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Welykholowa K, Allaire C, Fisher S, Epp A, Lee CE. Safety and Efficiency Outcomes of Ambulatory Gynaecologic Procedures in Canadian Surgical Centres Adopting a Common Model. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102336. [PMID: 38159680 DOI: 10.1016/j.jogc.2023.102336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The present study aims to compare the safety and efficiency outcomes of ambulatory gynaecologic procedures performed under conscious sedation and/or local anaesthetic at 2 Canadian institutions. METHODS A retrospective cohort study was completed over 1-year on patients presenting to the ambulatory care centres at 2 Canadian institutions that shared a common care model. Outcomes of interest were lead time (registration to discharge), procedural time, and intraoperative complications. Surgical data was derived from a retrospective chart review and outcomes were compared using the independent t test and one-way analysis of variance. RESULTS A total of 1495 and 1098 patients presented to the 2 sites. The average age of patients was 35.5 ± 12.3 years and 41.7 ± 10.2 years. The most commonly performed procedures were dilatation and curettages at the first centre and operative hysteroscopies at the second centre. Average lead times were similar: 170.3 ± 35.8 minutes and 171.6 ± 45.4 minutes (P = 0.45). There was a significant difference in mean procedural time being 9.8 ± 5.5 minutes and 17.0 ± 10.0 minutes (P < 0.001). The rate of minor intraoperative complications was 3.8% and 6.6% (P = 0.002); whereas the rate of major complications was 2.7% and 3.3% (P = 0.43). CONCLUSION In Canada, the majority of gynaecologic procedures are performed under general anesthesia. By comparing outcomes at 2 separate Canadian centres, we demonstrated the reproducibility of a common ambulatory model for minor gynaecologic procedures, supporting the implementation of similar care models across Canada.
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Affiliation(s)
- Kaylie Welykholowa
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie Fisher
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Annette Epp
- Department of Obstetrics and Gynaecology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Caroline E Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
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Cohen N, Nasra LA, Paz M, Kaufman Y, Lavie O, Zilberlicht A. Pain and anxiety management with virtual reality for office hysteroscopy: systemic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1127-1134. [PMID: 37917158 DOI: 10.1007/s00404-023-07261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Office hysteroscopy (OH) is a commonly performed procedure, although it might be associated with some degree of pain and anxiety. Our aim was to determine the effects of virtual reality on pain and anxiety levels felt by patients undergoing OH. METHODS MEDLINE, Embase, Google Scholar, Cochrane Library, clinicaltrials.gov, ProQuest, Grey literature, and manual searching of references within studies found in the initial search were systematically searched using the terms 'Virtual Reality' and 'Hysteroscopy' without time or language limitations. The review considered all studies assessing the impact of virtual reality (VR) over OH outcomes, and prospective randomized trials were included in the meta-analysis. Retrospective and case - control studies were excluded from the meta-analysis. RESULTS We identified 17 studies, of which four randomized controlled studies were included in the meta-analysis (327 participants, 168 in the VR group and 159 in the control group). On a 0-10 scale, pain sensation and maximal pain sensation during the operation were not statistically different between study and control groups (relative risk (RR) = -0.64, 95% C.I (-1.57)0.29) and (RR = -0.93, 95% C.I (-3.33) - 1.47), respectively. Anxiety measurement was statistically lower in the study group (RR = -1.73, 95% C.I (-2.79) - ( -0.67)). CONCLUSIONS The available data suggest that VR techniques do not decrease the pain sensation during OH however, they do contribute to a reduction in the anxiety levels experienced by patients. PROSPERO registration number CRD42023432819.
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Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel.
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel.
