TRANS-VAGINAL SONOGRAPHY POST OFFICE HYSTEROSCOPY AS A SCREENING TOOL FOR TUBAL PATENCY; A RELIABLE AND FEASIBLE TECHNIQUE IN AN OUTPATIENT SETTING

Introduction: Nowadays minimally invasive techniques are a leading factors in medicine. According to this trend, hysteroscopy has been used in gynecology more and more frequently. Office hysteroscopy gives opportunity for a faster examination with less costs and strain for the patient. Aim: The aim of this work was to get familiar with the novel method. The author examined the level of pain during hysteroscopy performed for different indications with different types of instruments. In addition, the novel method invented for evaluating tubal patency was compared to the gold standard laparoscopy in 70 tubes. Method: Office hysteroscopy was performed in 400 cases for indications according to the traditional method. All examinations were performed in University of Debrecen, Department of Obstetrics and Gynecology in an outpatient setting. A 2.7 mm diameter optic with diagnostic or operative sheet was used. Hysteroscopies were scheduled between the 4th and 11th cycle day. For recording pain level VAS was used in 70 cases. Comparison of hysteroscopic evaluation of tubal patency to the laparoscopic method was studies in 70 cases. Results: It was found that office hysteroscopy can be performed in an outpatient setting, without anesthesia. Pain level showed no difference among subgroups (nulliparous, non-nulliparous, postmenopausal, diagnostic, operative) (mean±SD, 3.5±1.01; p=0.34). For the evaluation of tubal patency, office hysteroscopy showed 92.06% accuracy when compared to laparoscopy. Conclusions: Office hysteroscopy has several advantages over traditional method. This procedure is fast, it has less strain for the patient. The novel method, rather than traditional hysteroscopy, should be used in the work-up of infertility as well. Orv. Hetil., 2014, 155(40), 1589–1597.

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New opportunities for the evaluation of infertility

Orvosi Hetilap ◽

10.1556/oh.2013.29642 ◽

2013 ◽

Vol 154 (33) ◽

pp. 1287-1290 ◽

Cited By ~ 2

Author(s):

Péter Török ◽

Tamás Major

Keyword(s):

Uterine Cavity ◽

Day Surgery ◽

Outpatient Setting ◽

Ambulatory Setting ◽

Office Hysteroscopy ◽

Tubal Patency ◽

The Past ◽

New Methods ◽

Laboratory Techniques ◽

Male Factors

Incidence of infertility increased in the past years and it affects 15% of couples. Female and male factors are responsible in 40% and 40% of the cases, respectively, while factors present in both females and males can be found in 20% of cases. Female factors can be further divided into organic and functional ones. Function of the female organs can be evaluated in an outpatient setting by well-developed laboratory techniques but evaluation of the uterine cavity and inspection of the tubal patency have been traditionally carried out in one-day surgery. However, the latter can be performed under ambulatory setting with the use of office hysteroscopy, so that the use of operating theatre and staff costs can be saved. Using selective pertubation for the evaluation of tubal patency via office hysteroscopy can reduce cost further. The new methods in infertility workup which can be performed in ambulatory setting have several advantages for the patients. Orv. Hetil., 2013, 154, 1287–1290.

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Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-05993-0 ◽

2021 ◽

Author(s):

Marlene Hager ◽

Johannes Ott ◽

Christian Göbl ◽

Iris Holzer ◽

Rudolf Seemann ◽

...

Keyword(s):

Cohort Study ◽

Primary Outcome ◽

Fluid Shift ◽

Tubal Patency ◽

Tubal Occlusion ◽

Hysteroscopic Surgery ◽

Before And After ◽

Vaginal Sonography ◽

Pouch Of Douglas ◽

Medical University

Abstract Purpose To determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency. Methods In a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation. Results Laparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift. Conclusion When CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.

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A novel use of vaginoscopic office hysteroscopy for prediction of tubal patency and peristalsis among infertile women: a preliminary study

Gynecological Surgery ◽

10.1007/s10397-016-0944-6 ◽

2016 ◽

Vol 13 (3) ◽

pp. 187-192 ◽

Cited By ~ 1

Author(s):

Atef M. Darwish ◽

Ahmad I. Hassanin ◽

Mahmoud A. Abdel Aleem ◽

Islam H. Aboushama ◽

Ibraheem I. Mohammad

Keyword(s):

Office Hysteroscopy ◽

Tubal Patency ◽

Infertile Women ◽

Preliminary Study

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Accuracy of a new hysteroscopic method in the assessment of tubal patency: Hysteroscopic Chromotubation

