Outpatient Hysteroscopy: (Green-top Guideline no. 59).

All gynaecology departments should provide a dedicated outpatient hysteroscopy service to aid care of women and people with abnormal uterine bleeding, reproductive problems, and insertion/retrieval of intrauterine devices. [Grade A] Written information should be provided to the woman prior to their appointment. This should include details about the procedure, the benefits and risks, advice regarding pre-operative analgesia, as well as alternative options for care and contact details for the hysteroscopy unit.

Opportunities for change and levelling up: a trust wide retrospective analysis of 8 years of laparoscopic and abdominal myomectomy.

Background: Laparoscopic myomectomy is increasingly considered the gold standard uterine preserving procedure and has well documented benefits over the open approach. Barriers that women have in accessing the most appropriate treatment need to be addressed to ensure optimal patient care and outcomes.

Objectives: To analyse rates of open and laparoscopic myomectomy at a large NHS trust and identify how many cases could potentially have been performed laparoscopically, and any variation between sites.

Qualitative study exploring which research outcomes best reflect women's experiences of heavy menstrual bleeding: stakeholder involvement in development of a core outcome set.

Objective: This work contributed to the development of a core outcome set (COS) for heavy menstrual bleeding (HMB). The objective was to determine which research outcomes best reflect how HMB affects women's lives and to identify additional research outcomes, not previously reported. It was important to explore and record participants' reasoning for prioritising outcomes and use this information to reinforce the patients' voice during later phases of the COS development.

Variation of outcome reporting in studies of interventions for heavy menstrual bleeding: a systematic review.

Background: Heavy menstrual bleeding (HMB) detrimentally effects women. It is important to be able to compare treatments and synthesise data to understand which interventions are most beneficial, however, when there is variation in outcome reporting, this is difficult.

Objectives: To identify variation in reported outcomes in clinical studies of interventions for HMB.

Methods used to assess outcome consistency in clinical studies: A literature-based evaluation.

Evaluation studies of outcomes used in clinical research and their consistency are appearing more frequently in the literature, as a key part of the core outcome set (COS) development. Current guidance suggests such evaluation studies should use systematic review methodology as their default. We aimed to examine the methods used.

Outcomes in prevention and management of miscarriage trials: a systematic review.

Background: There is a substantial body of research evaluating ways to prevent and manage miscarriage, but all studies do not report on the same outcomes.

Objective: To review systematically, outcomes reported in existing miscarriage trials.

Search Strategy: MEDLINE, Embase, CINAHL, and Cochrane were searched from inception until January 2017.

Accuracy of fetal fibronectin for assessing preterm birth risk in asymptomatic pregnant women: a systematic review and meta-analysis.

Introduction: Fetal fibronectin (fFN) is a validated test for assessing risk of preterm birth for women presenting with symptoms. Our aim was to evaluate the accuracy of fFN to detect the risk of preterm birth in asymptomatic women.

Material And Methods: Searches were conducted to identify studies where fFN was performed in asymptomatic women beyond 22 weeks' gestation.

Designing a lifestyle intervention to reduce risk of type 2 diabetes in postpartum mothers following gestational diabetes: An online survey with mothers and health professionals.

Objective: The aim of this study was to identify what components of a postpartum lifestyle intervention would engage postpartum mothers who had a diagnosis of gestational diabetes.

Study Design: Two online surveys were conducted, one involving postnatal mothers with GDM (n=83), and a second for health professionals (n=46).

Results: Seventy-eight percent of mothers were aware that healthy eating, exercise and weight management were all important to reduce risk of subsequent type 2 diabetes.

Participation in clinical trials improves outcomes in women's health: a systematic review and meta-analysis.

Background: Previous reviews examining the effect of participation in trials on outcomes have not consistently shown benefit. Obstetrics and gynaecology is a unique disease area posing challenges for both researchers and patients.

Objectives: To determine whether participation in randomised controlled trials (RCTs), compared with non-participation, has a beneficial effect on women's health.

A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding.

Uterine polyps can cause abnormal bleeding in women. Conventional practise is to remove them under general anaesthesia but advances in technology have made it possible to perform polypectomy in the office setting. We conducted a patient-preference study to explore women's preferences for treatment setting and to evaluate the effectiveness and treatment experience of women undergoing uterine polypectomy.

Systematic review of randomized trials of the effect of iron supplementation on iron stores and oxygen carrying capacity in pregnancy.

Introduction: Anemia in pregnancy affects 25% of all pregnancies in Europe with iron deficiency affecting even more. Despite supplementation, iron deficiency persists. This review will assess the effect on serum ferritin (iron stores) and hemoglobin (oxygen-carrying capacity) following iron supplementation in pregnant women with anemic and non-anemic iron deficiency.

Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding.