| | - Lelia Abu Nasra
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Moran Paz
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Yuval Kaufman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
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3
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Martire FG, Labanca L, Giorgi M, Selntigia A, Russo C, Centini G, Ginetti A, D’Abate C, Capriglione S, Exacoustos C, Catania F, Zupi E, Lazzeri L. The role of hysteroscopy with morcellator without anesthesia in the management of abnormal uterine bleeding. J Turk Ger Gynecol Assoc 2024; 25:1-6. [PMID: 38444293 PMCID: PMC10921079 DOI: 10.4274/jtgga.galenos.2023.2023-7-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/03/2023] [Indexed: 03/07/2024] Open
Abstract
Objective To evaluate the feasibility of hysteroscopy with morcellator without anesthesia and the diagnostic accuracy of 2D, 3D and power Doppler transvaginal sonography (TVS) in patients with abnormal uterine bleeding (AUB). Material and Methods This was a retrospective study including women with AUB. All patients underwent 2D, 3D and power Doppler TVS evaluation of the uterine cavity, and patients with suspicion on ultrasound (US) of endometrial pathology (EP) underwent hysteroscopy with morcellator without anesthesia. The painful symptomatology was assessed during the procedure using a visual analogue scale (VAS). Additionally, histological evaluation was performed. Results A total of 182 women underwent US imaging, of whom 131 (72%) had hysteroscopy. 130/131 patients completed the hysteroscopic examination with good compliance (VAS <4). One patient (0.8%) was unable to complete the procedure due to nulliparity and cervical stenosis. Of the 130 patients the US diagnosis was confirmed in 120 (92.3%), while in 10 patients (7.7%) the hysteroscopic diagnosis was different from the US diagnosis. Histological examination confirmed benign endometrial polyps in 115/130 patients (88.5%), while premalignant conditions were diagnosed in 3/130 patients (2.3%) and malignant conditions in 2/130 (1.5%). Of the 10 patients with endometrial thickening, two were diagnosed with a malignant condition. Conclusion This study confirmed the feasibility of managing patients with AUB and suspicion of EP using "see-and-treat" hysteroscopy with morcellator without anesthesia. This procedure has the potential to yield desired outcomes while minimizing pain and discomfort, presenting a feasible outpatient approach for both treating and preventing endometrial carcinoma without requiring anesthesia.
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Affiliation(s)
- Francesco Giuseppe Martire
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Luca Labanca
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Aikaterini Selntigia
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Consuelo Russo
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Alessandro Ginetti
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Claudia D’Abate
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Stella Capriglione
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Caterina Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecology of Unit, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Catania
- Department of Surgical Sciences, Gynecological Unit, Valdarno Hospital, Montevarchi, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy
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Etrusco A, Buzzaccarini G, Laganà AS, Chiantera V, Vitale SG, Angioni S, D’Alterio MN, Nappi L, Sorrentino F, Vitagliano A, Difonzo T, Riemma G, Mereu L, Favilli A, Peitsidis P, D’Amato A. Use of Diode Laser in Hysteroscopy for the Management of Intrauterine Pathology: A Systematic Review. Diagnostics (Basel) 2024; 14:327. [PMID: 38337843 PMCID: PMC10855490 DOI: 10.3390/diagnostics14030327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Hysteroscopy currently represents the gold standard for the diagnosis and treatment of intrauterine pathologies. Recent technological progress has enabled the integration of diagnostic and operative time, leading to the "see and treat" approach. Diode laser technology is emerging as one of the most innovative and intriguing techniques in this context. Methods: A comprehensive search of the literature was carried out on the main databases. Only original studies reporting the treatment of intrauterine pathologies using diode laser were deemed eligible for inclusion in this systematic review (PROSPERO ID: CRD42023485452). Results: Eight studies were included in the qualitative analysis for a total of 474 patients undergoing laser hysteroscopic surgery. Eighty-three patients had female genital tract abnormalities, 63 had submucosal leiomyomas, 327 had endometrial polyps, and one patient had a scar pregnancy. Except for leiomyomas, whose technique already included two surgical times at the beginning, only seven patients required a second surgical step. Cumulative rates of intraoperative and postoperative complications of 2.7% and 0.6%, respectively, were reported. Conclusions: Diode laser through "see and treat" hysteroscopy appears to be a safe and effective method. However, additional studies with larger sample sizes and improved designs are needed to consolidate the evidence currently available in the literature.
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Affiliation(s)
- Andrea Etrusco
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
- Unit of Gynecologic Oncology, National Cancer Institute IRCCS Fondazione “G. Pascale”, 80131 Naples, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy; (L.N.); (F.S.)
