Search

Objective: Intrauterine pressure catheter (IUPC) is the primary device used to evaluate uterine activity. In contrast to the IUPC, electrical uterine myography (EUM) enables noninvasive measurement of frequency, intensity, and tone of contractions. The aim of this study was to determine the accuracy of EUM compared to IUPC. Study Design: EUM measured myometrial electrical activity using a multichannel amplifier and a noninvasive position sensor. In all, 47 women in labor were monitored simultaneously with an IUPC and EUM. We compared the frequency, intensity, and tone of uterine contractions between the methods. Results: The correlation of the frequency, intensity, and tone of contractions between uterine electromyography and IUPC was strong with significant r values of 0.808-1 (P < .0001). Conclusion: Electrical uterine electromyography yields information about uterine contractility comparable to that obtained with IUPC. [Copyright &y& Elsevier]

An abstract of the article "Pipelle endometrial assessment: how effectively does it yield a diagnosis?" by A. Dutta, A. Balachandran, and A. Davies is presented.

Objective: The purpose of this study was to establish the validity of sonographic evaluation of lower uterine segment (LUS) thickness for complete uterine rupture. Study Design: A prospective cohort study of women with previous cesarean delivery was conducted. LUS thickness (full thickness and myometrial thickness only) was measured between 35 and 38 weeks gestation, and the thinnest measurement was considered to be the dependent variable. Receiver operating curve analyses and logistic regression were used. Results: Two hundred thirty-six women were included in the study. Nine uterine scar defects (3 cases of complete rupture during a trial of labor and 6 cases of dehiscence) were reported. Receiver operating curve analyses showed that full thickness of <2.3 mm was the optimal cutoff for the prediction of uterine rupture (3/33 vs 0/92; P = .02). Full thickness was also identified as an independent predictor of uterine scar defect (odds ratio, 4.66; 95% confidence interval, 1.04–20.91) Conclusion: Full LUS thickness of <2.3 mm is associated with a higher risk of complete uterine rupture. [Copyright &y& Elsevier]

Abstract: Background: Cystic adenomyosis is an extremely rare form of adenomyosis, particularly in the pediatric population. We report a unique case of an adenomyotic cyst in an adolescent girl. Case: A 16-year-old G0P0 presented with cyclic pelvic pain. Ultrasonography demonstrated a large cystic lesion, which was localized to the myometrium on computed tomography and magnetic resonance imaging. The lesion was surgically excised and confirmed to be cystic adenomyosis by pathology. Summary and Conclusion: Cystic adenomyosis is a rare cause of abdominopelvic pain and dysmenorrhea in adolescents. Imaging is key in distinguishing this disease from other congenital and acquired gynecological disorders. Awareness of this condition is important for timely, accurate diagnosis and intervention. [Copyright &y& Elsevier]

Objective: To describe incorrect positions of Essure microinserts detected at 3 months' follow-up. Design: Case report. Setting: Outpatient department of obstetrics and gynecology in a Dutch teaching hospital. Patient(s): Initial series of 100 patients who underwent hysteroscopic sterilization using Essure between December 2003 and June 2004. Intervention(s): Hysteroscopic placement of the Essure System, follow-up at 3 months with transvaginal ultrasound (TVU), and hysterosalpingography. Main Outcome Measure(s): Bilateral placement rate, tubal obstruction, and detection of incorrect Essure microinsert localization at follow-up after apparent successful bilateral placement. Result(s): Bilateral placement of Essure microinserts in one session was successful in 93 women (93%). In 90 of these women (96.8%), tubal obstruction was proven at follow-up 3 months later. Three incorrect positions of an Essure insert were seen: two expulsions and one perforation into the abdominal cavity. Conclusion(s): Incorrect position of Essure microinserts was seen only when the initial placement procedure was difficult. When a placement procedure was difficult or other suboptimal conditions are present during the procedure, we advise performing a TVU or pelvic X-ray in these women 4 weeks after the procedure or after the first vaginal bleeding, instead of waiting for follow-up after 3 months. [ABSTRACT FROM AUTHOR]

The article presents abstracts from the 12th World Congress on Menopause from May 19-23, 2008, which include topics on the relationship between endometrial thickness and pathology in women with postmenopausal bleeding, endometrial carcinoma, and hysteroscopy in women with postmenopausal bleeding.