Hysteroscopy is now an ambulatory procedure, having moved from a conventional day-case operating theatre environment to the outpatient clinic setting. Outpatient hysteroscopy can be used as a diagnostic test and as a therapeutic modality for women presenting with abnormal uterine bleeding. In many cases women can be diagnosed and treated efficiently during a single hospital appointment.

Evidence quality in clinical guidelines: a comparison of two methods.

Introduction: Guidelines report the quality of the evidence used when formulating recommendations to ensure transparency and allow end-users to assess the estimates of effect that underlie the recommendation. The aim of this study was to investigate the differences in grading of evidence quality between the Scottish Intercollegiate Guideline Network (SIGN) model and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method.

Materials And Methods: The GRADE system was used to create evidence profiles for recommendations from a guideline that used the SIGN method to assess the quality of evidence.

An economic evaluation of outpatient versus inpatient polyp treatment for abnormal uterine bleeding.

Objectives: To undertake a cost-effectiveness analysis of outpatient uterine polypectomy compared with standard inpatient treatment under general anaesthesia.

Design: Economic evaluation carried out alongside the multi-centre, pragmatic, non-inferiority, randomised controlled Outpatient Polyp Treatment (OPT) trial. The UK National Health Service (NHS) perspective was used in the estimation of costs and the interpretation of results.

Outpatient versus inpatient uterine polyp treatment for abnormal uterine bleeding: randomised controlled non-inferiority study.

Objective: To compare the effectiveness and acceptability of outpatient polypectomy with inpatient polypectomy.

Design: Pragmatic multicentre randomised controlled non-inferiority study.

Setting: Outpatient hysteroscopy clinics in 31 UK National Health Service hospitals.

A review of the literature regarding nutritional supplements and their effect on vaginal flora and preterm birth.

Purpose Of Review: The aim of this review was to evaluate recently published review articles which examine the use of nutritional supplements to prevent preterm birth (PTB) by modifying vaginal bacteria.

Recent Findings: Probiotics, vitamin D and vitamin C were all identified as nutritional supplements that have the potential to alter bacterial flora and consequently reduce PTB and treat or prevent genital infections. Evidence shows that probiotics may reduce the incidence of PTB as well as being effective at treating bacterial vaginosis, a known cause for PTB.

Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis.

Background: Heavy menstrual bleeding (HMB) and post-menopausal bleeding (PMB) together constitute the commonest gynaecological presentation in secondary care and impose substantial demands on health service resources. Accurate diagnosis is of key importance to realising effective treatment, reducing morbidity and, in the case of PMB, reducing mortality. There are many tests available, including transvaginal scan (TVS), endometrial biopsy (EBx), saline infusion sonography and outpatient hysteroscopy (OPH); however, optimal diagnostic work-up is unclear.

The role of ambulatory hysteroscopy in reproduction.

Hysteroscopy is a mainstay of modern gynaecologic practice. However, the role of ambulatory hysteroscopy and associated procedures has increased dramatically in recent years. The outpatient setting has associated benefits, both for the patient and economically.

Does cervical preparation before outpatient hysteroscopy reduce women's pain experience? A systematic review.

Background: Studies examining the use of pharmaceutical (prostaglandins, antiprogestogens) and mechanical (osmotic dilators) dilatation of the cervix before hysteroscopy under general anaesthesia have produced conflicting results regarding their effect on cervical dilatation and trauma during the procedure.

Objective: To compare the effect on pain and need for cervical dilatation of various methods of cervical preparation before outpatient hysteroscopy.

Search Strategy: MEDLINE, EMBASE and CINAHL were searched using a combination of the keywords 'hysteroscopy', 'vaginoscopy', 'cervical ripening', 'laminaria', 'progest*', 'prostaglandin', 'oestrogen''cervical preparation' and their associated Medical Subject Headings The Cochrane Library was searched using the keywords 'hysteroscopy' and 'cervical'.

A systematic review of the effect of the distension medium on pain during outpatient hysteroscopy.

Objective: To assess the effect of distension medium on pain during outpatient hysteroscopy.

Design: Systematic review and meta-analysis.

Setting: Outpatient hysteroscopy clinics.

Vaginoscopic approach to outpatient hysteroscopy: a systematic review of the effect on pain.

Background: Vaginoscopy, also known as the 'no-touch' technique, is an alternative method for performing hysteroscopy without the need for a vaginal speculum to view the cervix or cervical instrumentation to grasp and steady the cervix.

Objective: To examine the effect of a vaginoscopic approach to outpatient hysteroscopy on the patients' experience of pain, compared with a traditional approach using a vaginal speculum.

Search Strategy: MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched for relevant articles.

Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis.

Objective: To compare the effects of different types of local anaesthetic for pain control during outpatient hysteroscopy.

Design: Systematic review and meta-analysis of randomised controlled trials.

Setting: Outpatient hysteroscopy clinics.