S14 Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
to determine whether there are differences in rates or trends
across important socio-demographic, clinical, and hospital-levels
characteristics.
Design: A cross-sectional analysis of the Healthcare Cost and Utilization
Project’s Nationwide Inpatient Sample (HCUP-NIS), the largest all-payer
inpatient database in the United States, was conducted for all patients
who underwent surgical management of ectopic pregnancy. Joinpoint
regression was used to estimate temporal trends (including the annual
percent change [APC]) in salpingectomy versus salpingostomy during the
study period and to evaluate whether trends were different across
individual and hospital-level characteristics.
Setting: All community hospitals in the US participating in HCUP,
excluding rehabilitation and long-term acute care hospitals.
Patients: The study includes all inpatient hospitalizations for women
receiving treatment for ectopic pregnancy as identified using ICD-9-CM
codes.
Measurements and Main Results: During the study period, the number of
inpatient discharges for ectopic pregnancy decreased from 36,574 in 1998 to
21,426 in 2011. Among tubal ectopic pregnancies, which is the
most common type, the rate of salpingectomy increased steadily
during the study period (APC=1.2%; 95%CI: 1.0, 1.3). Conversely,
the rate of salpingostomy decreased moderately from 1998-2004
(APC= -3.7%; 95%CI: -6.3, -1.1), and then more drastically from
2004-2011 with a 10% annual decline (95%CI: -12.5, -6.6). There
were no statistically significant changes in the rate of other adnexal
surgery for ectopic pregnancy, or for medical management without
surgical treatment.
Conclusion: The rate of inpatient hospitalization for ectopic pregnancy
has decreased in the US over the past 15 years. When hospitalization
occurs, there is an increasing tendency to perform salpingectomy as
oppose to salpingostomy as surgical management approach of ectopic
pregnancy. There is no significant change in the trends for non-surgical
management.
36
Reproductive Outcomes of 10 Years Asherman’s
Surgery
Hanstede M, Emanuel MH. Ob/Gyn, Spaarne Gasthuis, Hoofddorp/
Haarlem, Noord Holland, Netherlands
Study Objective: To identify succes rates of hysterscopic adhesiolysis in
women with Asherman Syndrome and to study pregnancy rates, life birth
and obstetrie outcomes.
Design: Retrospective Cohort study and prospective follow up study.
Setting: University teaching hospital ‘Spaarne Ziekenhuis’. All women
with Asherman Syndromen were operated in this centre using
conventional instruments for hysterscopic adhesiolysis with fluoroscopic
guidance. After succesfull adhesiolysis an IUD was placed and adjudant
progesterone and oestrogen was given. Two months after surgery a
second look hysterscopy was performed.
Patients: Women who were diagnosed with Asherman Syndrome.
Confirmation of intrauterine adhesions was done by hysteroscopy.
All women underwend hysterscopic adhesiolysis with fluoroscopic
guidance.
In 10 years from 2003-2013 638 women were identified.
Data was collected from operation and second look hysteriscopy from the
hospital database. Patients were contacted by phone to get information on
reproductive outcomes.
Measurements and Main Results: More 55% of the patientes had severe
intra uterine adhesions. Most of them had an amenorroe. Succes rate was
defined as a normal uterine cavity with restore of normal menstrual
bloodflow after adhesiolysis. This succeded in 95%. Spontaneous
recurrence of inta uterine adhesions occurred in almost 30%. The follow
up rate was 80%. Pregnancy rate was 75% and life birth was 68% after
succesfull adhesiolysis. There was a five time increased change of a
placental problem post partum.
Conclusion: Patientes with Asherman Syndrome have a good chance of
restoration of the intra uterine anatomy after adhesiolysis but have a high
chance of recurrence of adhesions.
If adhesiolysis is succesful the chance of a life birth is 68%. The chance of
post partum placental problems is 5 times increased.
37
Genital Tuberculosis in Female Infertility: An Enigma
A.M. Luthra. Luthra Hospitals, Dehradun, Uttarakhand, India
Study Objective: Mycobacterial infection of the genital tract is a common
etiology for female infertility in developing countries. Aim of this study is to
evaluate plethora of laparoscopic and hysteroscopic appearances of
tuberculosis, to correlate them with Endometrial TB PCR and BACTEC
culture .
Design: Retrospective case series.
Setting: Tertiary care hospital in Northern India.
Patients: 100 infertile women in the reproductive age group (25-38 years)
were included in the study between January 2000 to January 2014. Laparo-
hysteroscopic assessment of female pelvis was done along with
endometrium sampling for PCR and BACTEC Cultures. The results were
retrospectively correlated with endoscopic appearance and treatment
options were offered accordingly.
Intervention: Patients were called for follow up one week post surgery for
PCR results, and 4 weeks later for Bactec culture reports.
Measurements and Main Results: Out of hundred women, 24 women
had endoscopic abnormalities suggestive of tuberculosis. 18 of these
women with positive endoscopic findings were PCR positive.
Sensitivity and specificity of endoscopic evaluation was 75% and 28%
respectively. Laparoscopic findings of caseous material. beading of
fallopian tubes, cornual block, thick omental adhesions, tubo-ovarian
adhesions and hydrosalpinx were strongly suggestive of tubercular
infection.
Hysteroscopic appearance of peri-ostial fibrosis, intra- uterine
synechiae and Asherman’’s syndrome were correlated with old tubercular
infection.
Conclusion: Endoscopic evaluation is a valuable tool to diagnose genital
Tuberculosis; and to assess the extent of the disease process. In
addition,the routine application of endometrium bacteriological PCR
assay and BACTEC cultures carries a great potential in improving the
diagnosis of genital tuberculosis.
38
Does the Mode of Surgery for Hydrosalpinges Affect
Outcome in In-Vitro-Fertilization (IVF) Cycles? A
Randomized Trial Comparing Laparoscopic
Salpingectomy and Proximal Tubal Occlusion (PTO)
Malhotra N, Vignarajan CP. Art Centre, Department of Obstetrics and
Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi,
India