Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

Ekta Singh Sahu, Jyoti Nath Modi
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2018 · vol. 7(6) , pp. 2202 · doi:10.18203/2320-1770.ijrcog20182320 · W2804915504
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Diagnostic laparoscopy and hysteroscopy revealed tubal abnormalities, pelvic adhesions, and endometriosis as common findings in women with subfertility, supporting its early inclusion in infertility workups.

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This retrospective record-based study analyzed 62 subfertile couples who underwent diagnostic laparoscopy with hysteroscopy at a single center over 2013–2016, describing demographic/clinical profiles and operative findings. Key findings were that tubal abnormalities were present in 33.8% of cases (with a higher proportion among secondary infertility), and leading other abnormalities included pelvic adhesions (25.8%), endometriosis (24.2%), and acute or chronic pelvic inflammatory disease evidence (19.3%). The authors conclude that although history, examination, and pelvic ultrasonography can suggest some conditions, many abnormalities—including endometriosis, tubal pathology, and adhesions—can only be detected with certainty via laparoscopy, though the study is limited by its retrospective design and single-institution sample. Relevance to endometriosis: the paper reports endometriosis among the most common operative findings in subfertile women undergoing laparoscopy/hysteroscopy, though the overall focus is on infertility workup and the spectrum of pelvic pathologies detected by these procedures.

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Abstract

Background: Diagnostic laparoscopy and hysteroscopy are considered the gold standard for diagnosing pelvic pathology in women among couples with infertility or subfertility. Knowledge of common pathologies in these patients would help plan investigations and deliver better care especially in resource limited settings. The current study was carried out to analyse the clinical-demographic profile and operative findings among women with subfertility undergoing diagnostic laparoscopy-hysteroscopy over a 4 years period.Methods: A retrospective record-based study conducted in the Department of Obstetrics and Gynaecology of People’s Hospital, PCMS and RC, Bhopal from 1st January 2013 to 31st December 2016 (4 years).Results: Sixty-two records of women with primary/ secondary infertility who underwent diagnostic laparoscopy-hysteroscopy during the study period satisfied the inclusion and exclusion criteria and were analyzed. Among these, 54 (87.09%) couples had primary infertility and 8 (12.9%) had secondary infertility. The mean age of women was 27.1 years (range 20-38 years; SD4.43). One third of women had more than 5 years duration of infertility. Eight (13%) had menstrual abnormalities. One or more tubal abnormality was found on diagnostic laparoscopy in 33.8% of all cases (31.4% of women with primary infertility and 50 % of women with secondary infertility). Pelvic adhesions (25.8%), endometriosis (24.2%) and evidence of acute or chronic pelvic inflammatory disease (19.3%) were the other leading abnormalities.Conclusions: While it is possible to suspect many abnormalities by a detailed history, a good examination and preliminary investigations such as the pelvic ultrasonography, a significant proportion of abnormalities such as the tubal abnormalities, endometriosis and pelvic adhesions can only be detected with certainty on laparoscopy. Hence it is recommended that diagnostic laparoscopy should be an early part of infertility work up.
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Background

Diagnostic laparoscopy and hysteroscopy are considered the gold standard for diagnosing pelvic pathology in women among couples with infertility or subfertility. Knowledge of common pathologies in these patients would help plan investigations and deliver better care especially in resource limited settings. The current study was carried out to analyse the clinical-demographic profile and operative findings among women with subfertility undergoing diagnostic laparoscopy-hysteroscopy over a 4 years period.

Methods

A retrospective record-based study conducted in the Department of Obstetrics and Gynaecology of People’s Hospital, PCMS and RC, Bhopal from 1st January 2013 to 31st December 2016 (4 years).

Results

Sixty-two records of women with primary/ secondary infertility who underwent diagnostic laparoscopy-hysteroscopy during the study period satisfied the inclusion and exclusion criteria and were analyzed. Among these, 54 (87.09%) couples had primary infertility and 8 (12.9%) had secondary infertility. The mean age of women was 27.1 years (range 20-38 years; SD4.43). One third of women had more than 5 years duration of infertility. Eight (13%) had menstrual abnormalities. One or more tubal abnormality was found on diagnostic laparoscopy in 33.8% of all cases (31.4% of women with primary infertility and 50 % of women with secondary infertility). Pelvic adhesions (25.8%), endometriosis (24.2%) and evidence of acute or chronic pelvic inflammatory disease (19.3%) were the other leading abnormalities.

Conclusions

While it is possible to suspect many abnormalities by a detailed history, a good examination and preliminary investigations such as the pelvic ultrasonography, a significant proportion of abnormalities such as the tubal abnormalities, endometriosis and pelvic adhesions can only be detected with certainty on laparoscopy. Hence it is recommended that diagnostic laparoscopy should be an early part of infertility work up. Metrics

References

Shah SJ, Shah AC, Trivedi YN. Study of combined laparoscopic and hysteroscopic findings in 100 cases of infertility. NHL J Med Sci. 2014;3(2):68-71. Puri S, Jain D, Puri S, Kaushal S, Deol SK. Laparohysteroscopy in female infertility: a diagnostic cum therapeutic tool in Indian setting. Int J Appl Basic Med Res. 2015;5(1):46-8. Gharekhanloo F, Rastegar F. Comparison of hysterosalpingography and laparoscopy in evaluation of female infertility. Medical Res Arch. 2017;5(6). Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007;22:1506-12. National Institute for Health and Care Excellence. Fertility: assessment and treatment. Clinical guideline CG 156. NICE, UK. 2013. Available at https://www.nice.org.uk/guidance/cg156/resources/fertility-problems-assessment-and-treatment-35109634660549 Accessed 10th January 2018. Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessment. Fertil Steril. 2011;95(7):2171-9. Mol BW, Collins JA, Burrows EA, van der Veen F, Bossuyt PM. Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod. 1999;14(5):1237-42. Sharma S, Mittal S, Aggarwal P. Management of infertility in low resource countries. BJOG. 2009;116(1):77-83. Widge A, Cleland J. The public sector's role in infertility management in India. Health Policy and Planning. 2009;24(2):108-15. Chimote A, Samal S, Hariharan C, Angik R. Laparoscopy and hysteroscopy in patients of infertility in a rural set up. Int J Reprod Contracept Obstet Gynecol. 2015;4(2):322-8. World Health Organization. Infertility definitions and terminology. Available at http://www.who.int/reproductivehealth/topics/infertility/definitions/en/ Accessed 9th January 2018. Bhandari S, Singh A, Agrawal P, Ganguli I. Findings in diagnostic laparoscopy in patients with unexplained infertility. Fertil Sci Res. 2015;2:29-3.

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