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Asherman Syndroom Behandeling in Nederland Het Effect van Centralisatie 2003-2013

Asherman Syndroom Behandeling in Nederland Het Effect van Centralisatie 2003-2013. Mark Hans Emanuel MD PhD Miriam Hanstede MD VVOG maart 2014 Spaarne Ziekenhuis Haarlem/Heemstede/Hoofddorp Universiteit van Amsterdam en Vrije Universiteit.

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Asherman Syndroom Behandeling in Nederland Het Effect van Centralisatie 2003-2013

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  1. Asherman Syndroom Behandeling in Nederland Het Effect van Centralisatie 2003-2013 Mark Hans Emanuel MD PhD Miriam Hanstede MD VVOG maart 2014 Spaarne Ziekenhuis Haarlem/Heemstede/Hoofddorp Universiteit van Amsterdam en Vrije Universiteit

  2. BelangenverstrengelingGeen in relatie tot het onderwerp van de voordracht VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  3. Asherman Syndrome VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  4. Definition 2 criteria • intra-uterine adhesions due to trauma of the endometrium of gravid or non gravid uterus • presence of symptoms VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  5. What do we knowaboutAshermanSyndrome? • rare • highest level hysteroscopic surgery • no RCT’s • high outcome variation VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  6. What do we knowaboutAshermanSyndrome? • rare • highest level hysteroscopic surgery • no RCT’s • high outcome variation VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  7. What do we knowaboutAshermanSyndrome? • rare? • highest level hysteroscopic surgery • no RCT’s • high outcome variation VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  8. Centralized Care in The Netherlands • small geographical area • small language area • only 1000 gynecologists • 16.8 mio citizens • social media /chat sites VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  9. Retrospective Cohort 2003-2013 • total 638 patients • mean age 35 years VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  10. VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  11. Treatment Protocol AshermanExpertise Centre research, treatment and expertise VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  12. Hysteroscopy with Fluoroscopic Control • Wamsteker, de Blok and Emanuel used since 1990 described in 1997 • Broome and Vancaillie 1999 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  13. VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  14. Grade of Intra Uterine Adhesions ESGE Internal cervical os 2 Internal cervical os 2a 3 Uterine cavity Uterine cavity 4 Uterine cavity 5 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  15. VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  16. VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  17. Yu et.al. Fertil Steril 2008 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  18. drop-out 13 (2.1%) drop-out 13 (2.1%) VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  19. Spontaneous Recurrence of Adhesions VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  20. Spontaneous Recurrence of Adhesions Yu et.al. Fertil Steril 2008 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  21. Primary Prevention 1st trimester post-partum VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  22. Recommendations for Future Research VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  23. Secondary Prevention RCT’s • SEPA I • Adjunctive Hormones vs. None • SEPA II • IUD vs. Foley/Cook catheter vs. Hyalobarrier VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  24. Life time Follow up Database I-follow up study database • approximately 1500 patients • starting 1989 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  25. Take to Work Messages • Best Treatment in our hands Hysteroscopy with Fluoroscopic Control • Centralization for achieving higher Success Rates • Primary Prevention should be focused on Post- partum Procedures • Need for EBM treatment for Secondary Prevention VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  26. Follow us http://www.asherman.nl VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  27. ThankYoum@emanuel.nl VVOG 2014 Mark Hans Emanuel m@emanuel.nl

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