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy; (L.N.); (F.S.)
| | - Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
| | - Tommaso Difonzo
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Liliana Mereu
- Unit of Obstetrics and Gynecology, Department of General Surgery and Medical-Surgical Specialism, University of Catania, P.O. “G. Rodolico”, Via Santa Sofia, 78, 95123 Catania, Italy;
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06135 Perugia, Italy;
| | - Panagiotis Peitsidis
- Department of Obstetrics and Gynecology, Helena Venizelou Hospital, 11521 Athens, Greece;
| | - Antonio D’Amato
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
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van Wessel S, Hamerlynck T, van Vliet H, Weyers S, Schoot B. Clinical evaluation of a new hand-driven hysteroscopic tissue removal device, Resectr ™ 5fr, for the resection of endometrial polyps in an office setting. Arch Gynecol Obstet 2023; 308:893-900. [PMID: 36920533 DOI: 10.1007/s00404-023-06995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE A first clinical evaluation of a new hand-driven hysteroscopic tissue removal device, Resectr™ 5fr, for office polypectomy without any anesthesia. METHODS Women with at least one small endometrial polyp were eligible. Hysteroscopic polypectomy was performed using the Resectr™ 5fr in an office setting, without any anesthesia. RESULTS One hundred and two hysteroscopic polypectomies were included in the analysis. The median installation time was 1.9 min (95% confidence interval (CI) 1.6-2.1). The median time to complete polyp removal was 1.2 min (95% CI 0.8-1.6). The median surgeon's safety, practical, and comfort scores on a 5-point Likert scale were high (5 (5-5), 5 (4-5), and 5 (4-5), respectively). Women's pain score was low (median 1 (0-3)), whereas the satisfaction rate was high (median 5 (5-5)), both on a 5-point Likert scale. There were two conversions (hysteroscopic scissors (n = 1), a new Resectr™ 5fr device (n = 1)). There was one incomplete procedure (tissue hardness). CONCLUSION Hysteroscopic removal of small polyps, using the [Formula: see text] 5fr in an office setting is feasible in terms of installation and resection time. Surgeon's practical, comfort, and safety scores are high, whereas women report low pain scores and high satisfaction rates. TRIAL REGISTRATION: Dutch Clinical Trial Registry (NTR 7119, NL6923): https://www.trialregister.nl/trial/6923 . Date of registration: 27/03/2018.
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Affiliation(s)
- Steffi van Wessel
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Tjalina Hamerlynck
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Huib van Vliet
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Steven Weyers
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Benedictus Schoot
- Women's Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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6
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Abd-ElGawad M, Abdelsattar NK, Kamel MA, Sabri YA, Fathy EM, El-Moez NA, Abdellatif YS, Metwally AA. The effect of music intervention in decreasing pain and anxiety during outpatient hysteroscopy procedure: a systematic review and meta-analysis of randomized control trials. BMC Womens Health 2023; 23:360. [PMID: 37408035 DOI: 10.1186/s12905-023-02489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 06/17/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Hysteroscopy is a common outpatient procedure but procedural pain limits its use. Music could be used as a pain-relieving intervention. We performed a systematic review and meta-analysis to investigate the effect of music on pain and anxiety during outpatient hysteroscopy. METHODS Four electronic databases were searched: PubMed, Scopus, Web of Science, and Cochrane Library, from inception to September 2022. We included only the Randomized Controlled Trials (RCTs) that investigated the effect of music on women who underwent outpatient hysteroscopy in reducing pain and anxiety levels compared to no music. We assessed the quality of included RCTs using the risk of bias tool 1 reported in the Cochrane Handbook of Systematic Reviews of Interventions. Data were pooled as the Mean Differences (MDs) with a 95% Confidence Interval (CI) in a random-effects model, using Review Manager 5.3 software. Also, we assessed the evidence of the results using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Three RCTs (540 women) were included. Music significantly reduced visual analogue scale (VAS) pain scores as well as State-Trait Anxiety Inventory (STAI) scores compared to controls (MD = -1.28; 95% CI [-2.19, -0.36]; P = 0.007) and (MD = -3.91; 95% CI [-6.98, -0.85]; P = 0.01) respectively. Also, the decrease in VAS score for pain was significantly greater in the music group (MD = 1.44; 95% CI [0.44, 2.45]; P = 0.005). However, the change in STAI showed no significant difference between the two groups. The GRADE ratings for all outcomes were very low. CONCLUSION Music is a potentially promising method for controlling pain for patients undergoing outpatient hysteroscopy; however, its effect in controlling anxiety is controversial.
