The randomised uterine septum transsection trial (TRUST) : Design and protocol

Peer reviewedPublisher PD

Levonorgestrel-releasing intrauterine system versus endometrial ablation for heavy menstrual bleeding

Acknowledgments: We thank all the women who participated in this trial; the participating general practitioners, gynecologists, and hospitals; the research nurses; and the staff of the Dutch Consortium for Studies in Women’s Health and Reproduction.Peer reviewedPublisher PD

Current practice in the removal of benign endometrial polyps: a Dutch survey

The purpose of this study is to evaluate the current practice of Dutch gynecologists in the removal of benign endometrial polyps and compare these results with the results of a previous study from 2003. In 2009 Dutch gynecologists were surveyed by a mailed questionnaire about polypectomy. Gynecologists answered questions about their individual performance of polypectomy: setting, form of anesthesia, method, and instrument use. The results were compared with the results from the previous survey. The response rate was 70% (585 of 837 gynecologists). Among the respondents, 455 (78%) stated to remove endometrial polyps themselves. Polyps were mostly removed in an inpatient setting (337; 74%) under general or regional anesthesia (247; 54%) and under direct hysteroscopic vision (411; 91%). Gynecologists working in a teaching hospital removed polyps more often in an outpatient setting compared with gynecologists working in a nonteaching hospital [118 (43%) vs. 35 (19%) p < 0.001]. These results are in accordance with the results from 2003. Compared to 2003 there was an increase in the number of gynecologists performing polypectomies with local or no anesthesia [211 (46%) vs. 98 (22%), p < 0.001]. An increase was also noted in the number of gynecologists using direct hysteroscopic vision [411 (91%) vs. 290 (64%), p < 0.001] and 5 Fr electrosurgical instruments [181 (44%) vs. 56 (19%), p < 0.001]. Compared to the situation in 2003, there is an increase in removal under direct hysteroscopic vision, with 5 Fr electrosurgical instruments, using local or no anesthesia. This implies there is progress in outpatient hysteroscopic polypectomy in the Netherlands

Preventing preterm birth with progesterone: costs and effects of screening low risk women with a singleton pregnancy for short cervical length, the Triple P study

Contains fulltext : 97255.pdf (postprint version ) (Open Access)BACKGROUND: Women with a short cervical length in mid-trimester pregnancy have a higher risk of preterm birth and therefore a higher rate of neonatal mortality and morbidity. Progesterone can potentially decrease the number of preterm births and lower neonatal mortality and morbidity. Previous studies showed good results of progesterone in women with either a history of preterm birth or a short cervix. However, it is unknown whether screening for a short cervix and subsequent treatment in mid trimester pregnancy is effective in low risk women. METHODS/DESIGN: We plan a combined screen and treat study among women with a singleton pregnancy without a previous preterm birth. In these women, we will measure cervical length at the standard anomaly scan performed between 18 and 22 weeks. Women with cervical length </= 30 mm at two independent measurements will be randomly allocated to receive either vaginal progesterone tablets or placebo between 22 and 34 weeks. The primary outcome of this trial is adverse neonatal condition, defined as a composite outcome of neonatal mortality and severe morbidity. Secondary outcomes are time to delivery, preterm birth rate before 32, 34 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We will assess growth, physical condition and neurodevelopmental outcome of the children at two years of age. DISCUSSION: This study will provide evidence for the usefulness and cost-effectiveness of screening for short cervical length at the 18-22 weeks and subsequent progesterone treatment among low risk women. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR207

The randomised uterine septum transsection trial (TRUST): Design and protocol

Background: A septate uterus is a uterine anomaly that may affect reproductive outcome, and is associated with an increased risk for miscarriage, subfertility and preterm birth. Resection of the septum is subject of debate. There is no convincing evidence concerning its effectiveness and safety. This study aims to assess whether hysteroscopic septum resection improves reproductive outcome in women with a septate uterus. Methods/design: A multi-centre randomised contr

Hysteroscopic Sterilization

promotiedatum: 5-6-2014 � prom-id: 1128

Placental Remnant Removal With the Hysteroscopic Morcellator

Study Objective To investigate the the effectiveness of removal of placental remnants with the hysteroscopic morcellator (Myosure, Hologic). Design Prospective trial multicenter. Setting Two Teaching Hospitals. Patients Patients with a placental remnant or miscarriage remnant were treated with a hysteroscopic morcellator to remove the remnant. Intervention Patients who complained of persisting bloodloss after delivery or miscarriage underwent a transvaginal ultrasound. If there was a suspicion of a placentalremnant, confirmation was achieved by hysteroscopy. If a remnants was present, patient could decide to be treated immediately in the office, or to get an appointment to be treated in the OR. Prospective data were registered in a CRF. Measurements and Main Results The prospective CRF consisted patientdata. Number of days after delivery or miscarriage, the size of the remnant measured on the day of surgery by TVU, the location of the remnant seen by hysteroscopy, time needed to remove the remnant, vision during removal and blood loss as well as fluidloss. Moreover the patient filled in a VAS score if she was treated in the office. Overall 39 patients were treated. 9 patients in the OR and 22 patient in the office with a placental remnant after delivery and 8 after a miscarriage. All patients but one could be treated adequately in one visit. One patient had fluid loss of more than 1000cc. One patient bloodloss 500 cc. The VAS had a mean of 2.3 on a scale of 0 till 10 for the patient wthout anesthesia. Conclusion Morcellation of placental remnant seems feasible with the Myosure morcellator (Hologic). As an office procedure it was scored in 95% as acceptable by the patients