Radiographic aspects of office hysteroscopic tubal occlusion with siloxane intratubal devices (the Ovabloc method)

To evaluate the importance of radiographs in women sterilized with hysteroscopically applied siloxane intratubal devices (ITDs). A retrospective study of the frequency of abnormal radiographs in 500 women was carried out. The agreement in judging these radiographs and the expected reliability of the sterilization was measured. Abnormal radiographs were mostly documented in the first 100 sterilization procedures. Agreement in judging the radiographs is substantial. Different agreements on the expected reliability are due to the difference in experience with this sterilization method. Four types of abnormal radiographs can be categorized. Judgment of the radiographs can easily be learned. For the assessment of the reliability, training is necessar

Office hysteroscopic tubal occlusion with siloxane intratubal devices (the Ovabloc method)

To study the results of the Ovabloc method for female sterilization used in an outpatient setting. A prospective longitudinal study at the Schieland Hospital of 411 patients who consented for the method for sterilization. For statistical analyses the x2 test is used for detection of differences between groups of patients. The life-table analysis is used for events during the follow-up period. Our results reflect those done under strict clinical conditions. The majority of the events took place in the first 36 months on Ovabloc. Unplanned pregnancies were mainly due to misdiagnosis in X-ray images and to incomplete procedures. The method failures are 3/1000 women in 12 months and 8/1000 women in 36 months. The follow-up should be extended to 12 months. The reversibility of the method remains questionable. The method should be offered to women with (relative) contraindications for laparoscopic sterilization such as severe obesity, extensive pelvic adhesions or anesthetic risk

Primary amenorrhea caused by crushing trauma of the pelvis

An 18-year-old woman sought treatment for primary amenorrhea. Crushing trauma of the pelvis in her childhood had caused separation between the uterine corpus and the cervix. Through a combined abdominal and vaginal approach the continuity of the uterine outflow tract was restored. Years later, after in vitro fertilization, the patient was delivered of a healthy term baby in an elective cesarean procedur

Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding?

To determine the predictive value of dilatation and curettage (D&C) for diagnosing intrauterine disorders in patients with persistent abnormal uterine bleeding. An observational descriptive study was performed in a large university-affiliated teaching hospital. The suspicion of intrauterine disorders described in theater-reports involving D&C was compared with the hysteroscopical findings in 131 premenopausal patients with persistent complaints of abnormal uterine bleeding who were referred by other gynecologists within six months after D&C. Pre-test probability (prevalence), post-test probabilities (predictive values) and likelihood-ratio's were calculated. The pre-test probability for all intrauterine disorders was 0.49. The post-test probabilities for a 'suspect' and a 'not suspect' D&C were 0.61 and 0.46 respectively with an overlap of confidence-intervals. The corresponding likelihood-ratio's were 1.69 and 0.87 respectively. D&C findings were of no value in the prediction of the presence or absence of intrauterine disorders in this population with persistent complaint

Feasibility of transposition of the ovaries in the surgical and radiotherapeutical treatment of cervical cancer

Ovaries are seldom subject to metastases and therefore their preservation is possible in radical cervical cancer surgery. However, with postoperative radiotherapy they cannot be preserved unless they are placed outside the radiation field. The practicality of this transposition was analysed in a series of 126 patients with cervical cancer. The ovaries were transposed intraperitoneally in a lateral and cranial direction in 44 of the 64 women under the age of 50 years. In 16 of these 44 women, only one ovary could be preserved and transposed. A critical analysis was performed of the ovaries' new location by plotting their position, marked by 2 clips each, in a single pelvis. In 68% of the women at least one ovary was placed outside the radiation field. However, because of scattered radiation, i.e. 5% of the total radiation dose at a distance of 4 cm outside the radiation field, a substantial loss of ovarian function may occur. In 32% of the women at least one ovary received less than this 5%. Optimal transposition may be achieved after extension of the abdominal incision. However, this will be unnecessary in most cases, since postoperative radiotherapy will be indicated in only approximately 15% of the wome

A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications

We determined the diagnostic value of transvaginal ultrasonography for endometrial and intrauterine abnormalities in patients with abnormal uterine bleeding. Between June 1, 1992, and June 1, 1993, 279 consecutive patients underwent transvaginal ultrasonography. Findings were compared with the final diagnosis established by diagnostic hysteroscopy and histologic examination. Transvaginal ultrasonography demonstrated a sensitivity of 0.96 and a specificity of 0.89. With a pretest probability (prevalence) of 0.42, this resulted in posttest probabilities of 0.03 in the case of a normal sonogram and 0.87 for an abnormal sonogram. The corresponding likelihood ratios were 0.04 and 9.09, respectively. Transvaginal ultrasonography seems to be an effective procedure to exclude endometrial and intrauterine abnormalities. Its use could be implemented as a routine first-step procedure in patients with abnormal uterine bleeding, and it selects those in need of further diagnostic evaluation in the case of an abnormal or inconclusive sonogra

Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?

Laparoscopy is regarded as the final decisive diagnostic test in suspected ectopic pregnancy. The new non-invasive diagnostic methods of transvaginal sonography and serum human chorionic gonadotrophin (HCG) monitoring now challenge this pivotal role of laparoscopy. In this prospective study the diagnostic value of an algorithm, combining transvaginal sonography with an HCG cut-off level between 1000 and 1500 IU/l (IRP) was tested in 208 consecutive women at risk for ectopic pregnancy. Three diagnostic categories are designated by the algorithm: intra-uterine pregnancy (n = 73), ectopic pregnancy (n = 89), and trophoblast in regression (n = 46). The latter category represents patients in whom no pregnancy could be located by transvaginal sonography, with an initial HCG concentration < 1500 IU/l, declining during follow-up. The algorithm has a sensitivity of 0.97, a specificity of 0.95, a likelihood ratio for a positive test of 19.4, and a likelihood ratio for a negative test of 0.03. The described diagnostic strategy thus proved extremely reliable in the safe management of patients at risk for ectopic pregnancy, and renders laparoscopy obsolet