Vaginoscopy “No Touch” Technique: A Feasible Alternative to Paracervical Block for in Office Hysteroscopy [34E]

INTRODUCTION:Hysteroscopy allows direct visualization of the uterine cavity. Traditionally, in office hysteroscopy is performed using a speculum and tenaculum to hold the cervix. However, the emergence of smaller diameter hysteroscopes along with the vaginoscopy no touch technique without the need of speculum or tenaculum has contributed for the procedure to be done in the office setting without the use of analgesia. This study reviews our experience of in office hysteroscopy using the vaginoscopy 'no touch' approach. METHODS:Retrospective chart review of 22 in office hysteroscopies performed without analgesia using the vaginoscopy “No touch” technique from June 1, 2017 to January 31, 2018. Patients received 200 mcg of oral Misoprostol 30 minutes before the procedure. Data gathered included age, body mass index, prior vaginal deliveries, and pain during the procedure. Success was measured as the ability to enter the endometrial cavity and perform the expected procedure. RESULTS:The median age 45 SD ±10.0 and BMI of 26.9 SD ±4.4. Hysteroscopic indications were2 (9.1%) postmenopausal bleeding, 5 (22.7%) retained IUD, 7 (31.8%) for suspected polyp, 8 (36.4%) for abnormal uterine bleeding. Of the 22 procedures, 18 were successful completed (80%). The median pain on VAS scale reported immediately after the procedure was 3.8 SD ±0.8 All four of the unsuccessful procedures were in postmenopausal females, two of which due to severe cervical stenosis. There were no complications. CONCLUSION:In office hysteroscopies using the vaginoscopy “no touch” technique is a feasible and safe procedure. We recommend adopting this innovative, painless technique

Perioperative Blood Transfusions: Risk Factors for Patients Undergoing Hysterectomy for Benign Disease [29B]

INTRODUCTION:Perioperative blood transfusion increases morbidity and increases significantly health care cost. Identifying risk factors for perioperative blood transfusion can help to minimize risks. Our objective was to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign indications. METHODS:We completed a retrospective chart review of patients who had undergone abdominal, laparoscopic, or vaginal hysterectomy. The following risk factors for blood transfusion were analyzed, 1. Route of Hysterectomy 2. Patientʼs BMI 3. Presence of adhesions 4. History of Cesarean Section 5. Uterine weight. Descriptive statistic was used to analyze the data. RESULTS:517 charts were reviewed. Forty-seven patients (9.09%) received perioperative blood transfusion. The route of hysterectomy was as followsTAH34/263 (12.92%), TLH5/119 (4.2%), LAVH3/35 (8.57%), and VH5/100 (5.0%). Abdominal hysterectomy was a significant risk factor for receiving blood transfusions (P=.017). The patients who needed blood transfusion had larger BMI 33.01 vs 29.5 (P=.002), larger uterine weight 933.4 gm vs 542.5 gm (P=.002). There was no association between the presence of adhesions (P=.91) nor history of cesarean section (P=.89) with the need to receive blood transfusion. When analyzing only the patients who underwent TLH, pelvic adhesions was found as a risk factor for perioperative blood transfusion (P=.024). CONCLUSION:Blood transfusion is a frequent complication in patients undergoing hysterectomy for benign disease. Having a large uterus and obesity are risk factors for the need to receive blood transfusion. The presence of pelvic adhesion was risk factor for blood transfusion only in patients undergoing a laparoscopic approach

Single live birth derived from conjoined oocytes using laser-cutting technique: a case report

The finding of conjoined oocytes is a rare occurrence that accounts for only 0.3% of all human retrieved oocytes. This phenomenon is quite different from that of a traditional single oocyte emanating from one follicle, and may result in dizygotic twins and mosaicism. Given the insufficient evidence on how to approach conjoined oocytes, their fate is variable among different in vitro fertilization (IVF) centres. In this observational report, we propose a new protocol for the use of these conjoined oocytes using intracytoplasmic sperm injection (ICSI), laser-cutting technique and next-generation sequencing (NGS). The first case report demonstrates that conjoined oocytes can penetrate their shared zona pellucida (ZP) at Day 6. The second case is that of a 25-year-old female patient who underwent a successful embryo transfer cycle after removal of one oocyte in which a pair of conjoined human oocytes underwent ICSI, laser-cutting separation and NGS testing. The patient achieved pregnancy and gave birth to single healthy female originally derived from conjoined oocytes. This case provided a means through which normal pregnancy may be achieved from conjoined oocytes using laser-cutting separation techniques. The protocol described may be especially beneficial to patients with a limited number of oocytes