Post procedural pregnancy occurrence risk after endometrial ablation: Pregnancy after endometrial ablation

International audienceObjective: The objective of the study was to analyse the pregnancy rate after curettage, 1G (Endometrial resection) and 2G (Endometrial ablation) procedures in women with abnormal uterine bleeding (AUB-O,E,N) to evaluate the rate of pregnancy following these procedures and to improve pre and post-therapeutic women information. Methods: This retrospective study analyzed data extracted from the French Hospital medical information database. All hospital stays with a diagnostic code for AUB and an appropriate surgical procedure coded between 2009 and 2015 were identified. A total of 109,884 women were included. Of these, 88,165 were followed up for 18 months, 80,054 for 24 months and 33,251 for 60 months. Outcomes were compared between second generation (2G) procedures, first-generation (1G) procedures (endometrial resection) and curettage. The rate of pregnancy was the primary end point. Results: 7863 women underwent a 2G surgical procedure (7.2%), 39,935 a 1G procedure (36.3%) and 38,923 a curettage (35.4%). The mean age of the women was 46 years (IC.95: 36.7-52.5), with no difference in age between groups. The rate of pregnancy after 2G, 1G and curettage was respectively 13 (1.5%), 617 (10.1%) and 1025 (11.1%). The primary endpoint was significantly different between 2G and 1G and curettage (p<0.0001) Conclusion: 2G procedures result in lower risk of pregnancy without requiring specific training for surgeons. However, endometrial ablation cannot be considered as a sterilization method nor an effective contraceptive procedure. In the absence of sterilization of either partner, women should continue to use contraception whatever their age and menstrual status

Transboundary geothermal resources of the Mura-Zala basin: a need for joint thermal aquifer management of Slovenia and Hungary

Large transboundary Upper Miocene geothermal sandy aquifers which are widely utilized by both countries forbalneological and direct heat purposes exist in the Slovenian-Hungarian border region. In NE Slovenia the totaldirect heat use was 382 TJ in 2010, while in SW Hungary it was 648 TJ, including utilization from basement reservoirs.The total installed capacity of the 13 Slovenian users was 38.8 MWt, while that of the 29 Hungarian userswas 70.6 MWt. Utilisation takes place without harmonized management strategies which might endanger the longtermsustainability of these systems. We aimed to overcome this by delineating a transboundary thermal groundwaterbody (TTGWB) Mura-Zala with an aerial extent of 4,974 km2 and with vertical extent between depths 500–2,200 m, which was done based on detailed geological, hydrological, geochemical and geothermal models as wellas numerical modelling. The regional groundwater flow in the Mura-Zala TTGWB is from west to east in general,the modeled cross-border flow is approximately 50 l/s. At present, thermal water abstraction rates from the Mura/Újfalu Fm. (61.8 l/s in the Slovenian and 67.3 l/s in the Hungarian part of the TTGWB) does not endanger the goodregional quantity status of the water body, and this should be maintained by allowing a maximum increase of thermalwater abstraction 3.5 times higher than today. However, to achieve target numbers for an increased proportionof geothermal energy in the total energy mix in both countries, we suggest that increase of thermal efficiency andre-injection should be prioritized apart from the higher thermal water abstraction with setting up limit of themaximum allowable drawdown