Is Valsalva maneuver an alternative to use tenaculum for endometrial sampling procedure in cases where the cervix cannot be passed spontaneously with pipelle? A randomized study

Abstract

Aim To evaluate the effect of the Valsalva maneuver on ease of the endometrial sampling procedure in cases where the cervix cannot be passed spontaneously. Methods A randomized prospective trial was conducted in 84 patients whose cervix could not pass spontaneously with pipelle, and they were randomized for the Valsalva maneuver or tenaculum groups. In 43 of a total of 84 patients, we requested Valsalva maneuver throughout the process to pass the cervical canal, and in 41 patients, we performed tenaculum to pass the cervix. Results Valsalva and tenaculum groups did not differ in success rates (P = 0.314). There was no difference between the two groups in the history of the disease, past surgery and education (P > 0.05). Conclusion In endometrial sampling procedure with pipelle, when the cervix cannot be passed spontaneously, the transition with the Valsalva maneuver should be tried before using the tenaculum. Thus, a more painful procedure can be avoided and patient satisfaction may increase.

Pipelle Endometrial Sampling With a Full Bladder Compared With Standard Care

“…Pretrial data have suggested a 30.0% insertion failure rate among control patients. Pilot data with the Valsalva maneuver from Narin et al 14 suggest that the relative risk (RR) of failure in patients in the experimental group in relation to those in the control group was 0.447. Assuming that a full bladder has the same efficacy as the Valsalva maneuver and applying an a of 0.05 and power of 80.0%, we needed 96 participants in each arm to detect a 20.0% difference between groups for Pipelle insertion failure rate (https://openepi.com/ SampleSize/SSCohort.htm).…”