Alison Sambrook

Clinical outcomes from a randomised comparison of Microwave Endometrial Ablation with Thermal Balloon endometrial ablation for the treatment of heavy menstrual bleeding.

Objective  To compare the clinical outcomes of microwave endometrial ablation and thermal balloon ablation for the treatment of heavy menstrual bleeding.

A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium: follow up at a minimum of 10 years: Randomised comparison: MEA versus TCRE

Objective  To compare outcomes and further operations at a minimum of 10 years following microwave endometrial ablation (MEATM) or transcervical resection of the endometrium (TCRE).

A Cost-Utility Analysis of Microwave Endometrial Ablation versus Thermal Balloon Endometrial Ablation

OBJECTIVE To evaluate the cost-effectiveness of microwave endometrial ablation (MEA) and thermal balloon endometrial ablation (TBALL) for heavy menstrual bleeding. METHODS A cost-utility analysis performed alongside a pragmatic RCT in a single hospital within Scotland on women undergoing MEA and TBALL. Resource use data collected from all 314 trial participants were combined with study specific and published unit cost data to estimate a cost per patient. Quality-adjusted life-years (QALYs) were based on EQ-5D responses at baseline, 2 weeks, 6 and 12 months. The incremental cost per QALY of TBALL versus MEA was calculated and bootstrapping was performed to determine the likelihood that a treatment would be cost-effective at different threshold values for societys willingness to pay for a QALY. RESULTS The mean cost of TBALL (10 years equipment life, 100 uses annually) of reusable equipment was pound181 (95% confidence interval [CI] pound70-434) greater than MEA. There were no statistically significant differences between the total nonhealth costs and health benefits of the two arms. On average, MEA provided more QALYs after adjusting for baseline EQ-5D score (0.017; 95% CI 0.017-0.051). In terms of mean incremental cost per QALY, MEA was, on average, dominant (less costly and at least as effective) and there was over a 90% chance that MEA would be considered cost-effective at a pound20,000 threshold of a cost per QALY. CONCLUSIONS MEA is likely to be more cost-effective than TBALL at 1 year. Further longer-term follow-up is, however, needed.

Outpatient microwave endometrial ablation: 5-year follow-up of a randomised controlled trial without endometrial preparation versus standard day surgery with endometrial preparation

Please cite this paper as: Sambrook A, Jack S, Cooper K. Outpatient microwave endometrial ablation: 5‐year follow‐up of a randomised controlled trial without endometrial preparation versus standard day surgery with endometrial preparation. BJOG 2010;117:493–496.

The treatment of hypertension in pregnancy

Hypertension in pregnancy is a leading cause of maternal death. It may represent pre-existing essential or secondary hypertension. Alternatively, it may have been induced by the pregnancy. Pregnancy-induced hypertension may develop after 20 weeks’ gestation, is not associated with proteinuria and generally resolves 6 weeks postpartum. In genetically-predisposed mothers, pregnancy-induced hypertension may take the form of pre-eclampsia, a condition characterized by hypertension, oedema and proteinuria. Antihypertensive drugs palliate this condition but the definitive treatment is delivery of the fetus. Antihypertensive drugs administered during the first trimester of pregnancy may have teratogenic effects, the period of greatest risk being from the third to the eleventh week of pregnancy. Drugs given later in pregnancy may adversely affect fetal growth and development. Those given close to term may impair labour or may have adverse effects on the neonate. An appendix to the British National Formulary lists the risks associated with the use of antihypertensive drugs during the various trimesters of pregnancy. Antihypertensive drugs commonly used in pregnant women include methyldopa (a drug that gives rise to a false sympathomimetic neurotransmitter), hydralazine (a vasodilator that may interfere with the intracellular release of calcium ions), labetalol (an antagonist at α1- and β1-adrenoceptors with partial agonist activity at β2-adrenoceptors), nifedipine (an inhibitor of calcium ion influx through L-type channels) doxazosin and prazosin (antagonists at α1-adrenoceptors) and antagonists at β-adrenoceptors. Magnesium sulphate is useful for the prevention and treatment of seizures associated with eclampsia but its co-administration with nifedipine is best avoided.

Laparoscopic exploration of obturator nerve

Obturator nerve injury is a recognised potential complication of paravaginal repair (Scotti et al., Am J Obstet Gynecol 179:1436, 1998). Non-absorbable sutures are utilised for a paravaginal repair in order to provide permanent support, and they can induce a fibrotic reaction, thereby contributing to the integrity of the repair. We present a case in which we hypothesise that the fibrotic reaction induced resulted in the tethering of the obturator nerve. This was released laparoscopically with immediate resolution of symptoms.