Pui Ling Leung

Sleep disturbances in Chinese pregnant women

In a prospective study of 247 pregnant Chinese women, the prevalence of sleep disturbances across pregnancy has been assessed using a set of validated questionnaires including the Sleep and Health Questionnaire (SHQ) and the Epworth Sleepiness Scale (ESS). The frequency of self‐reported snoring increased from 29.7% in the first trimester to 40.5% and 46.2% in the second and third trimesters, respectively, with an increase in the prevalence of moderate or severe snoring from 1% in the first trimester to 7.2% in the third trimester (P < 0.01). There was a higher frequency of moderate to severe snoring intensity among subjects with BMI ≥25 compared with those with BMI <25 kg/m2 in the third trimester (20.8%vs 5.3%, P < 0.01). Subjective sleepiness, as determined by the ESS, increased significantly from 8.6 to 9.4 and 9.6 in the first, second and third trimesters, respectively.

Health Status Function after Treatment with Thermal Balloon Endometrial Ablation and Levonorgestrel Intrauterine System for Idiopathic Menorrhagia: A Randomized Study

Aim: To compare patients’ health status function after treatment with thermal balloon endometrial ablation (TBEA) and levonorgestrel intrauterine system (LNG-IUS) for idiopathic menorrhagia. Methods: Forty-four patients were recruited into a randomized trial comparing their health status after treatment with TBEA or LNG-IUS for idiopathic menorrhagia. Results: At 1 year follow-up, the mean haemoglobin was significantly higher in women treated with TBEA (12.6 g/dl vs. 10.3 g/dl, p = 0.018). Iron deficiency occurred in 13.3% from the TBEA arm and in 50% from the LNG-IUS arm (p = 0.026). The women’s mean Short Form 36 Questionnaire general health perception scores (54.9 vs. 40.5, p = 0.024) and mental health scores (49.5 vs. 38.3, p = 0.021) in TBEA arm were significantly higher than in the LNG-IUS arm. The mental health domain score was also significantly lower in the LNG-IUS arm (46.1 vs. 38.3, p = 0.041). Conclusion: TBEA appears to offer better health status function at 1 year follow-up and to be more acceptable to our Chinese population in the treatment of idiopathic menorrhagia following failed medical treatment.

Hysteroscopic appearance of the endometrial cavity following thermal balloon endometrial ablation

OBJECTIVE To assess the appearance of the endometrial cavity after thermal balloon endometrial ablation. DESIGN Observational study. SETTING University teaching hospital. PATIENT(S) Twenty-two women who had undergone thermal balloon endometrial ablation and who were followed up for at least 6 months. INTERVENTION(S) Outpatient diagnostic hysteroscopy. MAIN OUTCOME MEASURE(S) Appearance of the endometrial cavity and presence of intrauterine adhesions on hysteroscopy. RESULT(S) Postablation intrauterine adhesions were found in eight women (36.4%); six had focal adhesions in the fundal area and two had complete obliteration of the cavity. Of these eight women, three had spotting during menstruation, three had hypomenorrhea, one had eumenorrhea, and one had amenorrhea. The uterine cavity was fibrotic in four (18%) women; all reported spotting during menstruation. Ten women had a normal uterine cavity; eight had hypomenorrhea, one had spotting, and one had eumenorrhea. CONCLUSION(S) The hysteroscopic appearance of the uterine cavity after thermal balloon endometrial ablation varies considerably. Menstrual outcome is associated with postablation appearance.

Life-table analysis of the success of thermal balloon endometrial ablation in the treatment of menorrhagia

OBJECTIVE To evaluate the change in intrauterine pressure during thermal balloon endometrial ablation and to identify risk factors associated with treatment failure. DESIGN Prospective observational study. SETTING University-affiliated teaching hospital. PATIENT(S) Seventy two consecutive patients with idiopathic menorrhagia refractory to medical treatment. INTERVENTION(S) Thermal balloon endometrial ablation under patient-controlled sedation. MAIN OUTCOME MEASURE(S) Change in intrauterine pressure during the treatment cycle and risk factors associated with treatment failure. RESULT(S) A spontaneous decrease in intrauterine pressure occurred in most patients (93%). The mean (+/-SD) decrease was 34.1 +/- 14.9 mm Hg, or 19.5% +/- 9.1%. The treatment failed in 10 patients (13.9%), and the mean end pressure was significantly lower in this group (131.1 +/- 14.1 mm Hg vs. 145.1 +/- 18.0 mm Hg; P=.02). The chance of success of treatment was significantly lower when the end pressure was <140 mm Hg (odds ratio, 0.42 [95% CI, 0.27 to 0.68]; P=.01), the intrauterine volume was >10 mL (odds ratio, 0.43 [95% CI, 0.22 to 0.83]; P=.058) and the uterus was retroverted (odds ratio, 0.36 [95% CI, 0.20 to 0.65]; P=.008). CONCLUSION(S) Maintaining high intrauterine pressure during the treatment cycle and correction of the retroversion may help to improve treatment success in thermal balloon endometrial ablation.