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Affiliation(s)
| | | | | | | | | | | | | | - Ahmed A Metwally
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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7
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Coimbra AC, Falcão V, Pinto P, Cavaco-Gomes J, Fernandes AS, Martinho M. Predictive Factors of Tolerance in Office Hysteroscopy - a 3-Year Analysis from a Tertiary Center. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:38-42. [PMID: 36878251 PMCID: PMC10021004 DOI: 10.1055/s-0043-1764361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE Pain is the primary limitation to performing hysteroscopy. We aimed to evaluate the predictive factors of low tolerance to office hysteroscopic procedures. METHODS Retrospective cohort study of the patients who underwent office hysteroscopy from January 2018 to December 2020 at a tertiary care center. Pain tolerance to office-based hysteroscopy was subjectively assessed by the operator as terrible, poor, moderate, good, or excellent. Categorical variables were compared with the use of the Chi-squared test; an independent-samples t-test was conducted to compare continuous variables. Logistic regression was performed to determine the main factors associated with low procedure tolerance. RESULTS A total of 1,418 office hysteroscopies were performed. The mean age of the patients was 53 ± 13.8 years; 50.8% of women were menopausal, 17.8% were nulliparous, and 68.7% had a previous vaginal delivery. A total of 42.6% of women were submitted to an operative hysteroscopy. Tolerance was categorized as terrible or poor in 14.9% of hysteroscopies and moderate, good, or excellent in 85.1%. A terrible or poor tolerance was more frequently reported in menopausal women (18.1% vs. 11.7% in premenopausal women, p = 0.001) and women with no previous vaginal delivery (18.8% vs. 12.9% in women with at least one vaginal birth, p = 0.007). Low tolerance led more often to scheduling a second hysteroscopic procedure under anesthesia (56.4% vs. 17.5% in reasonable-to-excellent tolerance, p < 0.0005). CONCLUSION Office hysteroscopy was a well-tolerated procedure in our experience, but menopause and lack of previous vaginal delivery were associated with low tolerance. These patients are more likely to benefit from pain relief measures during office hysteroscopy.
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Affiliation(s)
- Ana Carolina Coimbra
- Department of Gynecology, Centro Universitário Hopitalar de São João, Porto, Portugal
| | - Vera Falcão
- Department of Gynecology, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Pedro Pinto
- Department of Gynecology, Centro Universitário Hopitalar de São João, Porto, Portugal.,Department of Anatomy, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal
| | - João Cavaco-Gomes
- Department of Gynecology, Centro Universitário Hopitalar de São João, Porto, Portugal
| | - Ana Sofia Fernandes
- Department of Gynecology, Centro Universitário Hopitalar de São João, Porto, Portugal
| | - Margarida Martinho
- Department of Gynecology, Centro Universitário Hopitalar de São João, Porto, Portugal
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8
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Evaluating the Effectiveness of Pharmacological Strategies and Further Measures for Pain Relief during Hysterosonosalpingography: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12123185. [PMID: 36553192 PMCID: PMC9777723 DOI: 10.3390/diagnostics12123185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/19/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
This systematic review aims to evaluate the effectiveness of pharmacological and non-pharmacological strategies for pain relief in women during contrast-enhanced ultrasound for the assessment of tubal patency and uterine disease, compared with placebo or no intervention. In December 2021, we searched the electronic databases (Pubmed, Embase, Sciencedirect, the Cochrane library and Clinicaltrials.gov) without date restriction: We identified 10 randomized control trials (RCTs) (2098 women) eligible for this systematic review, after applying our inclusion and exclusion criteria. Among these, five studies compared the use of painkillers with the placebo, two studies compared different catheter positions in the cervix or in the uterine cavity, and two others considered different temperatures of the contrast medium, as a method to reduce pain. Topical lidocaine applied before the procedure may be associated with effective pain relief during hysterosonography, though the quality of this evidence is low. New echogenic contrast agents and their temperature at 37 °C ensure a less painful procedure. There is insufficient evidence to draw conclusions on the efficacy of other analgesics or strategies.
