26 research outputs found
Treatment of endometrioma for improving fertility
No full textEndometrioma is a frequent clinical manifestation of endometriosis. It is controversial how endometriomas may affect women's fertility. This review addresses: the impact of the endometrioma per se and of its surgical treatment on ovarian physiology, on the ovarian reserve, on spontaneous conception and pregnancy outcomes, and on IVF/ICSI outcomes.Based on current evidence, although there are plausible biological detrimental effects on the ovarian cortex surrounding the endometrioma and an impairment of the normal ovarian physiology, the clinical impact of the endometrioma per se is not significantly altered. There is a negligible detrimental effect on ovarian reserve with spontaneous ovulation not being impaired. Conversely, surgical excision of an endometrioma reduces ovarian reserve as measured by AMH levels. Studies investigating the impact of the endometrioma per se and of its surgical treatment in women requiring IVF/ICSI show similar implantation rates, clinical pregnancy rates and live birth rates between women with endometrioma and controls
Tubal ectopic pregnancy
No full textINTRODUCTION: Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others continue to grow and can lead to rupture of the tube. Risks are higher in women who smoke or have damage to the fallopian tubes due to pelvic infections, surgery, or previous ectopic pregnancy.METHODS AND OUTCOMES: We conducted a systematic overview aiming to answer the following clinical question: What are the effects of treatments for unruptured tubal ectopic pregnancy on subsequent fertility? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).RESULTS: At this update, searching of electronic databases retrieved nine studies. After deduplication and removal of conference abstracts, nine records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of six studies and the further review of three full publications. Of the three full articles evaluated, no systematic reviews and one RCT were added at this update. We performed a GRADE evaluation for three PICO combinations.CONCLUSIONS: In this systematic overview we present information relating to the effectiveness and safety of the following interventions for unruptured tubal ectopic pregnancy on subsequent fertility: expectant management, methotrexate, salpingotomy, and salpingectomy.</p
Hysteroscopic local anaesthetic intrauterine cornual 'focal local' block before endometrial ablation with direct cervical block in an outpatient setting:a feasibility study
No full textOBJECTIVE: To evaluate the safety, feasibility and efficacy of a hysteroscopic local anaesthetic intrauterine cornual block (ICOB) on women's perception of pain during outpatient Thermachoice endometrial ablation (TEA).STUDY DESIGN: Pre-menopausal women with heavy menstrual bleeding undergoing TEA were included in the study. The intervention used, ICOB, was a hysteroscopic injection of local anaesthetic into the myometrium just medial to each tubal ostium. The women also had a traditional direct cervical block (DCB). We measured the acceptability of ICOB and the pain score (visual analogue score scale) immediately after the procedure.RESULTS: We treated 30 patients (mean age 41 years, SD 6; BMI 29±7) between January 2012 and December 2012. All patients had a successful ICOB block and found TEA with ICOB acceptable. The mean VAS score was 3.5±2.7, which was two points lower compared to our earlier prospective cohort of patients undergoing TEA with only a DCB (mean 5.8±2.7, n=102). No serious complications occurred during the procedure or postoperatively. Three patients experienced a vasovagal response which resolved spontaneously.CONCLUSION: ICOB with DCB is a safe, feasible and efficacious method of pain control during TEA. There is however a need to evaluate efficacy of ICOB in a randomised placebo controlled trial.</p
The effectiveness of outpatient Thermachoice endometrial balloon ablation:A long-term 11-year outcome study
