Although correlated with adverse neonatal outcomes, most affected infants had clear amniotic fluid throughout labor. The presence of clear amniotic fluid is an unreliable sign of fetal well-being.
This study compared the cost and time involved of helium thermal coagulator (HTC) treatment with medical therapy using gonadotrophin-releasing hormone analogues in women with minimal to moderate endometriosis. In a prospective randomised controlled trial, 35 women with history of pain were, upon confirmation of minimal to moderate endometriosis at diagnostic laparoscopy, randomised to immediate surgical or medical treatment. They were asked to complete analogue pain score sheets, and their symptoms were reviewed before treatment and at 3, 6, and 12 months after treatment. The cost of the medical or surgical treatment was evaluated from the time of diagnosis to the time of cure or symptom relief. The average cost per Helica probe is £111.81 with the machine on free loan, and the total cost of a 6-month course of injectable Zoladex with add-back therapy is £811.92. The costs involved in the two treatment modalities were analysed using the Mann-Whitney test; a p-value <0.05 was considered significant. In the medical group, three women out of 18 were symptom-free, 11 required surgical treatment of endometriosis, one had a laparoscopically-assisted vaginal hysterectomy, and three became pregnant before their final reviews. In the surgical group, nine women were symptom-free at the end of 12 months, four required Zoladex therapy, one required oral contraceptive pills, and three required repeat surgical treatment. The average cost per patient in the surgical arm was £323.29 and in the medical arm was £918.12 (p<0.0001). Mean operating times in the surgical and medical arms were 32.35 min and 20.83 min, respectively. This suggests that when facilities and expertise are available, it is better to see and treat mild to moderate endometriosis. There were no surgical complications in our series. Surgical treatment with HTC therapy is safe and is a cheaper and more effective therapy. This is the first study that has looked at the cost-effectiveness of HTC therapy in managing mild to moderate endometriosis.
To assess the mode of laparoscopic entry technique among consultant gynaecologists in the United Kingdom and Ireland and to find out whether recent recommendations have influenced practice, an anonymous postal questionnaire was sent to 1,190 gynaecologists. Responses were analysed using an Excel spreadsheet. There was a 64% response rate. Of the respondents, the majority (90%) performed laparoscopy by using a Veress needle technique. Regarding the patient's position when inserting the scope, 61% used lithotomy with Trendelenberg tilt, and 39% used the flat position. The entry point used was subumbilical by 54% and intraumbilical by 44%. Thirty-eight percent used pressure and 62% used volume to decide when to insert the primary trocar. Only 26% of responding gynaecologists were aware of the Middlesbrough consensus document, but most who had attended a course were compliant with the guidelines. In conclusion, the majority of gynaecologists practiced closed laparoscopy and used the volume technique to achieve pneumoperitoneum. Only a small number of gynaecologists were aware of the recent recommendations regarding safe laparoscopic entry technique, suggesting that methods for disseminating recommendations must be improved.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.