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9
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Kovalak EE. Does “no-touch” technique hysteroscopy increase the risk of infection? Turk J Obstet Gynecol 2022; 19:145-151. [PMID: 35770455 PMCID: PMC9249365 DOI: 10.4274/tjod.galenos.2022.04272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Today, thanks to its many advantages, hysteroscopy with a vaginoscopic approach (no-touch) is increasingly being used more in outpatient diagnoses and treatments. However, there are concerns that the “no-touch” technique increases ascending genital tract infections since a speculum is not inserted, and disinfection of the cervix cannot achieve. Materials and Methods: Between 2011 and 2017, 302 patients who underwent office hysteroscopy with the vaginoscopic approach (group 1) and 254 patients who underwent hysteroscopy with the standard method under anesthesia in the operating room (group 2) were compared in terms of early complications (within two weeks postoperatively). The primary outcome was early postoperative infection, and the secondary outcome was other early complications, such as bleeding and rupture. Results: In this study, the success rate of hysteroscopy with the vaginoscopic approach was 96.4%. According to the visual analog scale scoring system, 88.7% of the patients described mild-to-moderate pain. When group 1 and 2 were compared in terms of postoperative infection (3% and 2.4%, respectively) and other early complication rates (0% and 0.8%, respectively), no statistically significant difference was found (p>0.05). Conclusion: Hysteroscopy with a vaginoscopic approach continues to be the gold standard method that is safe and well-tolerated by patients.
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10
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Zhong W, Chen C, Tang W. Effective Doses of Nalbuphine Combined with Propofol in Painless Hysteroscopy. Int J Gen Med 2022; 15:5609-5614. [PMID: 35719419 PMCID: PMC9199904 DOI: 10.2147/ijgm.s367449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Nalbuphine is becoming a common analgesic used in hysteroscopic operations. The aim of this study was to identify the median effective dose (ED50) and 95% effective dose (ED95) of nalbuphine combined with propofol in painless hysteroscopy. Patients and Methods Twenty-five patients aged 18–60 years with an American Society of Anesthesiologists classification of I–II who were scheduled for painless hysteroscopy were recruited. The initial dose of nalbuphine was set at 0.15 mg/kg and varied by 0.01 mg/kg according to the Dixon sequential method. The ED50/ED95 of nalbuphine combined with propofol for hysteroscopy was calculated by the probit method. Results The ED50 of nalbuphine was 0.122 (95% confidence interval (CI) 0.092–0.137) mg/kg, and the ED95 of nalbuphine was 0.153 (95% CI 0.138–0.361) mg/kg. Conclusion The ED50/ED95 values of nalbuphine combined with propofol in painless hysteroscopy are 0.122 mg/kg and 0.153 mg/kg, respectively. Nalbuphine at 0.153 mg/kg combined with propofol is effective and safe for painless hysteroscopy.
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Affiliation(s)
- Weiwei Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Chen Chen
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Weixiang Tang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
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De Silva PM, Carnegy A, Graham C, Smith PP, Clark TJ. Conscious sedation for office hysteroscopy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 266:89-98. [PMID: 34600190 DOI: 10.1016/j.ejogrb.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the role of conscious sedation on pain control in office hysteroscopy. METHODS MEDLINE, EMBASE, CINAHL and CENTRAL were searched from inception to the 30th October 2020 in order to perform a systematic review and meta-analysis of all randomized controlled trials investigating women undergoing office hysteroscopic procedures, allocated to either conscious sedation or a suitable comparator, where the outcome was pain. Data regarding adverse events, feasibility and satisfaction/acceptability were also collected. The Risk of Bias 2 tool was used to assess study quality. Standard mean differences (SMD) or Odds Ratios (OR), and their 95% confidence intervals (CIs) were calculated for continuous (e.g. mean pain) and dichotomous (e.g. side-effects) outcomes, respectively. RESULTS The literature search returned 339 results, of which seven studies were included for systematic review, with five studies having data suitable for meta-analysis. Intravenous conscious sedation, when compared with local anesthesia, reduced pain during (SMD -0.26, 95% CI -0.51 to -0.01), but not after (SMD -0.18, 95% CI -0.43 to 0.07) office hysteroscopy. No significant difference in side-effects were noted (OR 15.58, 95% CI 0.08 to 2891.91). Intravenous conscious sedation, when compared to an oral analgesic and antispasmodic, was associated with increased pain, both during (SMD 1.03, 95% CI 0.56 to 1.49) and after (SMD 0.49, 95% CI 0.04 to 0.93) hysteroscopy and had significantly more side-effects (OR 134.33, 95% CI 16.14 to 1118.17). Inhalational conscious sedation (70% N2O/30% O2), when compared to oral analgesia and anxiolysis, showed the greatest reduction in pain during hysteroscopy (SMD -1.04, 95% CI -1.57 to -0.52), however side-effects were not reported. Whilst patients and hysteroscopists were more satisfied with deeper levels of sedation, resulting side-effects, such as delirium, increased the level of post-procedural attention required, leading to a significantly lower level of satisfaction amongst nursing staff. CONCLUSION The routine use of conscious sedation in contemporary hysteroscopic practice should be avoided in the absence of any clear reduction in pain and a higher risk of side-effects.