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2017.692 ◽

2018 ◽

Vol 24 (2) ◽

pp. 82

Author(s):

Burak Yucel ◽

Emine Demirel ◽

Sefa Kelekci ◽

Kerem Doga Seckin ◽

Osama Shawki

Keyword(s):

Methylene Blue ◽

Cohort Study ◽

Gold Standard ◽

Uterine Cavity ◽

High Sensitivity ◽

Office Hysteroscopy ◽

Predictive Values ◽

Tubal Patency ◽

Infertile Women ◽

Sensitivity Specificity

ObjectiveThe aim of this study was to evaluate the diagnostic accuracy of hysteroscopic chromopertubation (HCT) in the assessment of tubal patency by comparing its results with laparoscopic chromopertubation (LCT).Study DesignThe population of this prospective cohort study consisted of both fertile and infertile women. Sixty-four women were included to the study. HCT was assessed by the observation of the transport of highly concentrated methylene blue from uterine cavity to tubal ostia. The results of HCT were compared with the results of LCT as a gold standard. The accuracy of HCT, sensitivity, specificity, positive and negative predictive values in diagnosing tubal patency were calculated.ResultsThe results of HCT and LCT were evaluated for right and left tubes, separately. One hundred and twenty-eight tubes were determined. Sensitivity, specificity, positive and negative predictive values for HCT were; 85.85%, 59.09%, 91% and 46.43%, respectively.Conclusion This study’s result showed that HCT had high sensitivity and moderate specificity values in the assessment of tubal patency. HCT during office hysteroscopy could give the chance to practitioners to assess tubal patency without subjecting the patient to multiple procedures.

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Lower Abdominal Pain During Office Hysteroscopy as a Guide in the Assessment of Tubal Patency in Infertile Women

Indian Journal of Public Health Research & Development ◽

10.37506/ijphrd.v11i3.1586 ◽

2020 ◽

Keyword(s):

Abdominal Pain ◽

Lower Abdominal Pain ◽

Office Hysteroscopy ◽

Tubal Patency ◽

Infertile Women

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Predictive values of bubble test during office hysteroscopy in assessment of tubal patency

SVU-International Journal of Medical Sciences ◽

10.21608/svuijm.2019.120933 ◽

2019 ◽

Vol 2 (1) ◽

pp. 25-30

Author(s):

Hazem H. Ahmed ◽

AbdEl-Naser A . Ali ◽

Mohamad A. Mohamad

Keyword(s):

Office Hysteroscopy ◽

Predictive Values ◽

Tubal Patency ◽

Bubble Test

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Abstract 657: Use of a Screening Tool Improves Appropriate Referral for Implantable Cardioverter Defibrillators for Primary Prevention

Circulation ◽

10.1161/circ.118.suppl_18.s_595-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Laura M Gravelin ◽

Michael Remetz ◽

Martha Radford ◽

Rachel Lampert

Keyword(s):

Primary Prevention ◽

Screening Tool ◽

Demographic Data ◽

Control Period ◽

Outpatient Setting ◽

Control Group ◽

Implantable Cardioverter Defibrillators ◽

Adherence To Guidelines ◽

Life Saving ◽

Physician Adherence

Background: The AHA/ACC released guidelines in 2006 recommending the use of ICDs in patients with EF less than 35%, congestive heart failure and/or myocardial infarction. Several studies have suggested that ICDs for primary prevention are underutilized. We sought to determine if use of a screening tool would increase adherence to guidelines. Methods: Data were collected prospectively at the Yale Cardiology Group office during September and October 2007 (screening period). All patients’ charts were flagged with a screening tool that asked if the EF was less than 35%; if they were referred to an electrophysiologist (EP) and if not, why not. Clinical and demographic data were collected by chart review to determine appropriateness of referral. Control data were obtained through retrospective review of charts corresponding to all patient visits during March and April 2007 (control period). Results: As shown in the table , the screening tool increased appropriate referral, from 39% of appropriate patients in the control group, to 72% during the screening period (p=0.06). More patients had been evaluated by an EP prior to the visit in the screening period (71%) than in the control period (47%). Approximately 2/3 of patients offered referral declined in both time periods. Conclusions: In this study, the first to investigate if a screening tool in the outpatient setting would increase the rate of appropriate patient referral for ICD as recommended by current ACC/AHA guidelines, utilization of a screening tool showed a trend toward increased physician adherence to guidelines. Surprisingly, over half of patients offered EP referral for ICD declined. Patient education regarding the benefits of ICDs may also increase appropriate use of this life-saving device.

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