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Bairaktaris D, Chorianopoulou E, Kokkali K, Stanc G, Iavazzo C. Endometrial Cancer in a Patient With Didelphys Uterus and a History of Renal Cancer: A Case Report and Literature Review. Cureus 2023; 15:e47114. [PMID: 38021547 PMCID: PMC10647939 DOI: 10.7759/cureus.47114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Müllerian duct anomalies (MDAs) concurrent with endometrial cancer are exceptionally rare, with only a few documented cases. Here, we present a case of endometrial cancer in both horns of a didelphys uterus in a 54-year-old woman with a history of renal cancer, who underwent left radical nephrectomy and left salpingo-oophorectomy. The patient sought medical evaluation due to postmenopausal vaginal bleeding. Hysteroscopy with dilation and curettage revealed the presence of two cervixes and two endometrial cavities, with pathology results indicating endometrioid adenocarcinoma (G1). Preoperative MRI staging confirmed the diagnosis of a double cervix and uterus. Subsequently, an open abdominal hysterectomy and a right salpingo-oophorectomy were performed, revealing a didelphys uterus (International Federation of Gynaecology and Obstetrics 2018, stage IA). This manuscript aims to explore the potential correlation between renal and endometrial malignancies in the presence of MDAs.
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Affiliation(s)
| | | | | | - Gabriela Stanc
- Pathology, Metaxa Memorial Cancer Hospital, Piraeus, GRC
| | - Christos Iavazzo
- Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, GRC
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Dave A, Kashiv P, Chaudhari K, Shrivastava D. Air Embolism: A Rare Lethal Complication of Hysteroscopy in a Young Woman Undergoing Infertility Workup. Cureus 2023; 15:e45069. [PMID: 37842363 PMCID: PMC10568039 DOI: 10.7759/cureus.45069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Compared to operative hysteroscopy, diagnostic hysteroscopy rarely leads to issues. However, one very uncommon yet potentially fatal complication is air embolism, with an incidence rate of three in 17,000 cases. This report describes an unexpected complication discovered during diagnostic hysteroscopy surgery. In the course of routine infertility testing, a 29-year-old woman underwent a diagnostic hysteroscopy under general anesthesia. Intraoperatively, her end-tidal carbon dioxide (EtCO2) levels decreased, oxygen saturation dropped, and heart rate increased, leading the anesthesiologists and critical care team to terminate the procedure and manage her further. Subsequent transesophageal echocardiography confirmed the diagnosis of air embolism. She was managed with 100% oxygen and inotropes and cardiopulmonary resuscitation but despite aggressive medical interventions, her condition did not improve, and she unfortunately passed away. To diagnose, prevent, and manage the potentially devastating consequences associated with diagnostic hysteroscopy, gynecologists and surgical teams must maintain vigilance. The focus should be on proper patient selection, optimal surgical techniques, and the use of high-quality equipment to mitigate the risk of air embolism.
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Affiliation(s)
- Apoorva Dave
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pranjal Kashiv
- Nephrology, Jawaharlal Nehru Medical College, Datta Meghe institute of Higher Education and Research, Wardha, IND
| | - Kamlesh Chaudhari
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepti Shrivastava
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Mazzon I, Etrusco A, Laganà AS, Chiantera V, Di Angelo Antonio S, Tosto V, Gerli S, Favilli A. Training in Diagnostic Hysteroscopy: The "Arbor Vitae" Method. Medicina (Kaunas) 2023; 59:1019. [PMID: 37374222 PMCID: PMC10302144 DOI: 10.3390/medicina59061019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Diagnostic hysteroscopy is the gold standard in the diagnosis of intrauterine pathology and is becoming an essential tool in the daily practice of gynecology. Training programs for physicians are necessary to ensure adequate preparation and learning curve before approaching patients. The aim of this study was to describe the "Arbor Vitae" method for training in diagnostic hysteroscopy and to test its impact on the knowledge and skills of trainees using a customized questionnaire. Materials and Methods: A three-day hysteroscopy workshop combining theory and practical "hands on "sessions with dry and wet labs has been described. The aim of the course is to teach indications, instruments, the basic principles of the technique by which the procedure should be performed, and how to recognize and manage the pathologies that can be identified by diagnostic hysteroscopy. To test this training method and its impact on the knowledge and skills of the trainees, a customized 10-question questionnaire was administered before and after the course. Results: The questionnaire was administered to 34 participants. All trainees completed the questionnaire, and no missing responses were recorded. Regarding the characteristics of the participants, 76.5% had less than 1 year of experience in performing diagnostic hysteroscopy and 55.9% reported performing fewer than 15 procedures in their career. For 9 of the 10 questions embedded in the questionnaire, there was a significant improvement in the scores between pre- and post-course, demonstrating a perceived significant improvement in theoretical/practical skills by the trainees. Conclusions: The Arbor Vitae training model is a realistic and effective way to improve the theoretical and practical skills required to perform correct diagnostic hysteroscopy. This training model has great potential for novice practitioners to achieve an adequate level of proficiency before performing diagnostic hysteroscopy on live patients.