Objective: This study was undertaken to evaluate transtubal fluid leakage after low pressure office saline solution hysteroscopy. Study Design: Forty stage I/II endometrial cancer patients were submitted to office hysteroscopy at the National Cancer Institute of Milan. Uterine cavity was distended by a 1000-mL saline solution bag, placed 50 cm above the patient’s plane. After visualization of uterine cavity, a radiotracer (technetirum Tc 99m) and patent blue dye were injected subendometrially. During the staging surgery peritoneal free fluid was analyzed to detect patent blue dye, technetium Tc 99m or free cancer cell by cytologic examination. Results: Technetium Tc 99m and patent blue dye were detected on the peritoneal surface and in the peritoneal fluid in 2 patients. In 1 of these peritoneal cytology was negative for cancer cells. Peritoneal cytology was positive in 2 cases. Conclusion: The risk of transtubal fluid leakage during hysteroscopy is absent when performed with intrauterine pressure less than 40 mm Hg. Transtubal fluid leakage is not a synonym of cancer cell dissemination. [Copyright &y& Elsevier]

: BACKGROUND The aims of this study were to find an ultrasonically echogenic material to study the uterine activity, and to test whether closing the vaginal speculum on the cervix prevents the displacement of the injected material. : METHODS A concentrated sperm suspension was used as an ultrasonically visible material. Forty-five women undergoing intrauterine insemination were randomized into: open speculum group (n = 23) and closed speculum group (n = 22). Mimicking embryo transfer, 50 ul of concentrated sperm suspension was injected intrauterine while the vaginal speculum was open in 23 patients. In the other group, the two blades of the vaginal speculum were closed on the cervix, then 50 ul of concentrated sperm suspension was injected. The ultrasonically visible material was observed in the uterine cavity for 10 min during which the procedure was video-recorded. : RESULTS The injected sperm suspension was clearly visible in all cases. In the closed speculum group, the echogenic droplet remained in the upper uterine segment in 18 cases (82%) and moved towards the lower uterine segment in six cases (18%). In the open speculum group, the echogenic droplet remained in the upper uterine segment in only six cases (26%) and it moved towards the lower uterine segment and passed through the cervical canal in 17 cases (74%). : CONCLUSIONS For the first time in the medical literature, a concentrated sperm suspension was used as an ultrasonographically visible material to study uterine activity. Closing the portio-vaginalis of the cervix prevents the displacement of the injected material. [ABSTRACT FROM AUTHOR]

BACKGROUND: To compare the tolerability and feasibility of the transvaginal and standard approaches in outpatient diagnostic hysteroscopy. METHODS: This randomized prospective trial was carried out in two centres to compare the transvaginal (n = 200) and conventional (n = 200) approaches during outpatient hysteroscopy. Patients were randomized by a computer-generated list. The main outcome measure was pain during the examination, measured on a visual analogue scale (VAS) graded from 0 to 10 (0 = lowest, 10 = highest). Secondary criteria were ease of instrument passage through the cervix, investigation quality and its duration. For data analysis, we used the chi-squared test or Fischer’s exact test for qualitative variables and the Mann-Whitney U-test for quantitative variables. RESULTS: Median VAS was rated at 0.5 for the vaginoscopic and 2 for the standard (P < 0.0001) approaches. The approaches did not differ significantly in investigation quality, procedure duration or ease of cervical passage (although the latter was more often easy transvaginally). CONCLUSIONS: The transvaginal approach is better tolerated than the conventional technique in outpatient diagnostic hysteroscopy. [ABSTRACT FROM AUTHOR]

