Etude n°2

• 2. High Rates of Perforation Are Found in Endovaginal Ultrasound Probe Covers Before and After Oocyte Retrieval for in Vitro Fertilization-Embryo Transfer

Cette étude se focalise sur la perforation des gaines stériles utilisées sur les sondes d'échographie vaginale en Fécondation In Vitro (FIV). Les perforations des gaines sont détectées par le test de l’eau. Pour 3 modèles de gaines :

• Avant usage 65% sont perforées, après examen 75% (Cook)
• Avant usage 25% sont perforées, après examen 81% (Swemed)
• Avant usage 0% sont perforées, après examen 25% (new Cook)

Plusieurs études (six) montrent que les gants sont souvent perforés (12-28%) en chirurgie générale, plastique, orthopédique, gynécologique et obstétrique. Les dispositifs médicaux contaminés sont un mécanisme possible de transmission du VIH, des hépatites, et des IST comme Chlamydia. Bien que l'échographie vaginale ne soit pas habituellement considérée comme une procédure invasive, elle peut être un risque potentiel d’infections. Les fabricants de sondes recommandent l’utilisation du trempage chimique dans du glutaraldéhyde mais ce produit est toxique et nocif. Il est nécessaire de désinfecter la sonde entre chaque utilisation pour éviter la transmission d’IST.

Objectives: To study perforation rates of sterile transvaginat ultrasound probe covers before and after oocyte retrieval (OPU) in an IVF-ET program.

Methods: Transvaginal ultrasound probe sheaths from two different manufacturers were studied, Cook Innoray (Cook-Canada # TTUPS-IO0) and Swemed Lab (Frolunda Sweden #715). After controlled ovarian stimulation, OPU was done using the needle guide of a sterile sheathed 5-MHz transvaginal ultrasound transducer (ATL Bothell, Washington, USA). A newer designed Cook probe cover supplied by the manufacturer was also tested after the company was made aware of our initial perforation results. Following each OPU, probe covers were examined for perforations by filting them with water and checking for leaks. If perforations were found, the vaginal transducer was disinfected by soaking for 20 min in 2% gluteraldehyde (Formac| Twenty unused sterile probe covers from each manufacturer were also tested for perforation

Results: After OPU we found 10/13 (75%) old Cook, and 35/43 (81%) Swemed probe covers to be perforated (NS). Only 5/20 (25%) of the new design Cook probe covers were perforated post OPU (P = 0.000005). Analysis of unused probe covers revealed 13/20 (65%) Cook, and 5/20 (25%) Swemed probe covers to be perforated (P = 0.02). None of 10 new design unused Cook probe covers were perforated before use.

Conclusions: Sterile transvaginal ultrasound probe covers have a very high rate of perforation even before use, It is important to examine probe covers for perforations after OPU procedures and to disinfect them as necessary to avoid the risk of sexually transmitted disease, Quality control between brands seems to vary and efforts should be made to develop a cooperative relationship with manufacturers to improve design and quality control in production of ultrasound probe covers used for IVF procedures.