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HYDROSONOGRAPHY FOR THE DIAGNOSIS OF RESIDUAL TROPHOBLASTIC TISSUE

HYDROSONOGRAPHY FOR THE DIAGNOSIS OF RESIDUAL TROPHOBLASTIC TISSUE. YARON ZALEL, MD. Sheba Medical Center, Israel. Incidence – 1%. Risk Factors – Termination of pregnancy (most common) Vaginal delivery

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HYDROSONOGRAPHY FOR THE DIAGNOSIS OF RESIDUAL TROPHOBLASTIC TISSUE

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  1. HYDROSONOGRAPHY FOR THE DIAGNOSIS OF RESIDUAL TROPHOBLASTIC TISSUE YARON ZALEL, MD Sheba Medical Center, Israel

  2. Incidence – 1% Risk Factors – Termination of pregnancy (most common) Vaginal delivery Caesarian Section Diagnosis – Diagnostic hysteroscopy - Only 70% detection rate

  3. Hydrosonography - Intrauterine saline instillation May improve our ability to evaluate the intrauterine pathology

  4. THE AIM To evaluate the accuracy, efficacy and safety of hydrosonography in diagnosing residual trophoblastic tissue

  5. Material & Methods 1998 - 2000 23 patients – Vaginal bleeding and/or pelvic pains All patients treated with oxytocic agent Methergin (Methylergometrine maleate)

  6. Material & Methods Hydrosonography – 8 French Foley catheter 3 ml balloon Plastic guide Catheter pulled back - ensure fixation - prevent spillage 2-5 ml saline Transvaginal sonography - Presence of lesion following instillation of saline Intralesional blood flow

  7. Material & Methods Operative Hysteroscopy - Transcervical extraction of residual throphoblast Standard 26Fr, continuous Bow Urologic Resectoscope (with 24Fr cutting loop) Dilatation of cervix- Hegar 9 Distention & irrigation – 1.5% glycin solution Controlled by hysteromat

  8. Results

  9. Results Pregnancy Types MA- 4 cases TOP - 4 cases CS - 1 case NVD - 3 cases

  10. Results Hydrosonography – Echogenic intra- uterine lesion Group 2 Group 1 11 patient 12 patient Detached from the wall Adherent to uterine wall Blood flow- 0/11 Blood flow- 4/12

  11. Hydrosonography & Residual throphoblast Post partum Post abortion

  12. Results Histology Confirmed throphoblast tissue in 12 (100%) Gr 1 - Blood clots / decidua in 4 of Gr 2 (cont. bleeding / doctors’ concern)

  13. Residual trophoblast Hydrosonography used for diagnosis- Endometrial polyps Sub-mucous myomas Thickened endometrium Tamoxyfen Infertility - endometrial cavity

  14. Residual trophoblast Diagnosis of residua - Diagnostic hysteroscopy- only 70% accuracy (blood clots, decidua) Hydrosonography- - intra-uterine lesion not detached from uterine wall - 100% accuracy

  15. Residual trophoblast Hydrosonography & Blood flow 4/12 in Gr. 1 Vs 0/11 in Gr. 2 P = 0.093 Presence - could add to diagnosis Absence - does not exclude (dead trophoblast)

  16. Hydrosonography & Blood flow Post abortion Blood flow within lesion

  17. Hydrosonography & Blood flow Post NVD

  18. Residual trophoblast Advantages of hydrosonography Post partum - cervix opened - Inflated balloon lower risk of uterine rupture Uterine anomalies - location of lesion with regard to anomaly Mininal invasive, Easy to learn

  19. Residual trophoblast Operative Hysteroscopy - Should follow hydrosonography Directed minimal curettage Little electricity Dilatation & Curettage - Blind non-directed Prevention of infection, scarring & Asherman’s

  20. Hydrosonography - Conclusion Intrauterine lesion, not detached following saline instillation! Blood flow ? Easy to learn, Office procedure Especially useful post-partum High accuracy Operative hysteroscopy follows

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