INTRODUTION: Hysteroscopy is one the main diagnostic and therapeutic tools of modern Gynecology, allowing a direct visualization of the uterine cavity for diagnosis and minimally invasive intervention with sampling or removal of any structural abnormalities. At our unit office-based diagnostic hysteroscopy is not available; as such the pre-operative imaging diagnosis is largely based on transvaginal or pelvic ultrasound, often with hysterosonography. OBJECTIVE: Evaluate de correlation between the pre-operative diagnosis, hysteroscopic findings, and histological analysis, concerning all hysteroscopies performed at our Outpatient Surgery Unit during 38 months of activity. METHODS: The authors performed a retrospective study based on the review of medical files from patients who underwent hysteroscopic procedures at our institution's Outpatient Surgery Unit from November 1st 2012 to December 31st 2015. RESULTS: During the study period 644 hysteroscopies were performed, all under sedation. The patients' average age was 55 years (27 to 87), 60% were post-menopausal and 77% presented co-morbidities, 8% having a history of breast cancer with current or previous treatment with tamoxifen. All patients had an ultrasound evaluation, 66% at our ultrasound unit (55% with hysterosonography). The main indications for hysteroscopy were: suspected post-menopausal asymptomatic polyps (34%); suspected pre-menopausal polyps (31%); suspected post-menopausal symptomatic polyps (12%); post-menopausal endometrial thickening (12%); retained trophoblastic products (2%). The main findings were: endometrial polyp(s) (70%); endometrial thickening/irregularities (6%); polypoid/secretory endometrium (2%); submucosal leiomyoma (1,2%); suspicious vegetative formations (0,5%); no abnormalities, normal endometrium (11%). Cervical dilation was used in 14% of the procedures; in 0,8% the endometrial cavity was not accessed due to cervical stenosis. Globally, intra-operative findings were concordant with the presumptive diagnosis by ultrasound in 77% of cases, 82% when hysterosonography was previously used. Bipolar energy was used in 39% of the operative procedures; curettage was performed in 37% of the cases. There was four cases of endometrial adenocarcinoma and two of complex hyperplasia with atypia. The diagnosed complications were: uterine perforation (n = 5); bowel injury (n = 1); moderate uterine bleeding (n = 3). CONCLUSION: The indications and complications rate were similar to other centers described in literature. The previous detailed ultrasound study with hysterosonography resulted in a high rate of agreement between the presumptive diagnosis and intra-operative findings, resulting in a more accurate referral to operative hysteroscopy and obviating a previous diagnostic hysteroscopy. This strategy has been previous advocated by other authors, which reduces the number of hysteroscopies per patient, and is particularly relevant in centers without the possibility of office-based procedures.

2000 and 31st December 2014 were studied. The data was obtained from the National Obstetric Information System, Malta. Results: A total of 39,683 mothers were assessed. In the 20-29 years cohort included 31,037 mothers while 8646 patients were 35 years and over. In the 20-29 year age group 67.77% of mother delivered vaginally while 27.73% delivered by caesarean sections. Contrastingly 56.73% of mothers with advanced age delivered vaginally and a significant 40.08% delivered by caesarean sections. The mean birth weight of neonates of mothers aged 20-29 years was 3228.89 g while the mean birth weight of neonates of the elderly mothers was 3208.52 g (p-value: 0.300653). There was also no statistical difference between the two average Apgar scores at 1 min (p-value: 0.748359). Live births and neonatal survival up to 28 days occurred in 99.09% of babies delivered by mothers of 20-29 years and 98.87% of babies delivered by mothers with advanced maternal age. Conclusions: Mothers with advanced maternal age were found to have a significantly higher caesarean rate when compared to younger aged mothers but there was no statistical difference in the neonatal outcomes.

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