Do postmenopausal women with thickened endometrium on trans-vaginal ultrasound in the absence of vaginal bleeding need hysteroscopic assessment? A Pilot Study

We aimed to determine the incidence of endometrial cancer in a cohort of postmenopausal women with thickened endometrium but no bleeding referred for hysteroscopy and determine the risk estimate of cancer using a cut-off of > 11 mm. This retrospective study of asymptomatic postmenopausal women with thickened endometrium on trans-vaginal scan referred for hysteroscopy was performed using data from 2008 to 2010. In total 63 women were identified. 2 cases of endometrial cancer were identified with an incidence of 3.17%. 22 cases had endometrial thickness (ET) > 11 mm of which 2 were malignant giving a risk estimate for endometrial cancer of 9.1%. 61 women had benign pathology, 40.98% had atrophic endometrium and 59.02% had benign polyp. In conclusion, the incidence of endometrial cancer in postmenopausal women with thickened endometrium on transvaginal scan without vaginal bleeding is low and ET of 11 mm or more seems realistic to use as a cut-off for referral for hysteroscopy.

Management of suspected ectopic pregnancy: An audit from East Kent NHS Hospital Trust

This is a retrospective case note analysis of 105 suspected cases of ectopic pregnancies that underwent laparoscopy within a stipulated 12-month period, September 2001 to August 2002. The management and care of these women was reviewed using the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on management of ectopic pregnancies as well as local guidelines developed from the RCOG guidance. Other criteria used to review patient care were derived from the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD). A large number of procedures (51.13%) which include laparoscopy, laparotomy and combined procedure were performed by the consultant. Approximately 90.19% of all procedures were performed during official working hours, which is in keeping with the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommendation. Other standards and criteria used were the use of anti-D immunoglobulin and the use of thromboprophylaxis. A total of 86.7% of non-sensitised Rhesus negative women received anti-D immunoglobulin; 96% of suspected ectopic pregnancies were diagnosed within 96 h of initial presentation. In 80% of cases, betahCG results were available within 24 h of request. Only 26% of ectopic pregnancies were successfully treated using laparoscopy, indicating that even though operative laparoscopy is the preferred approach, operative complications and haemoperitoneum, can lead to changes in surgical approach. The results of the audit identified areas for improvement and offers a practical solution through recommendations based on the audit process.