No full textThe aim of this study was to evaluate the long-term treatment outcomes of outpatient Thermachoice balloon endometrial ablation under a direct local anaesthetic cervical block (LA-Thermachoice). This paper is a prospective cohort study and a postal questionnaire survey in a UK teaching hospital with the participation of 253 women with heavy menstrual bleeding (HMB) undergoing LA-Thermachoice over an 11-year period between 2001 and 2011. Treatment success was measured by postoperative bleeding patterns, improvement in dysmenorrhoea, patient satisfaction and post-procedure hysterectomy rates. LA-Thermachoice was completed in 98 % of women. The survey response rate was 78 %. The median follow-up interval was 71 months (SD 42). Seventy-nine percent of the responders reported significant improvement in HMB with 40 % amenorrhoea rate and 86 % improvement in dysmenorrhoea. Eighty-one percent felt that the benefit of procedure was maintained over a long period of time. Eighty-six percent of women were satisfied with the outcome of their procedure. The case notes of non-responders were examined to check if any had undergone hysterectomy since the LA-Thermachoice procedure. In total, only 16 % of women had a hysterectomy. This study represents the largest published series of local anaesthetic thermal endometrial ablation, reporting clinical outcomes with 11 years (median 71 months) of post-treatment follow-up. It demonstrates that the patient satisfaction with LA-Thermachoice is high, and is maintained over a long period of time after the procedure.</p
Hysteroscopic local anesthetic intrauterine cornual block in office endometrial ablation:a randomized controlled trial
No full textOBJECTIVE: To evaluate the efficacy of a hysteroscopic local anesthetic intrauterine cornual block (ICOB) on pain experienced during office endometrial ablation (EA) in addition to a traditional direct local anesthetic cervical block (DCB).DESIGN: Prospective, randomized, double-blind, placebo-controlled trial.SETTING: University teaching hospital.PATIENT(S): Women with heavy menstrual bleeding scheduled for an office endometrial ablation.INTERVENTION(S): Before office EA, DCB plus hysteroscopic ICOB just medial to each tubal ostium using local anesthetic mixture made up of 1 mL 3% mepivacaine plus 1 mL 0.5% bupivacaine versus control group receiving DBC plus ICOB with 2 mL of placebo (saline).MAIN OUTCOME MEASURE(S): Primary outcome: pain reported during procedure via visual analogue scale (VAS) from 0 to 10; secondary outcomes: postoperative pain, rescue analgesic requirement, and duration of hospital stay.RESULT(S): Most characteristics were similar across groups. The mean VAS score during the procedure was statistically significantly lower by 1.44 (95% confidence interval, -2.65 to -0.21) in the active group compared with the placebo group. There were no statistically significant differences between the two groups in the postprocedural mean VAS scores, rescue analgesic requirement, or duration of hospital stay.CONCLUSION(S): Used in addition to DCB, ICOB reduces the pain experienced during office EA compared with DCB alone.CLINICAL TRIAL REGISTRATION NUMBER: NCT01808898.</p
Analysis of an innovative one-stop, hospital-based, outpatient acute gynaecology clinic:model for taking the service to community
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Sensitivity to scale of willingness-to-pay within the context of menorrhagia
No full textObjectivesWillingness-to-pay (WTP) provides a broad assessment of well-being, capturing benefits beyond health. However, the validity of the approach has been questioned and the evidence relating to the sensitivity of WTP to changes in health status is mixed. Using menorrhagia (heavy menstrual bleeding) as a case study, this exploratory study assesses the sensitivity to scale of WTP to change in health status as measured by a condition-specific measure, MMAS, which includes both health and non-health benefits. The relationship between EQ-5D and change in health status is also assessed.MethodsBaseline EQ-5D and MMAS values were collected from women taking part in a randomized controlled trial for pharmaceutical treatment of menorrhagia. Following treatment, these measures were administered along with a WTP exercise. The relationship between the measures was assessed using Spearman's correlation analysis, and the sensitivity to scale of WTP was measured by identifying differences in WTP alongside differences in MMAS and EQ5D values.ResultsOur exploratory findings indicated that WTP, and not EQ-5D, was significantly positively correlated with change in MMAS, providing some evidence for convergent validity. These findings suggest that WTP is capturing the non-health benefits within the MMAS measure. Mean WTP also increased with percentage improvements in MMAS, suggesting sensitivity to scale.ConclusionWhen compared to quality of life measured using the condition-specific MMAS measure, the convergent validity and sensitivity to scale of WTP is indicated. The findings suggest that WTP is more sensitive to change in MMAS, than with EQ-5D
