in the name of god abortion &hysteroscopy
DESCRIPTION
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). - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/1.jpg)
In The Name of GodIn The Name of God
Abortion &Hysteroscopy Abortion &Hysteroscopy
Shirin GhazizadehTehran University of Medical Sciences
Aban 1393
![Page 2: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/2.jpg)
Role of Hysteroscopy in AbortionRole of Hysteroscopy in Abortion
• Recurrent pregnancy loss (RPL)
• Retained tissue
• Polyp/myoma
• Uterine synechia
• Septate uterus
• Recurrent pregnancy loss (RPL)
• Retained tissue
• Polyp/myoma
• Uterine synechia
• Septate uterus
![Page 3: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/3.jpg)
Recurrent pregnancy loss (RPL) Recurrent pregnancy loss (RPL) • >3 (non)consecutive losses of clinically
recognized pregnancies <20th w <500gr– (ectopic, molar, and biochemical pregnancies
are not included) – It may be primary or secondary
• ASRM >2 failed pregnancies (ultrasound or histopathological)
• >3 (non)consecutive losses of clinically recognized pregnancies <20th w <500gr
– (ectopic, molar, and biochemical pregnancies are not included)
– It may be primary or secondary
• ASRM >2 failed pregnancies (ultrasound or histopathological)
![Page 4: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/4.jpg)
Retained tissue Retained tissue
• Hysteroscopy removal is much less traumatic
• Hysteroscopy removal is much less traumatic
![Page 5: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/5.jpg)
Retained fetal bonesRetained fetal bones• Iatrogenic secondary infertility caused
by residual intrauterine fetal bone after midtrimester abortion.
• An intrauterine device-like effect
• Iatrogenic secondary infertility caused by residual intrauterine fetal bone after midtrimester abortion.
• An intrauterine device-like effect
![Page 6: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/6.jpg)
Sub mucousal myoma / polyp Sub mucousal myoma / polyp
• Abnormal uterine bleeding
• Recurrent pregnancy loss
• Infertility
• Abnormal uterine bleeding
• Recurrent pregnancy loss
• Infertility
![Page 7: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/7.jpg)
Polyps Polyps
• Premenopausal – symptomatic polyps – asymptomatic polyps >1.5
• Postmenopausal – all endometrial polyps (Grade 1B)
• Premenopausal – symptomatic polyps – asymptomatic polyps >1.5
• Postmenopausal – all endometrial polyps (Grade 1B)
![Page 8: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/8.jpg)
Hysterscopic MyomectomyHysterscopic 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
• 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
![Page 9: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/9.jpg)
Distinguishing myoma versus myometrium
Distinguishing myoma versusmyometrium
![Page 10: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/10.jpg)
Intrauterine adhesionsIntrauterine adhesions
![Page 11: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/11.jpg)
Intrauterine adhesionsIntrauterine adhesions
• Trauma– missed or incomplete abortion,
postpartum hemorrhage, or retained placental remnants
• Genital tuberculosis
• Trauma– missed or incomplete abortion,
postpartum hemorrhage, or retained placental remnants
• Genital tuberculosis
![Page 12: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/12.jpg)
Intrauterine adhesionsIntrauterine 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
• 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
![Page 13: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/13.jpg)
Uterine septum Uterine septum
![Page 14: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/14.jpg)
Uterine septumUterine septum
• semirigid or rigid scissors (5-7 French)
• Bi/unipolar wire
• (KTP/532), (Nd:YAG), or argon lasers.
• semirigid or rigid scissors (5-7 French)
• Bi/unipolar wire
• (KTP/532), (Nd:YAG), or argon lasers.
![Page 15: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/15.jpg)
hysteroscopic correction of arcuate uterus prior to IVF?
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,
• Measurement by sonohysterography – Fm (fundal myometrial thickness) – Cm (cornual myometrial thickness)
• Incision of the incomplete septum. • Fm >11 mm • Fm-Cm >5 mm,
![Page 16: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/16.jpg)
Arcuate uterusArcuate uterus• Metroplasty, as well as making the
uterine cavity wider, leads to better uterine perfusion.
• Improvement of uterine artery Doppler velocimetry indices after metroplasty
• Metroplasty, as well as making the uterine cavity wider, leads to better uterine perfusion.
• Improvement of uterine artery Doppler velocimetry indices after metroplasty
![Page 17: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/17.jpg)
Outpatient hysteroscopy and subsequent IVF cycle outcome Outpatient hysteroscopy andsubsequent 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
• 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
![Page 18: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/18.jpg)
"Chromohysteroscopy""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
• 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
![Page 19: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/19.jpg)
Conclusion(1)Conclusion(1)
• Diagnostic hysteroscopy should be a routine procedure during diagnostic laparoscopy in infertile women
• Diagnostic hysteroscopy should be a routine procedure during diagnostic laparoscopy in infertile women
![Page 20: In The Name of God Abortion &Hysteroscopy](https://reader035.vdocuments.mx/reader035/viewer/2022062517/56812fdd550346895d955451/html5/thumbnails/20.jpg)
Conclusion(2)Conclusion(2)
• Office mini-hysteroscopy should be incorporated in infertility work up
• Office mini-hysteroscopy should be incorporated in infertility work up