Patient-Controlled Sedation for Outpatient Thermal Balloon Endometrial Ablation

STUDY OBJECTIVE To evaluate the effectiveness, safety, and patient satisfaction with patient-controlled sedation during thermal balloon endometrial ablation. DESIGN Prospective observational study (Canadian Task Force classification II-2). SETTING University-affiliated teaching hospital. PATIENTS Thirty consecutive women with idiopathic menorrhagia refractory to medical treatment. INTERVENTION Thermal balloon endometrial ablation under patient-controlled sedation with a mixture of propofol and alfentanil through an analgesia pump. MEASUREMENTS AND MAIN RESULTS Pain was assessed using a descriptive pain score and the procedure was divided into four stages for assessment: catheter insertion, preheating phase, treatment cycle, and end of treatment. Patient satisfaction was assessed using the 8-item client satisfaction questionnaire. The procedure was well tolerated with good cooperation and no oversedation. Preheating was the most painful, and pain could be alleviated by asking the patient to self-administer a bolus of anesthesia before that phase. The median consumption of propofol was 35 mg (range 0-70 mg) and of alfentanil was 175 microg (range 50-200 microg). There were no intraoperative complications and the overall success rate in treating menorrhagia was 87%. Over 85% of the women did not think that general anesthesia was necessary. They all were highly satisfied and would recommend the procedure to others. CONCLUSION Patient-controlled sedation is a safe and effective method of alleviating pain and discomfort during thermal balloon ablation and is well accepted by patients.

Postablation–tubal sterilization syndrome following thermal balloon endometrial ablation

A 45-year-old woman, gravida 4, para 2, had a 4-year history of menorrhagia associated with iron deficiency anemia, which could not be controlled with medical treatment. Outpatient diagnostic hysteroscopy showed a normal uterine cavity and the endometrial biopsy revealed secretory endometrium. She had had two uncomplicated vaginal deliveries and two first-trimester abortions and had undergone laparoscopic tubal ligation 18 years ago. She was treated with a dose of gonadotropin-releasing hormone analog, subcutaneous Triptorelin (Decapeptyl) 3.75 mg, for endometrial priming and underwent endometrial ablation using the ThermaChoiceTM uterine balloon therapy system (Gynecare, Ethicon Inc, USA). The patient remained amenorrheic in the first 3 months after the ablation and then her period returned, which was light but associated with severe lower abdominal pain requiring intramuscular analgesic injection. At the fourth month, physical and transvaginal ultrasound examination revealed a normal pelvis. Her pain became progressively worse, requiring oral analgesic almost daily. At the seventh month, ultrasound examination showed a hypoechogenic area inside the uterine cavity and bilateral tubular hypoechogenic cystic adnexal masses of 5 cm and 8 cm on the left and right sides, respectively, compatible with a hematometra with bilateral hematosalpinges. She was diagnosed to have postablation-tubal sterilization syndrome. The patient was advised to undergo either a laparoscopic assisted vaginal hysterectomy or laparoscopic bilateral salpingectomy together with hysteroscopic lysis of intrauterine adhesions. However, she declined further surgical treatment. Two months later, she had an episode of heavy menstrual flow and after that her lower abdominal pain was much improved. Subsequently, her menstrual flow became normal and the pain lessened. Ultrasound examination at the 16 month showed a reduction in the size of the hematosalpinges to 2 cm on the left side and 4 cm on the right side, but the hematometra persisted.

Preference on the Treatments for Menorrhagia in Hong Kong Chinese Women

Background: Menorrhagia is a common gynecological problem and its management options vary from medical to surgical treatment. With the development of the new minimally invasive therapies, there is a paucity of data in the preference and acceptance on these treatment options, especially in the Chinese population. Methods: An anonymous survey using a self-constructed questionnaire was undertaken on women with heavy menstrual bleeding referred to the specialty clinic in a university teaching hospital. The aim was to elicit women’s knowledge and preferences for the treatment options for menorrhagia. Results: A total of 200 Chinese women returned their questionnaire with a response rate of 62%. Over 90% of them were unaware of other alternative treatment options for menorrhagia. Eumenorrhea was the desired treatment outcome in 173 (86.5%) women while only 15 (7.5%) and 12 (6%) wished to have oligomenorrhea and amenorrhea respectively. Drug therapy was the preferred first-line treatment in 87% and none preferred to undergo hysterectomy. When the medical treatment failed, 16% of women would not accept any other forms of treatment. For the rest of them, an L-norgestrel-releasing intrauterine device was the preferred option in 53.6%, endometrial ablation in 19%, while only 5.4% would prefer hysterectomy. Conclusion: The awareness of alternative treatment options for menorrhagia in Hong Kong Chinese women is very deficient and eumenorrhea is the desired treatment outcome, rather than oligomenorrhea or amenorrhea.

Intrauterine Pathology in Women with Abnormal Uterine Bleeding Taking Hormone Replacement Therapy

STUDY OBJECTIVE To assess the frequency of intrauterine pathology among women with abnormal uterine bleeding (AUB) while taking hormone replacement therapy (HRT), and correlate pathology with clinical features. DESIGN Retrospective review (Canadian Task Force classification II-2). SETTING University teaching hospital-based outpatient clinic. PATIENTS Ninety-nine women. INTERVENTION Observational evaluation. MEASUREMENTS AND MAIN RESULTS Intrauterine pathology was found in 16 (18.6%) of 99 women with AUB. The frequency was 4 times higher in those with AUB after achieving amenorrhea with a continuous combined regimen of HRT than in those with AUB with only 6 months of HRT. It was also higher in patients taking a continuous combined regimen in whom AUB lasted for more than 6 months. CONCLUSION Hysteroscopic examination with endometrial sampling is recommended if AUB continues after the first 6 months of HRT or if it occurs after a period of amenorrhea.