Objective: To report the case of an infertile female patient with cystic fibrosis who was diagnosed with endocervical metaplasia of the endometrium at diagnostic hysteroscopy and successfully treated with an oral estroprogestinic formulation. Design: Case report. Setting: University hospital. Patient(s): A 27-year-old infertile female patient with cystic fibrosis. Intervention(s): Hysteroscopy with multiple random biopsies was performed at the time of the first visit and after a 10-month cycle with an oral estroprogestinic formulation. Main Outcome Measure(s): Hysteroscopic evaluation with target biopsy; histological examinations of endometrial specimens. Result(s): Our patient benefited from a 10-month cycle with an oral estroprogestinic formulation. At the control visit we noticed a significant improvement in the hysteroscopic appearance of her endometrium, and the histological examination confirmed the complete reversion of the metaplastic alterations previously observed. Conclusion(s): The present report suggests a novel histological alteration possibly involved in affecting fertility in women with cystic fibrosis. In addition, the positive response to the estroprogestinic treatment observed in our patient poses new questions regarding the relationship between ovarian hormones and cystic fibrosis transmembrane conductance regulator protein regulation, offering interesting perspectives for a hormonal therapy in the treatment of subfertility in women with cystic fibrosis. [Copyright &y& Elsevier]

The article presents a case study on severe pelvic infection following diagnostic hysteroscopy in women with pre-existing tubal disease. A 55-year-old woman who had previously been treated for many years with danazol for severe endometriosis presented with irregular vaginal bleeding. She was admitted for a diagnostic hysteroscopy and biopsy under a general anaesthetic using saline for distension. She was treated with intravenous gentamicin and metronidazole. She made a quick recovery. On review in clinic 6 weeks later her tenderness had gone and the cystic lesions had disappeared.

Responds to comments made on the authors' article concerning an experimental model of gastroschisis using fetoendoscopy. Distinction between amniotic fluid (AF) exchange and amnioinfusion; Methods to lower the intraamniotic meconium concentration; Strategies to minimize repetitive utero puncture and perform the AF exchange several times, far more often than actually acceptable in clinical practice.

Presents a letter to the editors of the 'American Journal of Obstetrics and Gynecology' replying to comments made by Franklin Loffer regarding an article by the author which showed that the direct visualization of the uterine cavity provides a better triage than saline hysterography.

Presents a letter to the editors of the 'American Journal of Obstetrics and Gynecology' regarding an article by L.M. Mihm, et al, which showed that the direct visualization of the uterine cavity provides a better triage than saline hysterography.

The article presents research which dealt with the routine diagnostic hysteroscopy that is not necessary for premenopausal women with abnormal uterine bleeding. Endometrial biopsy has been assessed to sample only a small percentage of the endometrial tissue with a lower sensitivity for focal and pedunculated lesions. It has been recommended that failure to detect intracavity lesions could be decreased or even eliminated by complementing endometrial sampling with outpatient hyteroscopy. The researchers also analyzed whether adding hysteroscopy to the evaluation routinelt would provide clinical benefit.

The article presents a gynecology case report involving Rokitansky-Kuster-Hauser syndrome. It focuses on a 35-year old woman who has been suffering from pelvic pain for 10 years. The syndrome, characterized by an absence of the uterus, has been associated with an abnormality on the chromosomes and on the development of uterine fibroids. It claims that the chromosomal abnormality found during ultrasonic diagnosis has made the case unique.

The article cites a study which examines the level of anxiety in women undergoing outpatient hysteroscopy. It uses 30 women who undergone their first outpatient hysteroscopy by giving them a questionnaire. The anxiety levels of women are measured using the Spielberger State-Trait Anxiety Index. The result indicates that women's anxiety is high before their outpatient hysteroscopy procedures, and suggests the importance of providing information to patients who will undergo hysteroscopy.

Provides information on research conducted on home uterine monitoring used in preventing premature deliveries. Information on how this research was conducted; Pregancy outcomes from using uterine monitoring.