INTRODUCTION:The utility and accuracy of hysterosalpingogram in a community hospital setting were evaluated for accuracy in predicting uterine cavity pathology.METHODS: A retrospective chart review was performed for all hysteroscopic procedures that had a hysterosalpingogram performed between August 1, 2012, and August 25, 2014, at a single community hospital in an inner-city setting. Hysterosalpingogram reports by a radiologist were reviewed, and hysteroscopy operative reports were reviewed that were performed by a reproductive endocrinologist.
RESULTS:A total of 60 patients were identified. Average age was 31.3 years (median 34 years). Findings correlated for tubal diagnosis in 88.4% of patients. However, for uterine cavity defects, the accuracy was lowest for the finding of uterine septum on hysteroscopy; hysterosalpingogram reported normal findings on all six patients encountered in this series. High sensitivity and correlation were found for findings of intrauterine adhesions (95%), submucosal myomas, and endometrial polyps (90%). The findings for submucosal myomas and endometrial polyps were confirmed with final pathology.CONCLUSION: Hysterosalpingogram has a low sensitivity for finding of uterine septum in this setting. Further studies are needed for correlation with clinical impression by a reproductive endocrinologist.INTRODUCTION: Reproductive health care providers need recommendations on applications (apps) for patient use, particularly apps for menstrual cycle and fertility tracking, because these apps are frequently downloaded by women and can be used by clinicians when evaluating menstrual problems. METHODS: We searched PubMed and OVID MEDLINE for literature on women's reproductive health apps and searched the Apple iTunes store for menstrual cycle and fertility tracking apps. We recorded price, user rating, functionality, and whether an app was developed or recommended by medical experts.
RESULTS:We identified six articles, all published since 2012, that discuss apps for patient use regarding women's reproductive health; none focused specifically on menstrual cycle or fertility tracking. The apps search identified 94 unique apps for menstrual cycle tracking, priced from free to $16.99. Sixteen (17%) free apps also had paid versions. User ratings ranged from 1.5-4.5 of 5 stars. App functionality included the ability to create a password (43%), tailor for irregular cycles (23%), back up or restore data (22%), select a pregnancy mode (20%), export or e-mail data (10%), or connect to social media (7%).
factors for perineal lacerations requiring suture in vaginal deliveries without episiotomy.
METHODS:We conducted a prospective cohort study including 400 vaginal deliveries assisted in a public hospital in Brazil. During the second stage of labor, maneuvers as such directed pushing, fundal pressure, and Valsalva maneuver were avoided. A policy of no episiotomy was followed with strategies for perineal protection that included warm compresses and intrapartum perineal massage. We calculated the relative risk and its 95% confidence interval (95% CI). Multivariate analysis was performed to determine the adjusted risk of need for suture.
RESULTS:We analyzed 400 women who had vaginal deliveries with no episiotomy and 6% of instrumental deliveries. The rate of perineal lacerations in primiparous (210) was 56.7% and in multiparous (190) 30%. Suture was necessary in 23% of women (30% of primiparous and 15.3% of multiparous). In multivariate analysis, the factors that remained associated with increased risk of need for suture were primiparity (adjusted risk 1.81, 95% CI 1.25-2.89) and instrumental delivery (adjusted risk 3.78, 95% CI 1.21-18.66).CONCLUSION: There was a reduced need for suture in vaginal deliveries with the application of a protocol of perineal protection and no episiotomy. Primiparity and instrumental delivery were associated with increased risk of need for suture.Financial Disclosure:
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