Hysteroscopic Endometrial Resection in the Management of Abnormal Uterine Bleeding Among Libyan Women

Background: Abnormal uterine bleeding (AUB) is a major health problem and it is a substantial cause of ill health in women. Medical treatment has a high failure rate and adverse effects. There are few published data on hysteroscopic endometrial resection (HER) in the management of patients with AUB.Objective: To investigate the efficacy and outcomes of hysteroscopic endometrial resection (HER) in patients with AUB.Materials and Methods: A descriptive hospital - based study was carried out at the departments of Obstetrics and Gynecology, Misurata and Sirt, Libya, during the period from January 2009 to December 2013. Women with AUB were recruited in the study. All women had a detailed medical and obstetrical history, physical examination and the hysteroscopic endometrial ablation and were followed-up for success or failure of the procedure which was assessed via symptoms (bleeding).Results: A total of 120 women with mean (SD) of age and parity of 42.3 (6.8) years and 3.8 (2.4), respectively were recruited in the study initially. Thirty (25%) of these women were lost of followup Therefore, only 70 women (50 with DUB, and 20 women with fibroids) were available for the final analysis. All women underwent hysteroscopic endometrial resection and 28 of them had hysteroscopic myomectomy. The success rate was 92.8% (65/70) after 2 years follow up. All the five women with failure of the procedure were younger (<40 years); had bleeding with dysmenorrhea, bigger uterine size, thicker endometrium (> 7 mm) and they had fibroids.Conclusions: Endometrial resection is an effective procedure in the majority of women with AUB, especially in those over age of 40 and without an increase in uterine size and has no fibroids.Keywords: Uterine bleeding, hysteroscopic, endometrial resection, Libya

Hysteroscopy in Libyan women with Recurrent Pregnancy Loss

Background: Hysteroscopy is an efficient procedure of management in many gynecologic conditions. There are few published data on hysteroscopy and recurrent pregnancy loss especially in developing countries.Objectives: To assess hysteroscopic findings in patients with consecutive miscarriages, and to compare the prevalence of uterine abnormalities between women with two and three or more miscarriages.Methods: Three hundred and twenty four women with two or more consecutive miscarriages were enrolled in the study. All participants underwent a diagnostic hysteroscopy. Congenital (arcuate uterus, septate uterus, unicornuate uterus) and acquired uterine abnormalities (intrauterine adhesions, polyp and submucous myoma) were documented. The findings were compared between the groups of women with two miscarriages and women who had three or more miscarriages.Results: Out of a total of 324 women [their mean (SD) of the age and gravidity was 28.3 (6.5) years and 5.1(1.5), respectively] 135 (41.7%) and 189 (58.3%) had two consecutive miscarriages and three or more consecutive miscarriages, respectively. While 194 (59.9%) women had no pathological findings on hysteroscopy, 130 (40.1%) women were found to have uterine anomalies. The congenital anomalies were found in 79 (24.4%) and the acquired were in 51 (15.7%) women. In comparison with women who had three or more miscarriages, women who had two miscarriages had significantly higher number of congenital anomalies, 53/135 (39.2%) vs. 26/189 (13.8%), P < 0.001. However there was no significant difference in the acquired anomalies between women who had two miscarriages and women who had three or more miscarriages.Conclusions: Patients who had two consecutive miscarriages were found to have a higher prevalence of congenital anatomical abnormalities. Diagnostic hysteroscopy should be carried out after two such miscarriages.Keywords: Hysteroscope, Recurrent Pregnancy Loss, miscarriage, Libya

A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy

Background: Urinary tract infections (UTIs) are common in pregnancy and account for the highest proportion of primary care antibiotic prescriptions issued to pregnant women in the UK. It is well known that antibiotic use is associated with increased antimicrobial resistance and therefore measures to minimise antibiotic use for UTI prevention have been studied. The efficacy and safety of these measures in pregnancy have not been addressed and therefore the aim of this study was to systematically review the literature to identify and evaluate potential measures to prevent UTIs in pregnant women. Methods: Ten databases (EMBASE, AMED, BNI, CINAHL, Medline, PubMed, PsycINFO, Cochrane Trials, Scopus and Science Direct) were systematically searched in July 2017 for studies reporting non-antibiotic measures to prevent UTIs in pregnancy. The terms (“urinary tract infection”or UTI or bacteriuria or cystitis) AND (prevention) AND (pregnan*) were used. The quality of the publications was appraised using the Critical Appraisal Skills Programme (CASP) checklists for cohort study, case-control study and randomised controlled trial. The results were synthesised using a textual narrative approach. Results: Search results yielded 3276 publications and after reviewing titles and removing duplicates, 57 full text articles were assessed for eligibility and eight were included in the review. Five different approaches (hygiene measures, cranberry juice, immunisation, ascorbic acid and Canephron® N) have been identified, all of which are reported to be safe in pregnancy. Conclusion: The quality of the evidence varied considerably and only hygiene measures were supported by evidence to be recommended in practice. Future work needs to concentrate on strengthening the evidence base through improved design and reporting of studies with a focus on immunisation, ascorbic acid and Canephron® N

Value of hysteroscopy in management of unexplained infertility

Objective: To assess the value of hysteroscopy in unexplained infertility. Methods: 200 infertile women in whom standard infertility investigations revealed no abnormalities were included in the study between January 2009 and December 2013. All women underwent hysteroscopy for diagnosis and treatment of any uterine lesion which was previously undetected by hysterosalpingography (HSG). Treated women were followed up for one year during which pregnancy rate was determined. As all other causes that contribute to infertility (other than the subtle uterine lesions) were excluded. No other infertility treatment was performed during this period. Results: Of the 200 women studied, hysteroscopy revealed abnormalities in 65 (33%) women. Most uterine abnormalities were mild adhesions, small submucous myomas and polyps and their incidence was greater in women aged ≥ 30 years and women with secondary infertility. The overall pregnancy rate in the treated women within one year of follow up was 46%. Conclusion: As a cause of unexplained infertility, subtle uterine abnormalities are diagnosed only during hysteroscopy and they are relatively common in infertility women. Although the presence of these abnormalities is not detected by the basic investigations for infertility, their correction seems to be necessary when infertility is desired and other infertility causes are excluded