Hysterosalpingography After Radiofrequency Endometrial Ablation and Hysteroscopic Sterilization as a Concomitant Procedure

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 126; no. 3; pp. 628 - 634
• Main Authors: Hopkins, Matthew R, Laughlin-Tommaso, Shannon K, Wall, Darci J, Breitkopf, Daniel M, Creedon, Douglas J, El-Nashar, Sherif A, Famuyide, Abimbola O
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.09.2015
• Subjects: Academic Medical Centers; Adult; Case-Control Studies; Combined Modality Therapy; Confidence Intervals; Endometrial Ablation Techniques - methods; Female; Follow-Up Studies; Humans; Hysterosalpingography - methods; Hysteroscopy - methods; Middle Aged; Odds Ratio; Postoperative Care - methods; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Sterilization, Reproductive - adverse effects; Sterilization, Reproductive - methods; Treatment Outcome
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000000950

OBJECTIVE:To evaluate the accuracy of hysterosalpingography (HSG) in patients who underwent concomitant radiofrequency endometrial ablation and hysteroscopic sterilization. METHODS:This historical cohort study was conducted at a midwestern academic medical center. A total of 186 women (94 with combined procedure and 92 with sterilization alone) were identified as having undergone intervention between January 1, 2003, and June 30, 2011. Two reviewers blinded to the surgical procedure interpreted the standard clinically indicated HSGs in each group. RESULTS:The primary outcome assessed was the inability to rely on the microinserts for contraception based on HSG interpretation using manufacturersʼ guidelines (unsatisfactory HSG). Position of the devices and occlusion of tubes were assessed on all 3-month and, when available, all 6-month repeat HSGs. At the 3-month HSG, 5 of 76 (6.6%, 95% confidence interval [CI] 2.2–14.7%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.3%, 95% CI 10.1–29.3%) in the combined group (P=.03). After accounting for the seven patients who underwent repeat HSG at 6 months, 3 of 76 (3.95%, 95% CI 0.8–11.1%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.31%, 95% CI 10.1–29.3%) in the combined group (P=.005). CONCLUSION:After completing all clinically indicated HSGs, patients who undergo concomitant radiofrequency endometrial ablation and hysteroscopic sterilization have an approximate fivefold increase (odds ratio 5.45, 95% CI 1.48–20.0) in the rate of unsatisfactory HSG for purposes of documenting tubal occlusion. LEVEL OF EVIDENCE:II