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Affiliation(s)
- Ivan Mazzon
- Arbor Vitae Endoscopic Centre, 00191 Rome, Italy; (I.M.); (S.D.A.A.)
| | - Andrea Etrusco
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | | | - Valentina Tosto
- Centre for Research in Perinatal and Reproductive Medicine, University of Perugia, 06123 Perugia, Italy;
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, 06123 Perugia, Italy;
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, S. Maria della Misericordia Hospital, Perugia University, 06123 Perugia, Italy;
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Yousif A, Moustafa ASZ, Abuzeid OM, Corrado JM, Abdullah A, Abuzeid MI. Limitations of imaging screening tests in the detection of incomplete uterine septum or arcuate uterine anomaly. Int J Gynaecol Obstet 2022; 159:544-549. [PMID: 35315517 DOI: 10.1002/ijgo.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine the detection rates of hysterosalpingogram (HSG), transvaginal 2D ultrasound (TV 2D US), transvaginal 3D ultrasound (TV 3D US) in diagnosing of incomplete uterine septum (IUS) and significant arcuate uterine anomaly (AUA). METHODS This retrospective cohort study included patients with infertility or recurrent pregnancy loss (516) that were found to have IUS (317) or significant AUA (199) on diagnostic hysteroscopy (DHS). We compared the detection rate of the various radiological tests in all patients with documented IUS or AUA on DHS. RESULTS The diagnosis of IUS and AUA was made in 49.7% on HSG, 54.2% on TV 2D US and 69.5% on TV 3D US. When both HSG and TV 2D US or HSG and TV3D US were used, the diagnosis was correct in 67.7% and 82.6% of patients, respectively. CONCLUSION Although HSG, TV 2D US, TV 3D US are useful in the screening for IUS/AUA, none of these imaging tests alone or in combination are accurate enough to rule out the diagnosis of such congenital uterine anomalies. In patients with a history of infertility or RPL and negative radiologic tests, DHS is the only reliable method to rule out IUS or significant AUA.
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Affiliation(s)
- Abdelrahman Yousif
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, College of Human Medicine, Flint, Michigan, USA
| | - Ahmed S Z Moustafa
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Omar M Abuzeid
- Division of Maternal Fetal-Medicine, Department of Obstetrics and Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, New York, New York, USA
| | | | - Ahmed Abdullah
- Women's Heath, Department of Obstetrics and Gynecology, McLaren Medical Center, Flint, Michigan, USA
| | - Mostafa I Abuzeid
- IVF Michigan Rochester Hills & Flint, PC, Rochester Hills, Michigan, USA.,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hurley Medical Center/Michigan State University, College of Human Medicine, Flint, Michigan, USA
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Guraslan H, Senturk MB, Dogan K, Yuksel B, Kaya C, Karacan T, Karabay Akgul O, Ceylan Y. Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope? J Obstet Gynaecol Res 2022; 48:1418-1425. [PMID: 35274418 DOI: 10.1111/jog.15219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/16/2021] [Accepted: 02/28/2022] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope. METHODS A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. RESULTS Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n = 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p = 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p = 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p <0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. CONCLUSION In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.
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Affiliation(s)
- Hakan Guraslan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet B Senturk
- Department of Obstetrics and Gynecology, Tekirdag Namik Kemal University, Tekirdag /, Turkey
| | - Keziban Dogan
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Berkay Yuksel
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Tolga Karacan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Karabay Akgul
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yasin Ceylan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Mandato VD, Torricelli F, Mastrofilippo V, Pirillo D, Annunziata G, Ciarlini G, D'Ippolito G, Bartolomeo EDI, Aguzzoli L. Impact of a Province-wide Endometrial Cancer Guideline on Daily Practice. Anticancer Res 2021; 41:937-948. [PMID: 33517300 DOI: 10.21873/anticanres.14847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Most women are managed by a general gynaecologist rather than being centralized in an oncogynaecology unit, resulting in different clinical management. In 2006, a hub & spoke model was introduced in the Provincial Healthcare System of Reggio Emilia, and shared guidelines were written. We aimed to verify the adherence to guidelines and the consequent improvements in quality care. PATIENTS AND METHODS All patients who underwent a hysterectomy for endometrial cancer in the Reggio Emilia Province hospitals from 2000 to 2016 were included in the study. Clinical and pathological data were carefully recorded for each patient included. RESULTS This study included 132 and 277 patients in the periods before and after the implementation of the guideline, respectively. In the post-guideline period, the use of hysteroscopy, magnetic resonance, laparoscopy and adjuvant treatment significantly increased. CONCLUSION Common shared guidelines and a clinical audit can help in improving centralization, resulting in an increased quality of care.
