Uterine distension media for outpatient hysteroscopy

Abdallah, Karim S.; Gadalla, Moustafa Abdelhafez; Breijer, Maria; Mol, Ben Willem J.

doi:10.1002/14651858.cd006604.pub2

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…For example, in a study by Yang R. et al (2014), patients whose control hysteroscopy showed no CE signs exhibited better IVF outcomes as compared to women whose recovery was assessed via immunohistochemistry (no PCs) [75]. Also, hysteroscopy is a technique that enables endometrial material sampling under visual control [76][77][78]. However, despite the fact that the use of hysteroscopy with biopsy is mandatory in focal endometrial lesions, its effectiveness is yet to be evaluated in CE diagnosis [15,[79][80][81][82][83].…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Lokshin,

Kutsenko,

Borovikov

et al. 2023

Kuban. nauсh. med. vestnik

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Background. The relevance of the problem is related to the high prevalence of chronic endometritis (CE); its role in female infertility, implantation failures during assisted reproductive technology procedures, and recurrent miscarriage; as well as the lack of a unified strategy in the diagnosis and treatment of this pathology. The present systematic review with a meta-analysis focuses on evaluating the impact of CE and its therapy on the outcome of in vitro fertilization. In addition, the effect of CE of various severity on the outcomes of assisted reproductive technologies is analyzed. Objective. To analyze the effect of CE of varying severity and its treatment on the outcomes of in vitro fertilization. Methods. Using PubMed, Medline, Scopus, Embase, ELibrary, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry, and Russian Science Citation Index, a systematic search was conducted for articles published over the past 12 years that met the following criteria: randomized controlled trial examining the effect of CE of varying severity on fertility and ways to treat it. The following indicators were calculated: ongoing pregnancy/live birth, clinical pregnancy, and miscarriage rates. A total of 4145 patients (from ten studies) were included. A meta-analysis was performed using Stata 11.0 software (The Cochrane Collaboration, Oxford, UK). The heterogeneity was considered low at I2 <30%, moderate at 30–50%, and high at >50%. Results. Women with CE exhibited lower ongoing pregnancy/live birth (OR 1.97; p = 0.02) and clinical pregnancy rates (OR 2.28; p = 0.002) as compared to women without it. CE treatment increased the ongoing pregnancy/live birth (OR 5.33; p < 0.0001) and clinical pregnancy rates (OR 3.64; p = 0.0001). In vitro fertilization outcomes were comparable in women treated for CE and women without CE (ongoing pregnancy/live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Women with severe CE exhibited lower ongoing pregnancy/live birth (OR 0.43; p = 0.003) and clinical pregnancy rates (OR 0.40; p = 0.0007). Mild CE showed no significant effect on in vitro fertilization outcomes (ongoing pregnancy/ live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Conclusion. The conducted meta-analysis showed that CE significantly reduces the ongoing pregnancy/live birth and clinical pregnancy rates in infertile women undergoing in vitro fertilization. Noteworthy is that antimicrobial therapy in such patients improves the results of assisted reproductive technologies, which are comparable to those of patients without CE. The negative impact of this pathology on the implantation capacity of the endometrium is most often observed in the severe form, while its mild form has virtually no effect on the in vitro fertilization outcome.

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Section: Interpretation Of Resultsmentioning

confidence: 99%

Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Lokshin,

Kutsenko,

Borovikov

et al. 2023

Kuban. nauсh. med. vestnik

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“…The Cochrane Database Systematic Review in 2021 concluded that normal saline results in fewer adverse events such as shoulder-tip pain and vasovagal reaction. Vaginoscopy is also easier with a fluid distension medium 35 . The use of warm saline (rather than room temperature saline) is a common practice, despite lacking evidence of pain reduction in outpatient hysteroscopy.…”

Section: Uterine Distension Mediamentioning

confidence: 99%

Pain relief in hysteroscopy

Law

2023

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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Pain is a major barrier to successful outpatient hysteroscopy. Multiple factors can cause pain during the procedure including patient factors such as cervical stenosis and anxiety and procedural factors such as hysteroscope diameter and operative procedures. Pain relief strategies tailored to needs for Hong Kong women may enhance patient satisfaction and the success rate of outpatient hysteroscopic procedures.

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“…83 The frequency of vasovagal reactions during office hysteroscopy appears to be reduced with the use of a flexible rather than rigid hysteroscope and normal saline instead of CO 2 for distension. 84,85 Management includes stopping the procedure immediately, monitoring vital signs, and initiating supportive care measures. These include repositioning in supine position with legs elevated (Trendelenburg), encouraging deep breathing, and using ammonia or other aromatic spirits.…”

Section: Challenges and Complicationsmentioning

confidence: 99%

Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology

Orlando

Bradley

2022

Obstetrics &Amp; Gynecology

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Hysteroscopy provides a minimally invasive strategy to evaluate intrauterine pathology and manage conditions such as abnormal uterine bleeding, infertility, intrauterine adhesions, mu ¨llerian anomalies, and intrauterine foreign bodies. Increasing access to hysteroscopy procedures in the office has the potential to improve patient care by minimizing financial and logistical barriers, aiding in streamlined diagnosis and treatment planning, and potentially averting unnecessary operative procedures and anesthesia. Office hysteroscopy refers to procedures performed in outpatient settings where pain management involves no medications, oral nonsedating medications, local anesthetic agents, or oral or inhaled conscious sedation. We present best practices for the implementation of hysteroscopy in an office setting. These include appropriate patient selection, optimal procedural timing, cervical preparation for patients at highest risk of cervical stenosis or pain with dilation, individualized pain-management strategies, use of distension media, and video monitoring to engage patients in the procedure. We describe miniaturized equipment for use in the office setting and "no-touch" vaginoscopic approaches to limit patient discomfort. With appropriate training and experience, office hysteroscopy presents a simple and cost-effective modality for optimizing gynecologic care for our patients.

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Uterine distension media for outpatient hysteroscopy

Cited by 6 publications

References 32 publications

Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Pain relief in hysteroscopy

Implementation of Office Hysteroscopy for the Evaluation and Treatment of Intrauterine Pathology

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