Faculty Bibliography

OBJECTIVE: The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome. STUDY DESIGN: A large prospective multicenter database was studied. Subjects were divided into three groups: (1) no bleeding, (2) light bleeding, and (3) heavy bleeding. Univariate and multivariable logistic regression analyses were used. RESULTS: The study comprised 16,506 patients: 14,160 patients without bleeding, 2094 patients with light bleeding, and 252 patients with heavy bleeding. Patients with vaginal bleeding, light or heavy, were more likely to experience a spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2, respectively) and cesarean delivery (odds ratio, 1.1 and 1.4, respectively). Light bleeding subjects were more likely to have preeclampsia (odds ratio, 1.5), preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio, 1.6). Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0), preterm premature rupture of membranes (odds ratio, 3.2), and placental abruption (odds ratio, 3.6). CONCLUSION: First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding

OBJECTIVE: The purpose of this study was to evaluate a new device that couples any standard transvaginal ultrasound transducer to a special tenaculum by means of a specially designed adaptor that enables real-time ultrasound imaging and guidance of intrauterine surgical procedures. STUDY DESIGN: Forty-five patients who underwent intrauterine surgical interventions were evaluated. Forty of these patients had pregnancy terminations. Three patients had curettage for early pregnancy complications. One patient had a polyp removed, and one patient underwent hysteroscopic submucous myomectomy. Five attending physicians performed 26 procedures. Four residents in training performed 19 procedures. All operators were instructed in the assembly and use of the device before their first procedure. Evaluation of the device was done by means of a detailed questionnaire. RESULTS: The procedures were completed successfully and without complications. The time that was involved for the various components of the surgical procedures was recorded; 83% to 90% of the time the operators felt that the technique increased safety and accuracy for the parameters that were evaluated. They required fewer intrauterine instrument manipulations; in 85% of the cases, they could detect the exact end point of the procedure more accurately. In 12% of cases, the operators felt that the device interfered with the performance of the procedure. CONCLUSIONS: The transvaginal ultrasound-assisted gynecological surgery system provided high-resolution images of the cervical canal and the uterine cavity during all stages of the procedure and provided improved indication of the procedure's end point. The increased safety and accuracy that was reported by most users was encouraging. The transvaginal ultrasound-assisted gynecologic surgery system appears to provide an enhanced alternative to transabdominal ultrasound guidance for intrauterine surgical procedures