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Affiliation(s)
- Vincenzo Dario Mandato
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy;
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Unit of Surgical Gynecol Oncology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Debora Pirillo
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Gianluca Annunziata
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Gino Ciarlini
- Unit of Surgical Gynecol Oncology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Giovanni D'Ippolito
- Unit of Obstetrics and Gynaecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Erminia DI Bartolomeo
- Transfusion Medicine Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Surgical Gynecol Oncology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
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Saccardi C, Vitagliano A, Marchetti M, Lo Turco A, Tosatto S, Palumbo M, De Lorenzo LS, Vitale SG, Scioscia M, Noventa M. Endometrial Cancer Risk Prediction According to Indication of Diagnostic Hysteroscopy in Post-Menopausal Women. Diagnostics (Basel) 2020; 10:diagnostics10050257. [PMID: 32349386 PMCID: PMC7277718 DOI: 10.3390/diagnostics10050257] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 12/15/2022] Open
Abstract
We conducted a prospective observational study investigating the clinical relevance of endometrial thickness (ET) and abnormal uterine bleeding (AUB) on endometrial cancer (EC) risk in a cohort of postmenopausal patients undergoing diagnostic hysteroscopy and endometrial biopsy. Patients were divided into two groups according to the indication of diagnostic hysteroscopy: ET_Group (asymptomatic patients with endometrial thickness ≥ 4 mm) and AUB_Group (patients with a history of abnormal uterine bleeding). We further divided the AUB_Group into two subgroups based on endometrial thickness (AUB_Subgroup1: ET < 4 mm; AUB_Subgroup2: ET ≥ 4 mm). The primary outcome was the risk of endometrial cancer and atypical hyperplasia according to the indications of diagnostic hysteroscopy (AUB, ET ≥ 4 mm or both). The secondary outcome was to determine the best cut-off value of endometrial thickness to predict endometrial cancer in asymptomatic postmenopausal women. The prevalence of endometrial cancer and atypical hyperplasia in AUB_Group and ET_Group was 21% and 6.7% respectively. As well as for EC alone, higher prevalence of both conditions was observed in AUB_Subgroup2 (29.3%) in comparison to AUB_Subgroup1 (10.6%; p < 0.001). In asymptomatic patients the cut-off of endometrial thickness that showed the best sensitivity and specificity to diagnose endometrial cancer (100% and 80% respectively) was 11 mm (AUC of 91.4%; Expβ: 1067; CI 95%). In conclusion, considering the high risk of neoplasia, diagnostic hysteroscopy with endometrial biopsy should be mandatory in cases of abnormal uterine bleeding in postmenopausal patients. Moreover, we want to emphasize the need for further evidence stating the clinical relevance of endometrial thickness value in asymptomatic patients and the impact of individual risk factors on endometrial cancer development.
