THURSDAY, SEPTEMBER 7 67

p=O.OOl). There was no association with patient’s age and menopausal status. Conclusions: If the hysteroscopic findings were definitely abnormal, the posttest probability is substantially increased. Hyperplasia was, but cancer was not, more common in women with endometrial polyps than in those without. If the hysteroscopic and sonographic endometrial assessment is consistent with endometrial atrophy, insufficient sample on outpatient endometrial biopsy is reassuring

FC4.24.04 ENDOMETRIAL ABLATION AND UTERINE ARTERY BLOOD FLOW: RESULTS OF A PROSPECTIVE LONGITUDINAL STUDY S. Okolo (11, K. Mohammed (2), (1) Royal Free & University College Medical School, Pond Street, London, United Kingdom, NW3 2QG, (2) North Middlesex Hospital, London, United Kingdom.

Introduction: Endometrial ablation is now established as a first line treatment for menorrhagia. Reduced endometrial thickness and intra- uterine synechiae contribute to the reduction in menstrual loss but little is known of the associated changes, if any, in uterine artery blood flow which is ultimately responsible for endometrial perfusion. Subjects & Methods: We therefore monitored uterine artery pulsed Doppler blood flow before and after endometrial resection with loop diathermy in 11 non-obese (body mass index < 28 kgim2) women aged 42.2 + 1.25 years (mean + sem) who had gonadorelin (Zoladex, Zeneca UK) down-regulation four weeks before surgery. Assessments were made before down-regulation, immediately pre-operatively, and at 1,6, 12 and 24 weeks post-operatively. Results: 10 women (90.9 %) experienced satisfactory reduction in their menstrual loss at 24 weeks but one woman requested a hysterectomy for continuing menorrhagia. mean uterine volume was unchanged. endometrial thickness decreased from 6.0 + 0.47 mm (mean + sem) before down-regulation to 3.2 + 0.43 mm at 24 weeks whilst pulsatility index increased by 36 % from 2.245 + 0.156 to 3.051 + 0.025 in the left uterine artery (p = 0.004) and by 30 % in the right artery from 2.386 + 0.227 to 3.098 + 0.114 (p = 0.034). in the patient with continuing menorrhagia, the increase in mean pulsatility index was much less at 14% and 19% for the left and right arteries respectively. Conclusion: Endometrial ablation is associated with reduced uterine artery blood flow, and Doppler blood flow measurements may predict women whose ablation will fail.

FC4.24.05 OPERATIVE HYSTEROSCOPY, AN ANALYSIS OF 286 CASES C.Prevedourakis. N. Makris, M. Dachlythas, 1”’ Dept. OBIGYN, University of Athens, Alexandra Gen. & Maternity Hospital, Athens, Greece.

Objectives: The contribution of operative hysteroscopy in endometrial problems. Study Methods: Two hundred and eighty six non pregnant women 21 to 49 years of age with several uterine pathology (169 adhesions, 48 polyps, 24 myomas, 17 septated uteri and 28 dispaced IUD’s) were submitted to operative hysteoscopy from 1992 to 1999. The procedure was done after hospital admission, under general anesthesia and cervical dilation with a double channel sheath operative endoscope or a resectoscope. Sodium Chloride 0.9% or Dextrose 5% were applied according to the use of monopolar or bipolar current through Hysteromat as distention mediums, a cold light source of 250 watts and a video camera connected with a video and monitor of Wolf Company. The duration of the intervention ranged between 15-40 min, and the consumption of the distention medium was between 400-950 ml respectively. Results: Successful hysteroscopic surgery in all the presented cases with no side-effects or complications during or after the above operations and the follow-up 2 moths later revealed a normal cervical and uterine cavity in all the presented cases with 42 term pregnancies until now. Conclusions: Operative hysteroscopy is the method of choice for the treatment of the endometrial abnormalities.

FC4.24.06 ENDOMETRIAL LASER INTRAUTERINE THERMAL THERAPY (ELITT): A NEW APPROACH TO THE TREATMENT OF MENORRHAGIA .I. Donnez, M. Nisolle, R. Polet, Dept. OBIGYN, Catholic University of Louvain, University Clinic, Brussels, Belgium

Objectives: We have developed a new global endometrial ablation technique - Endometrial Laser Intrauterine Thermo-Therapy (ELITT). This study is conducted to confirm the clinical applicability of this method. Study Methods: The technique involves a diode laser system (21W, 830nm), and a disposable applicator designed to conform to the inner shape of the uterus. The applicator includes three optical light diffusers that are designed to transmit laser light in all directions. During the 7- minute procedure, the laser light fills the uterine cavity assuring complete therapy of the endometrium including the cornua. Results: After the first phase of development (1994.1996) 100 patients were included in a prospective study started in February 1997. The results in terms of amenorrhea and spotting are 86% at 6 months and 90% at 12 months. There were no uterine perforation and serious adverse affects during or immediately postoperatively. In 2 cases, cornual hematometra was diagnosed by echography. Conclusions: The ELITT procedure, which can be performed in an outpatient setup, is a safe, effective and simple method offering excellent alternative to conventional endometrial ablation techniques and hysterectomies.

