Background:
Conventionally, endometrial pathologies of varying complexity have been surgically treated as inpatients under a general or regional anesthetic.
Aim:
In this paper, we evaluate the safety and efficacy of hysteroscopic morcellation of endometrial pathology in the form of endometrial polyps (EPs) and submucosal fibroids in an outpatient setting for both simple and complex lesions using the Myosure™ device.
Methods:
Two hundred and forty-nine hysteroscopic resections were performed in an outpatient setting at the < BLINDED FOR REVIEW > from May 2014 to March 2021. The median age of the patients was 54 years. More than half of the patients presented with postmenopausal bleeding; 64% were diagnosed with EPs and 24% with submucous fibroids (SMFs). The size, topography, extension, penetration, and wall classification system scoring system were used to grade them as simple (≤4) or complex (≥5) pathologies.
Results:
90% of pathologies were simple (≤4), of which complete resection was carried out in 95% of patients; 10% of the pathologies were complex (≥5), of which 63% had complete resection. Two patients with complex pathologies returned for completion surgery as a two-step procedure. No procedure was abandoned due to the patient intolerance. The median intraprocedure pain score visual analog scale was 5/10 and immediate postprocedure pain score was 1/10. Notably, there was no intra- or post-procedure complications.
Conclusion:
Outpatient resection of endometrial pathology, both simple and complex, can be safely and effectively performed using hysteroscopic morcellator (Myosure™) and is accepted and well tolerated by patients.
Objective To determine the impact of the COVID-19 pandemic and service modification on obstetric outcomes. Design: Single centre retrospective study Setting: Royal Bolton Hospital, United Kingdom. Population or Sample: Obstetric population in the prepandemic and pandemic periods. Methods Data on Obstetric services and pregnancy outcomes of women during the pandemic was compared to those of women prior to the pandemic and introduction of service modification. Statistical analysis was performed using SPSS, with data comparison between both groups done using nonparametric Chi-square test. Main Outcome Measures: Comparable perinatal and maternal outcomes. Results There was no significant difference in the induction of labour rates (38.8% pre-pandemic vs 38.3% pandemic, p= 0.78), use of epidural anaesthesia in labour (13.2% prepandemic vs 15.9% pandemic, p= 0.06), instrumental deliveries (13.0% prepandemic vs 12.3% pandemic, p= 0.56) and caesarean sections (28.9% prepandemic vs 31.7% pandemic, p= 0.09). There was significant reduction in the use of general anaesthesia for caesarean sections (8.9% vs 4.9%, p= 0.03) as well as antenatal admissions during the pandemic (23.9% vs 18.5%, p= <0.0001). The number of antenatal growth scans performed during the pandemic was significantly increased (18.5% vs 20.1%, p= <0.003). The perinatal outcome in both periods are comparable, with no significant difference in the rates of preterm birth, stillbirth, early neonatal deaths and neonatal unit admissions. Conclusions Despite changes in obstetric care following the pandemic, pregnant women were able to access care with no significant adverse impact on obstetric outcomes.
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