In The Name of God Abortion Hysteroscopy Shirin
In The Name of God Abortion &Hysteroscopy Shirin Ghazizadeh Tehran University of Medical Sciences Aban 1393
Role of Hysteroscopy in Abortion • • • Recurrent pregnancy loss (RPL) Retained tissue Polyp/myoma Uterine synechia Septate uterus
Recurrent pregnancy loss (RPL) • >3 (non)consecutive losses of clinically recognized pregnancies <20 th w <500 gr – – • (ectopic, molar, and biochemical pregnancies are not included) It may be primary or secondary ASRM >2 failed pregnancies (ultrasound or histopathological)
Retained tissue • Hysteroscopy removal is much less traumatic
Retained fetal bones • • Iatrogenic secondary infertility caused by residual intrauterine fetal bone after midtrimester abortion. An intrauterine device-like effect
Sub mucousal myoma / polyp • • • Abnormal uterine bleeding Recurrent pregnancy loss Infertility
Polyps • Premenopausal – symptomatic polyps – asymptomatic polyps >1. 5 • Postmenopausal – all endometrial polyps (Grade 1 B)
Hysterscopic Myomectomy • European Society of Hysteroscopy (ESH) – – – Type 0 - completely within the cavity Type I - extend < 50 % into the myometrium Type II - extend >50 % within the myometrium
Distinguishing myoma versus myometrium
Intrauterine adhesions
Intrauterine adhesions • Trauma – missed or incomplete abortion, postpartum hemorrhage, or retained placental remnants • Genital tuberculosis
Intrauterine adhesions • Foley cath. compared with IUD – ↑ Normal menses )81 versus 63%( – ↑ conception rates )34 versus 23 %( – ↓ Need for reoperation • 5 mg estrogen daily for 30 days
Uterine septum
Uterine septum • • • semirigid or rigid scissors )5 -7 French( Bi/unipolar wire )KTP/532(, )Nd: YAG(, or argon lasers.
hysteroscopic correction of arcuate uterus prior to IVF? • Measurement by sonohysterography – Fm (fundal myometrial thickness) – Cm (cornual myometrial thickness) • Incision of the incomplete septum. • • Fm >11 mm Fm-Cm >5 mm,
Arcuate uterus • • Metroplasty, as well as making the uterine cavity wider, leads to better uterine perfusion. Improvement of uterine artery Doppler velocimetry indices after metroplasty
Outpatient hysteroscopy and subsequent IVF cycle outcome • Meta-analyses of five studies – Improving result in subsequent IVF cycle • • )relative risk = 1. 75, 95% CI 1. 51 -2. 03). Mini-hysteroscopy with no intervention before IVF treatment
"Chromohysteroscopy" • • 5 ml of 1% methylene blue dye Group I: 19 patients focal dark staining • • 10 cases of endometritis Group II: 15 patients diffuse light blue staining • normal histopathology
(Conclusion(1 • Diagnostic hysteroscopy should be a routine procedure during diagnostic laparoscopy in infertile women
Conclusion(2) • Office mini-hysteroscopy should be incorporated in infertility work up
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