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Affiliation(s)
- Prathiba M De Silva
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
| | - Alasdair Carnegy
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Christopher Graham
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Paul P Smith
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham Women's Hospital, Mindelsohn Way, Birmingham B15 2TG, UK
| | - T Justin Clark
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham Women's Hospital, Mindelsohn Way, Birmingham B15 2TG, UK
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Nanayakkara P, Xiao J, Aref-Adib M, Ades A. Increasing the adoption of ambulatory hysteroscopy in Australia - cost comparisons and patient satisfaction. J OBSTET GYNAECOL 2021; 42:509-513. [PMID: 34167426 DOI: 10.1080/01443615.2021.1916814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We present the findings of a prospective cohort study in a single tertiary hospital to review the patient experience and economic benefit of ambulatory hysteroscopy (AH). Data were collected between May 2017 and February 2020. Patient satisfaction was measured with qualitative survey. Hospital level financial data were obtained over two financial years (2017/18 and 2018/19) to identify seasonal variation. The primary outcome was patient satisfaction and the secondary outcome was cost of AH compared to hysteroscopy under GA. Three hundred and twenty-nine patients underwent AH. Two hundred and ninety-eight responses (91%) were collected. Ninety-five percent of procedures were successful. Median pain score was five out of 10. Despite pain, 94% of patients would undergo AH again and 97% would recommend it. The average hospital cost for AH was $259 compared with $3098 for hysteroscopy under GA. These findings support AH as a safe, well-tolerated and economically viable alternative to hysteroscopy under GA.Impact StatementWhat is already known on this subject? Hysteroscopy is traditionally performed in an operating theatre under general anaesthesia (GA). Technological advancements allow for the procedure to be performed in an outpatient setting. Despite advantages of ambulatory hysteroscopy (AH), GA hysteroscopy is still the predominant intervention in Australia.What the results of this study add? Patient satisfaction in AH was assessed. The median pain score was five out of 10. Despite pain, 94% of patients would undergo AH again and 97% would recommend it.What the implications are of these findings for clinical practice and/or further research? AH is a well-tolerated alternative to hysteroscopy under GA with significant cost benefits to the hospital and high patient satisfaction. Further research should focus on direct comparison of the two procedure approaches using randomised controlled trials.
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Affiliation(s)
- Pavitra Nanayakkara
- Department of Gynaecology, Epworth Hospital, Richmond, Australia.,Ambulatory Gynaecology Service, Royal Women's Hospital, Parkville, Australia
| | - Joyce Xiao
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Mehrnoosh Aref-Adib
- Department of Gynaecology, Epworth Hospital, Richmond, Australia.,Ambulatory Gynaecology Service, Royal Women's Hospital, Parkville, Australia
| | - Alex Ades
- Department of Gynaecology, Epworth Hospital, Richmond, Australia.,Ambulatory Gynaecology Service, Royal Women's Hospital, Parkville, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia
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De Silva PM, Carnegy A, Smith PP, Clark TJ. Vaginoscopy for office hysteroscopy: A systematic review & meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252:278-285. [PMID: 32645643 DOI: 10.1016/j.ejogrb.2020.06.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of the vaginoscopic approach to office hysteroscopy on patients' experience of pain, when compared with the traditional approach where a vaginal speculum is used. METHODS Medline, Embase, CINAHL and the Cochrane library were searched from inception until December 2019, in order to perform a systematic review and meta-analysis of all randomised controlled trials investigating vaginoscopy compared to traditional hysteroscopy on pain experienced by women undergoing diagnostic or operative hysteroscopy in an office setting. Data regarding procedural time, feasibility, incidence of vasovagal reactions and complications, acceptability and satisfaction were also recorded. RESULTS The literature search returned 363 results of which seven were selected for systematic review, and six for meta-analysis. The vaginoscopic approach was associated with a statistically significant reduction in pain (4 studies including 2214 patients; SMD -0.27, 95 % CI -0.48 to -0.06), procedural time (6 studies including 2443 patients; SMD -0.25, 95 % CI -0.43 to -0.08) and the incidence of vasovagal episodes (3 studies including 2127 patients; OR 0.35; 95 % CI 0.15 to 0.82). Failure rates between the two techniques were similar (p = .90). No study reported significant differences in complications or patient or clinician acceptability or satisfaction. CONCLUSION Clinicians performing office hysteroscopy should use the vaginoscopic technique because it makes office hysteroscopy quicker, less painful and reduces the likelihood of inducing a vasovagal reaction. The traditional approach should only be used when vaginoscopy fails or when the need for cervical dilatation is anticipated.
