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Minimising the risk of infection and bleeding at trans-vaginal ultrasound guided ovum pick-up

Transvaginal ovum pick-up (OPU) is associated with a common risk of minor vaginal bleeding (0.5% -8.6%), a rare risk of severe intra-abdominal bleeding (0.02% – 0.7%), risk of pelvic infection (0.4% - 1.3%) and a risk of accidental injury to other pelvic organs.
The use of doppler ultrasound, the use of topical anti-bacterial agents to clean the vagina, and prophylactic antibiotics to minimise the risk of infection has also been controversial.
This survey would help us identify the world-wide clinical practice of patients at risk of excessive vaginal bleeding or developing pelvic infection. It would also enable to identify measures for early recognition of intra-abdominal bleeding and various management options to reduce significant bleeding complications and pelvic infection.
This study was suggested by: Dr Harish M Bhandari and Dr. Rina Agrawal,
Centre for Reproductive Medicine, Warwick Medical School University
Hospitals of Coventry and Warwickshire , UK

Do you routinely undertake the following investigations before OPU? (multiple answers possible)
  • Full Blood Count
  • Coagulation profile
  • High vaginal swab
  • Chlamydia swab

 

In your practice, which of the following women have increased risk of bleeding complications following OPU? (multiple answers possible)
  • underweight (BMI: <20)
  • Normal weight (BMI: 20-24.9)
  • Overweight (BMI: 25 – 29.9)
  • Obesity (BMI >30)
  • Polycystic ovarian syndrome
  • More than 10 oocytes retrieved

 

Do you clean the vagina before OPU to minimise the risk of infection?
  • Clean the vagina with sterile water
  • Clean the vagina with antiseptics
  • Both
  • No cleaning

 

Do you routinely give antibiotics?
  • Yes
  • No
  • Only if they have risk factors such as endometrioma, PID, pelvic adhesions , other

 

If you give antibiotics, how many doses?
  • Single dose of a single antibiotic
  • Single dose of Combination of antibiotics
  • Single/combination antibiotics for 24 hours
  • Single/combination antibiotics for 5 days
  • Not giving antibiotic
  • Other

 

Which aspiration needle do you prefer to use for OPU?
  • Single lumen
  • Double lumen

 

What needle size do you prefer to use for follicle aspiration?
  • 15 -16 gauge
  • 17 gauge
  • 18 gauge
  • 19 gauge
  • 20 gauge

 

Do you use Doppler ultrasound routinely at OPU?
  • Yes
  • No
  • Only in difficult/specific cases

 

Do you routinely use ultrasound scan before discharge the patient home to check for pelvic collection?
  • Yes
  • No

 

For how many hours is the patient being observed in the unit before discharge after OPU?
  • Less than 1 hour
  • 1-2 hours
  • 2-4 hours
  • 4-6 hours
  • More than 6 hours

 

Who discharges the patient after OPU?
  • Doctor
  • Nurse
  • None

 

Do you routinely do a blood count before discharge after OPU?
  • Yes
  • No

 

In case vaginal bleeding not responding to vaginal compression, which of the following interventions do you undertake? (multiple answers possible)
  • Firm vaginal pressure for 3-5 minutes
  • Vaginal tamponade (vaginal pack) ≥ 2 h
  • Suturing of the bleeding area
  • Diathermy to the bleeding area
  • Absorbable haemostat (TachoSil®, Surgicel® etc.)
  • Overnight admission to hospital
  • All the above

 

For a diagnosed haemoperitoneum which of following interventions would you prefer to undertake?
  • Conservative management (hospitalization with close monitoring)
  • Diagnostic Laparoscopy and proceed
  • Explorative Laparotomy and proceed
  • Blood transfusion