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In The Name of God Abortion &Hysteroscopy

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).

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In The Name of God Abortion &Hysteroscopy

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  1. In The Name of God Abortion &Hysteroscopy Shirin Ghazizadeh Tehran University of Medical Sciences Aban 1393

  2. Role of Hysteroscopy in Abortion • Recurrent pregnancy loss (RPL) • Retained tissue • Polyp/myoma • Uterine synechia • Septate uterus

  3. 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) 

  4. Retained tissue • Hysteroscopy removal is much less traumatic

  5. Retained fetal bones • Iatrogenic secondary infertility caused by residual intrauterine fetal bone after midtrimester abortion. • An intrauterine device-like effect

  6. Sub mucousal myoma / polyp • Abnormal uterine bleeding • Recurrent pregnancy loss • Infertility

  7. Polyps • Premenopausal • symptomatic polyps • asymptomatic polyps >1.5 • Postmenopausal • all endometrial polyps (Grade 1B)

  8. 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

  9. Distinguishing myoma versus myometrium

  10. Intrauterine adhesions

  11. Intrauterine adhesions • Trauma • missed or incomplete abortion, postpartum hemorrhage, or retained placental remnants  • Genital tuberculosis

  12. 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

  13. Uterine septum

  14. Uterine septum • semirigid or rigid scissors (5-7 French) • Bi/unipolar wire • (KTP/532), (Nd:YAG), or argon lasers.

  15. 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,

  16. 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

  17. 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

  18. "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

  19. Conclusion(1) • Diagnostic hysteroscopy should be a routine procedure during diagnostic laparoscopy in infertile women

  20. Conclusion(2) • Office mini-hysteroscopy should be incorporated in infertility work up

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