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Affiliation(s)
- Prathiba M De Silva
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Alasdair Carnegy
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Paul P Smith
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - T Justin Clark
- Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TG, UK
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De Silva PM, Carnegy A, Smith PP, Clark TJ. Local anaesthesia for office hysteroscopy: A systematic review & meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252:70-81. [PMID: 32570188 DOI: 10.1016/j.ejogrb.2020.05.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare the effects of different types and routes of administration of local anaesthetic for pain control during and after office hysteroscopy. METHODS Medline, Embase, CINAHL and the Cochrane library were searched from inception until October 2019, in order to perform a systematic review and meta-analysis of all randomised controlled trials investigating the use of a local anaesthetic compared to a control, for pain relief in women undergoing diagnostic or operative office hysteroscopy. Average pain scores and data regarding side-effects, feasibility, complications, acceptability and satisfaction were collected. RESULTS The literature search yielded 612 citations. A total of 37 studies were included for systematic review, of which data from 20 studies were used for meta-analysis. Local anaesthesia was associated with significantly reduced pain during (SMD -0.57, 95 % CI -0.79 to -0.34) and after (SMD -0.30, 95 % CI -0.54 to -0.06) office hysteroscopy but did not reduce vasovagal episodes (OR 0.73, 95 % CI 0.50-1.09). A reduction in intra-procedural pain was observed regardless of type or route of administration. Local anaesthesia did not significantly reduce the risk of procedural failure (OR 0.72, 95 % CI 0.47-1.11). Insufficient data regarding complications, acceptability and satisfaction were available for meta-analysis. CONCLUSION Local anaesthesia via any route of genital tract administration, should be considered when undertaking office diagnostic or operative hysteroscopy to reduce pain during and after the procedure. Further research is needed to understand whether the pain control benefits of local anaesthesia remain apparent with vaginoscopic approaches to office hysteroscopy that avoid genital tract instrumentation.
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Affiliation(s)
- Prathiba M De Silva
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Alasdair Carnegy
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Paul P Smith
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - T Justin Clark
- Birmingham Women's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TG, UK
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Kamath MS, Bosteels J, D'Hooghe TM, Seshadri S, Weyers S, Mol BWJ, Broekmans FJ, Sunkara SK. Screening hysteroscopy in subfertile women and women undergoing assisted reproduction. Cochrane Database Syst Rev 2019; 4:CD012856. [PMID: 30991443 PMCID: PMC6472583 DOI: 10.1002/14651858.cd012856.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Screening hysteroscopy in infertile women with unexplained infertility, or prior to intrauterine insemination (IUI) or in vitro fertilisation (IVF) may reveal intrauterine pathology that may not be detected by routine transvaginal ultrasound. Hysteroscopy, whether purely diagnostic or operative may improve reproductive outcomes. OBJECTIVES To assess the effectiveness and safety of screening hysteroscopy in subfertile women undergoing evaluation for infertility, and subfertile women undergoing IUI or IVF. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL CRSO, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (September 2018). We searched reference lists of relevant articles and handsearched relevant conference proceedings. SELECTION CRITERIA Randomised controlled trials comparing screening hysteroscopy versus no intervention in subfertile women wishing to conceive spontaneously, or before undergoing IUI or IVF. DATA COLLECTION AND ANALYSIS We independently screened studies, extracted data, and assessed the risk of bias. The primary outcomes were live birth rate and complications following hysteroscopy. We analysed data using risk ratio (RR) and a fixed-effect model. We assessed the quality of the evidence by using GRADE criteria. MAIN RESULTS We retrieved 11 studies. We included one trial that evaluated screening hysteroscopy versus no hysteroscopy, in women with unexplained subfertility, who were trying to conceive spontaneously. We are uncertain whether ongoing pregnancy rate improves following