FC4.24.07 THERMAL ENDOMETRIAL ABLATION WITH FOLEY CATHETER BALLOON Sinnh KC, Sengupta R, Agarwal N, Misra K’ Department of Obstetrics & Gynaecology and Pathology’, University College of Medical Sciences and GTB Hospital, Delhi, India.

Objective: To evaluate the effectiveness and safety of a technique for thermal endometrial ablation. Method: A simple device comprising a Foley catheter No. 14F, a three- way can&a and a 20.cc syringe was used for thermal endometrial ablation. The balloon of the catheter was inflated within the uterine cavity with boiling normal saline for 9 minutes. The safety and effectivity of the technique was assessed in three steps; on uterine specimens, on intact uteri during hysterectomy and two weeks prior to hysterectomy. In step IV, this technique was used as primary treatment in 10 patients with menorrhagia, who were followed for 6 to 48 months. Results: The mean maximum endometrial cavity temperature was 91’ C whereas serosal temperature was below 37” C. None of the balloon ruptured in all the steps. In 13 of 14 specimens in step II, there was a zone of hyperaemia with a depth of 3 to 7 mm. The corresponding histological picture was extensive haemorrhage and fragmentation of glands throughout the endometrium including the cornual regions. Consistent findings were noted in step III. There was a statistically significant positive correlation between the volume of fluid injected and depth of hyperaemia. In step IV, all 10 patients were relieved of symptoms for a period ranging from 6 to 48 months. None had amenorrhea. 2 patients underwent hysterectomy for recurrence of symptoms; one in 6 months and the other in 42 months. First patient had a small submucous fibroid on histology whereas in the second, the endometrium was proliferative. Conclusion: This technique could be a simple, effective, inexpensive and safe alternative to hysteroscopic endometrial ablation.

FC4.24.08 TOOLS AND TECHNIQUES TO FACILITATE OFFICE BASED ENDOMETRIAL SAMPLING R. Jackson Dept. OB/GYN Peace Arch Hospital, White Rock, BC, -> Canada.

Objectives: The aim of the study was to identify tools and techniques to facilitate office based endometrial sampling. Study Methods: The patients received pre-procedure information. Non- steroidal anti-inflammatories were administerd 30 minutes prior to the procedure. The cervix was sprayed with Hurricaine spray (20%

68 THURSDAY, SEPTEMBER 7

benzocaine Beutlich Pharmaceuticals). The anterior lip of the cervix and the endocervical canal was pained with Hurricane gel. Injectable xylocaine 2% in the anterior lip, endocervix and paracervix (using needle adapters 3”, 4” or 5” at 4 and 8 o’clock positions) enabled accurate placement of the injection as well as withdrawal to ensure non- vascular injection. 2mm (extra thin) laminaria placed in the endocervical canal for extremely stenotic cervixes. Atraumatic teflon reusable OS dilators enabled the external cervical OS to be successfully located the endocervical canal located and dilated in a gentle atraumatic fashion with the gradual increments of the dilators. False passage creation was avoided the plastic endometrial biopsy curette introduced. Syringe or plunger based curettes are available. Diameter, flexibility, access holes for ports on distal ends, pre-formed shapes, cutting edges, vary from curette to curette. Results: Uterine cavity was accessed and endometrial sampling performed in 95% of patients in the study. Conclusions: Uterine Cavity access and endometrial biopsy can be accomplished in a simple, safe and efficacious manner in an office setting.

FC4.24.09 DILATION OF CERVIX IN OUTPATIENT HYSTEROSCOPY: A RANDOMIZED DOUBLE-BLINDED CONTROLLED STUDY OF LOCAL LIGNOCAINE EFFECT ON PAIN SCORING A.Y.K. Won& K.S. Wang, L.C.H. Tang, Dept. OBIGYN, Kwong Wah Hospital, Hong Kong, SAR China.

Objectives: To assess the efficacy of lignocaine gel to reduce the pain during outpatient hysteroscopy in patients requiring dilation of cervix, in comparison to placebo group (no anesthesia). Study Methods: Six hundred Chinese women undergoing outpatient hysteroscopy in Kwong Wah Hospital were included in this prospective, randomized double-blinded, placebo-controlled study. 300 patients were randomized into the lignocaine group which received lignocaine gel application to the cervix. The other 300 patients in the placebo group received KY Jelly. All of them underwent the usual hysteroscopic examination (rigid hysteroscope, 5mm sheath, CO, as inflating medium) in which dilation of cervix was performed when insertion of the hysteroscope was difficult due to tight cervical OS. Each patient graded her pain severity throughout the procedure at every l-minute interval using the Present Pain Intensity Scale (score O-5). 81 patients in the lignocaine group and 94 in the placebo group required dilation of the cervix and their mean pain score, overall pain score and duration of the procedure were compared using the significance testing. Failed procedure rate was compared using the chi square test. Results: The mean pain score, overall pain score, and duration of procedure in the lignocaine group were 1.91*0.79, 12.98e9.14, and 6.21e3.17 minutes respectively; whereas, in the placebo group were 2.00*0.74, 13.90*8.10 and 6.55e2.34 minutes. There was no significant difference in these parameters between the groups. The procedure was abandoned due to excessive pain in one patient in the lignocaine group, and another one in the placebo group. No significant difference was observed. Conclusion: In our study population, dilation of cervix during outpatient hysteroscopy is well tolerated in the absence of local anesthesia; and that local application of lignocaine gel has no significant effect in reducing the pain scoring.

