Pressure dynamics in the non-gravid uterus: intrauterine pressure cannot confirm tubal occlusion after non-surgical permanent contraception

Patil, Eva; Thurmond, Amy S.; Edelman, Alison; Fu, Rongwei; Lambert, William E.; Seguin, Jacqueline; Jensen, Jeffrey T.

doi:10.1016/j.contraception.2017.06.013

Cited by 3 publications

(9 citation statements)

References 22 publications

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“…One non-blinded boardcertified radiologist who specializes in women's imaging conducted all study procedures. We used the same equipment and settings as described in our prior study [8]. In the present study, after placement of the hysterosalpingogram catheter (5-Fr balloon catheter (MM1154; Monarch Medical, Cumming, GA, USA)), we used an infusion pump to deliver normal saline under continuous pressure monitoring until we reached one of the following endpoints: delivery of the entire volume of 10mL; a peak pressure of 450mmHg; or the participant requested the infusion to stop due to intolerable discomfort.…”

Section: Methodsmentioning

confidence: 99%

“…After one minute, we withdrew the delivered fluid through the hysterosalpingogram catheter and recorded the volume instilled and recovered. We then repeated the procedure using contrast under fluoroscopy to confirm tubal patency or occlusion as previously described [8]. We did not place a tenaculum or other instrument on the cervix during the procedure.…”

Section: Methodsmentioning

confidence: 99%

“…We used an inline pressure monitor (DPT-100, Utah Medical, Midvale, UT) and the PressureMAT™ (PendoTech, Princeton, NJ) system and software to record pressure through an intrauterine balloon catheter as previously described [8], and stored data on a secure, encrypted laptop. To manage data from participant questionnaires and the radiologist's procedure notes we used the REDCap™ electronic data capture tool [10].…”

Section: Methodsmentioning

confidence: 99%

“…For these reasons, our team continues to explore ways to confirm tubal occlusion after transcervical permanent contraception in an office setting with low-cost and low-technology needs. Our initial study explored the measurement of intrauterine pressure as a way to differentiate between women with patent and occluded fallopian tubes [8]. While we did not demonstrate a difference in peak intrauterine pressure between women with occluded and patent tubes (292.7 mmHg vs 293.8 mmHg, p=.95) [8], we did notice a small difference in the amount of contrast used between participants with open (6.9±1.9 mL) and blocked (5.2±2.7 mL, p<.01) fallopian tubes.…”

Section: Introductionmentioning

confidence: 99%

“…Our initial study explored the measurement of intrauterine pressure as a way to differentiate between women with patent and occluded fallopian tubes [8]. While we did not demonstrate a difference in peak intrauterine pressure between women with occluded and patent tubes (292.7 mmHg vs 293.8 mmHg, p=.95) [8], we did notice a small difference in the amount of contrast used between participants with open (6.9±1.9 mL) and blocked (5.2±2.7 mL, p<.01) fallopian tubes. Based on this observed difference, we selected 10 mL as a sufficient and practical volume to study whether fluid instilled into the uterus may be lost to the peritoneal cavity in women with open fallopian tubes, and whether the amount of fluid recovered after infusion of a standard volume into the uterine cavity might be predictive of tubal occlusion.…”

Section: Introductionmentioning

confidence: 99%

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Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study,

et al. 2020

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Objectives: To determine if women with tubal patency experience more fluid loss compared to those with bilateral tubal occlusion following intrauterine instillation of fluid via a balloon catheter. Study Design:In this prospective cohort pilot study, we enrolled women with prior Essure ® procedures and healthy controls from September 2016-July 2017. We excluded women using an implant or intrauterine device, or with a prior cesarean delivery or permanent contraception procedures other than Essure ® . An infusion pump delivered saline via balloon catheter under continuous pressure monitoring. After one minute, we withdrew the fluid and recorded volumes in and out. Subjects then underwent hysterosalpingogram for evaluation of tubal patency. We conducted crude analyses with t-tests and sensitivity analyses.Results: We recruited 23 participants; ten provided analyzable data in each group. Hysterosalpingogram confirmed patency in all control and occlusion in all post-Essure ® subjects in the analysis group. We found the median volume of saline lost among control subjects [7.8 mL (7.4, 8.4)] larger than post-Essure ® participants [2.2 mL (2.0, 3.8), p<0.01]. While 50% of control subjects tolerated the full 10mL of fluid instillation, none of the post-Essure ® subjects tolerated this volume (p=0.03). A combination of saline loss ≤4mL and participant intolerance of the full 10mL volume yielded sensitivity of 0.80 (95%CI: 0.57, 1.00) and specificity of 1.00 for bilateral tubal occlusion. Conclusion:Instillation of a fixed volume into the uterus may discriminate between women with tubal patency and occlusion following permanent contraception procedures with high specificity

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study,

et al. 2020

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Building Evidence through Research

Rodríguez¹,

Goldberg²

2021

Advancing Women's Health Through Medical Education

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Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study

Wang,

Chen,

et al. 2024

Quant Imaging Med Surg

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Background Although the application of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) has relatively good diagnostic accuracy for assessing the patency of the fallopian tubes, the evaluation process mainly relies on morphological findings of the fallopian tubes and pelvic cavity. The purpose of this study was to explore the relationship of peak injection pressure during 4D-HyCoSy and tubal patency to provide a quantitative indicator for the evaluation of fallopian tube patency. Methods This study included infertile patients who underwent 4D-HyCoSy and laparoscopic chromopertubation (LC) between 2020 and 2022, with LC serving as the reference test for assessing tubal patency. For the HyCoSy procedure, the ultrasound contrast agent was injected automatically using a liquid injection machine, and real-time pressure values were recorded. Patients were classified based on tubal patency status in LC as bilaterally patent, unilaterally patent, or bilaterally nonpatent. The average peak injection pressure and contrast agent volume of different groups were compared. Receiver operating characteristic (ROC) curve analysis was employed to determine the cutoff value. Results A total of 268 infertile patients were enrolled in the study. With LC as the standard examination, the sensitivity and specificity of 4D-HyCoSy in diagnosing nonpatent fallopian tubes were 91.1% and 95.1%, respectively. In general, peak injection pressure was observed to gradually increase as tubal patency decreased (P<0.001), with average peak injection pressures of 233.5±66.3, 338.8±99.8, and 469.6±63.1 mmHg in the bilaterally patent, unilaterally patent, and bilaterally nonpatent groups, respectively. The volume of contrast agent used in patients in the bilaterally nonpatent group was significantly lower than that in the other two groups (P<0.01), with average volumes of 22.7±6.3, 24.3±9.3, and 18.9±9.2 mL, respectively. When one fallopian tube was patent, the area under the curve (AUC) for distinguishing obstruction from patency of the other fallopian tube was 0.827, with a sensitivity of 79.8% and a specificity of 74.3% (cutoff value: 254.3 mmHg). Similarly, when one fallopian tube was nonpatent, the AUC was 0.866, with a sensitivity of 90.6% and a specificity of 78.3% (cutoff value: 401.3 mmHg). Conclusions Peak injection pressure during 4D-HyCoSy demonstrates promising diagnostic performance in evaluating fallopian tube patency in infertile patients.

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Pressure dynamics in the non-gravid uterus: intrauterine pressure cannot confirm tubal occlusion after non-surgical permanent contraception

Cited by 3 publications

References 22 publications

Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study,

Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study,

Building Evidence through Research

Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study

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