a screening hysteroscopy in women with at least two years of unexplained subfertility (RR 4.30, 95% CI 2.29 to 8.07; 1 RCT; participants = 200; very low-quality evidence). For a typical clinic with a 10% ongoing pregnancy rate without hysteroscopy, performing a screening hysteroscopy would be expected to result in ongoing pregnancy rates between 23% and 81%. The included study reported no adverse events in either treatment arm. We are uncertain whether clinical pregnancy rate is improved (RR 3.80, 95% CI 2.31 to 6.24; 1 RCT; participants = 200; very low-quality evidence), or miscarriage rate increases (RR 2.80, 95% CI 1.05 to 7.48; 1 RCT; participants = 200; very low-quality evidence), following screening hysteroscopy in women with at least two years of unexplained subfertility.We included ten trials that included 1836 women who had a screening hysteroscopy and 1914 women who had no hysteroscopy prior to IVF. Main limitations in the quality of evidence were inadequate reporting of study methods and higher statistical heterogeneity. Eight of the ten trials had unclear risk of bias for allocation concealment.Performing a screening hysteroscopy before IVF may increase live birth rate (RR 1.26, 95% CI 1.11 to 1.43; 6 RCTs; participants = 2745; I² = 69 %; low-quality evidence). For a typical clinic with a 22% live birth rate, performing a screening hysteroscopy would be expected to result in live birth rates between 25% and 32%. However, sensitivity analysis done by pooling results from trials at low risk of bias showed no increase in live birth rate following a screening hysteroscopy (RR 0.99, 95% CI 0.82 to 1.18; 2 RCTs; participants = 1452; I² = 0%).Only four trials reported complications following hysteroscopy; of these, three trials recorded no events in either group. We are uncertain whether a screening hysteroscopy is associated with higher adverse events (Peto odds ratio 7.47, 95% CI 0.15 to 376.42; 4 RCTs; participants = 1872; I² = not applicable; very low-quality evidence).Performing a screening hysteroscopy before IVF may increase clinical pregnancy rate (RR 1.32, 95% CI 1.20 to 1.45; 10 RCTs; participants = 3750; I² = 49%; low-quality evidence). For a typical clinic with a 28% clinical pregnancy rate, performing a screening hysteroscopy would be expected to result in clinical pregnancy rates between 33% and 40%.There may be little or no difference in miscarriage rate following screening hysteroscopy (RR 1.01, 95% CI 0.67 to 1.50; 3 RCTs; participants = 1669; I² = 0%; low-quality evidence).We found no trials that compared a screening hysteroscopy versus no hysteroscopy before IUI. AUTHORS' CONCLUSIONS At present, there is no high-quality evidence to support the routine use of hysteroscopy as a screening tool in the general population of subfertile women with a normal ultrasound or hysterosalpingogram in the basic fertility work-up for improving reproductive success rates.In women undergoing IVF, low-quality evidence, including all of the studies reporting these outcomes, suggests that performing a screening hysteroscopy before IVF may increase live birth and clinical pregnancy rates. However, pooled results from the only two trials with a low risk of bias did not show a benefit of screening hysteroscopy before IVF.Since the studies showing an effect are those with unclear allocation concealment, we are uncertain whether a routine screening hysteroscopy increases live birth and clinical pregnancy, be it for all women, or those with two or more failed IVF attempts. There is insufficient data to draw conclusions about the safety of screening hysteroscopy.
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Affiliation(s)
- Mohan S Kamath
- Christian Medical CollegeDepartment of Reproductive MedicineIda Scudder RoadVelloreTamil NaduIndia632004
| | - Jan Bosteels
- Cochrane BelgiumAcademic Centre for General PracticeKapucijnenvoer 33blok J bus 7001LeuvenBelgium3000
| | - Thomas M D'Hooghe
- University Hospital GasthuisbergLeuven University Fertility CentreHerestraat 49LeuvenBelgium3000
| | - Srividya Seshadri
- The Centre for Reproductive & Genetic Health256 Gray’s Inn RoadLondonUKWC1X 8LD
| | - Steven Weyers
- University Hospital GhentObstetrics and GynaecologyDe Pintelaan 185GhentBelgium
| | - Ben Willem J Mol
- Monash UniversityDepartment of Obstetrics and Gynaecology246 Clayton RoadClaytonVictoriaAustralia3168
| | - Frank J Broekmans
- University Medical CenterDepartment of Reproductive Medicine and GynecologyHeidelberglaan 100UtrechtNetherlands3584 CX
| | - Sesh Kamal Sunkara
- King's College LondonDivision of Women's Health, Faculty of Life Sciences & MedicineStrandLondonUKWC2R 2LS
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