FC4.25 INDUCTION AND LABOR

FC4.25.01 AN OBJECTIVE MEASURE OF CERVICAL RIPENESS AT INDUCTION OF LABOUR USING ELECTRICAL IMPEDANCE MEASUREMENTS MP S Wisher’, NJ Avis”, BH Brown”‘, SR Killick and SW Lindow, Department Obstetrics & Gynaecology, University of Hull, UK,’ Department of Applied Statistics, University of Hull, UK “The Centre for Virtual Environments, University of Salford, UK, “‘Department of Medical Physics and Clinical Engineering, University of Sheffield, UK.

Objective: To produce an objective measure of prelabour cervical change (ripeness) at induction of labour using electrical impedance measurements.

Method: Electrical impedance measurements were made in 86 patients at the time of induction of labour. Digital examination of the cervix was performed and a Bishop’s score was recorded. Each patient had at least four readings taken. The measurements were made using an 8mm pencil probe, with four gold electrodes mounted flush with the face of the probe. The probe was applied to the external cervical OS anteriorly and a current of lOpA was passed between an adjacent pair of electrodes. The resulting potential was measured between the remaining pair. This potential equates to the cervical resistivity Measurements were made at a frequency of 4.8kHz. Results: An average value for resistivity was obtained by taking the mean of all the readings made in each patient. The mean resistivity for the unfavourable group (Bishop score ~4) was 7.039m, and 5.349m for the favourable group ( Bishop score>4). Independent t-tests demonstrated significant difference between the two groups (t=2.714, p=.OO8). Conclusion: This preliminary study demonstrates the ability of electrical impedance measurements to characterise cervical ripeness at induction of labour, and raises the possibility of a clinical use for this technology in the prediction of labour onset and perhaps more importantly in preterm labour.

FC4.25.02 GROUP B STREmOCOCCUS ACQUISITION AND INFECTION RATE AFTER UNDER WATER DELIVERY R.A. Zanetti DBllenbachl, I.HGslil, R Frei2, W.Holzgrevel. 1Dept. OBIGYN, Women’s University Hospital, 4031 Basel, Switzerland; 2Dept. of Central Laboratory, University Hospital, 4031 Basel, Switzerland

Objectives: Deliveries under water are becoming more popular. It is unclear if this birth method implies an increased risk of infection to the mother and the neonate. The aim of the study was to investigate the acquisition and infection rate with Group B Streptococcus (GBS) after water deliveries. Study Methods: 53 women with a spontaneous cephalic delivery at term were included in this case control study. 29 women entered the study group and delivered in water. 24 women took a tub bath during labor and entered the control group for delivery. We took vaginal and rectal swabs antenatally, examined lliter of water postnatally and took swabs from the neonates nose and pharynx. We used a highly sensitive culture in a selective broth and a hybridisation method for GBS detection (AccuProbeTM). GBS positive women received intrapartum chemoprophylaxis. Statistical analysis: two tailed Fisher exact test for 2x2 tables. Results: The prevalence of intrapartum maternal GBS carriers was 37.93% (11129) for the study group versus 37.5% (9124) for the control group (p=l). The neonate acquisition rate was 10.34% (3129) versus 12.5% (3124) (p=l). The water was contaminated in 24.14% (7129) versus 16.66% (4124) (p=O.74). We did not observe maternal or neonatal infections. Conclusion: The prevalence of intrapartum maternal GBS carriers were identical. The neonates showed no statistical difference in GBS acquisition rate. There was no significant difference in the contamination rate of the water. Our data suggest that a delivery under water does not imply an increased risk of GBS infection or acquisition.

FC4.25.03 PHASE II TO DETERMINE THE POTENTIAL EFFICACY AND SAFETY OF NITRIC OXIDE FOR CERVICAL RIPENING IN PREGNANCY AT TERM B. Chanrachakul, Y.Herbutya. Dept. OBIGYN, Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok 10400, Thailand.

Objective: To determine the efficacy and safety of nitric oxide for cervical ripening. Study Methods: Thirty pregnant women were randomized to receive intravaginally either 500 pg glyceryl trinitrate, 40 mg isosorbide mononitrate or 3 mg prostaglandin E2 tablet for cervical ripening. Results: The changing of Bishop score was not significant difference among the glyceryl trinitrate group, the isosorbide mononitrate group and the prostaglandin E2 group, but the effect of glyceryl trinitrate and isosorbide mononitrate was predominantly on the changing of the