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Affiliation(s)
- Carlo Saccardi
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Amerigo Vitagliano
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Matteo Marchetti
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Alice Lo Turco
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Sofia Tosatto
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | - Michela Palumbo
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
| | | | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy
| | - Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Abano Terme, 35031, Italy
| | - Marco Noventa
- Department of Women’s and Children’s Health, University of Padua, 35100 Padua, Italy
- Correspondence: ; Tel.: +39-3476-527-255
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Leung S, Leyland N, Murji A. Decreasing Diagnostic Hysteroscopy Performed in the Operating Room: A Quality Improvement Initiative. J Obstet Gynaecol Can 2016; 38:351-6. [PMID: 27208604 DOI: 10.1016/j.jogc.2016.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 11/03/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES At our institution, diagnostic hysteroscopy (DH), often combined with uterine curettage, commonly has been performed in the main OR with the patient under general anaesthesia. Our objective was to create targeted interventions aimed at decreasing the number of DHs performed in the OR by 75% over one year. METHODS This quality improvement initiative had a quasi-experimental (time-series) design. To obtain baseline numbers of DHs performed each month, we conducted a retrospective chart audit at a university teaching hospital. We implemented the following three groups of interventions: (1) staff education and case review, (2) accessible sonohysterography, and (3) an operative hysteroscopy education program. Procedures were tracked prospectively over a 12-month intervention period and an additional 12-month maintenance period. RESULTS One hundred eleven DHs were performed at baseline. During the intervention period, 33 DHs were performed, a 70% reduction from baseline. This resulted in related savings of $126 984 and 12.5 surgical days. In the final quarter of the intervention period, there was an 81% reduction in the number of DHs with adequate preoperative evaluation compared with baseline. Twenty DHs were performed in the maintenance period, an 82% reduction from baseline. The absolute number of complications from DH remained constant during the study period. CONCLUSION Carefully planned and targeted interventions to change the culture at our institution decreased the number of DHs performed in the main OR. These initiatives improved patient care, saved costs, and improved OR utilization. Long-term follow-up showed maintenance of the improvements in the year subsequent to the interventions.
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Affiliation(s)
- Stephanie Leung
- Hamilton Health Sciences Centre, McMaster University, Hamilton ON
| | - Nicholas Leyland
- Hamilton Health Sciences Centre, McMaster University, Hamilton ON
| | - Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON
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Stefanescu A, Marinescu B. Diagnostic hysteroscopy - a retrospective study of 1545 cases. Maedica (Bucur) 2012; 7:309-314. [PMID: 23483793 PMCID: PMC3593281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 11/05/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The development of hysteroscopy has provided a minimally invasive approach to common gynecologic problems, such as abnormal uterine bleeding. Diagnostic hysteroscopy is considered now "the gold standard" by the Association of Professors of Gynecology and Obstetrics (2002) in investigation of abnormal uterine bleeding (AUB) in order to rule out organic endouterine causes of AUB. Although the World Health Organization (WHO) recommends hysterosapingography (HSG) alone for management of infertile women many specialists use hysteroscopy as a first-line routine exam for infertility patients regardless of guidelines. MATERIAL AND METHOD This paper is a retrospective study of 1545 diagnostic hysteroscopies performed in the "Prof. Dr. Panait Sirbu" Obstetrics and Gynecology Hospital between January 1, 2008 and June 30, 2011. The following parameters were studied: diagnostic hysteroscopy indications, type of anesthesia used, correlation between pre-and postoperative diagnoses. OUTCOMES Of 1545 diagnostic hysteroscopies, 78% of cases were performed without anesthesia; of the total of 299 cases of primary infertility diagnostic hysteroscopy showed in 34% of cases tubal obstruction and endouterine pathology; of the total 396 cases of secondary infertility under investigation, diagnostic hysteroscopy showed in 40% of cases tubal obstruction and endouterine pathology; the highest accuracy of HSG was noted for uterine malformation and minimal accuracy was observed for intrauterine adhesions. CONCLUSIONS Our experience supports the opinion that diagnostic hysteroscopy should be a first-line routine exam in infertility.Because of the high rate of false positive results for HSG in our study and considering the other studies in specialty literature, we always perform a diagnostic hysteroscopy before Assisted Human Reproduction procedures regardless of the HSG aspect.
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Pansky M, Feingold M, Sagi R, Herman A, Schneider D, Halperin R. Diagnostic hysteroscopy as a primary tool in a basic infertility workup. JSLS 2006; 10:231-5. [PMID: 16882426 PMCID: PMC3016139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess the value of diagnostic hysteroscopy in a primary workup of infertility. METHODS We performed a retrospective analysis (Canadian Task Force Classification II-2) of 221 infertile patients referred to the Outpatient Center for Uterine Cavity Evaluation and the Tel-Aviv University affiliated Assaf Harofe Medical Center for evaluation of the uterine cavity. Patients underwent a diagnostic office hysteroscopy. RESULTS Hysteroscopy revealed an abnormal uterine cavity in 30% of women evaluated for either primary or secondary infertility. No significance was found regarding the total number of intrauterine pathologies when comparing the groups of primary versus secondary infertility. CONCLUSION Routine diagnostic hysteroscopy should be part of an infertility workup in primary and secondary infertility.
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Affiliation(s)
- Moty Pansky
- Department of Obstetrics & Gynecology, Assaf Harofe Medical Center, Zerifin, Israel.
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