 1 woman had a cesarean delivery at 25 weeks of pregnancy; and 4 patients had a cesarean delivery after 37 weeks of pregnancy. Median duration of the 4 subsequent pregnancies at delivery was 37 weeks (interquartile range [IQR], 37-38 weeks). Median birth weight was 3040 g (IQR, 2500-3250 g). CONCLUSION: Subsequent pregnancy is possible after transvaginal cervicoisthmic cerclage using a synthetic sling.