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Fertility and Sterility Mar 2021Congenital and acquired uterine anomalies are associated with recurrent pregnancy loss (RPL). Relevant congenital Müllerian tract anomalies include unicornuate,... (Review)
Review
Congenital and acquired uterine anomalies are associated with recurrent pregnancy loss (RPL). Relevant congenital Müllerian tract anomalies include unicornuate, bicornuate septate, and arcuate uterus. Recurrent pregnancy loss has also been associated with acquired uterine abnormalities that distort the uterine cavity such as, notably, intrauterine adhesions, polyps, and submucosal myomas. Initial evaluation of women with RPLs should include an assessment of the uterine anatomy. Even if proof of efficacy of surgical management of certain uterine anomalies is often lacking for managing RPLs, surgery should be encouraged in certain circumstances for improving subsequent pregnancy outcome. Uterine anomalies such as uterine septa, endometrial polyps, intrauterine adhesions, and submucosal myomas are the primary surgical indications for managing RPLs.
Topics: Abortion, Habitual; Female; Humans; Hysteroscopy; Pregnancy; Urogenital Abnormalities; Uterus
PubMed: 33712099
DOI: 10.1016/j.fertnstert.2020.12.003 -
Medicina (Kaunas, Lithuania) Nov 2022Leiomyomas are the most common pelvic tumors. Submucosal fibroids are a common cause of abnormal bleeding and infertility. Hysteroscopic myomectomy is the definitive... (Review)
Review
Leiomyomas are the most common pelvic tumors. Submucosal fibroids are a common cause of abnormal bleeding and infertility. Hysteroscopic myomectomy is the definitive management of symptomatic submucosal fibroids, with high efficacy and safety. Several techniques have been introduced over time and will be covered in depth in this manuscript. Advances in optics, fluid management, electrosurgery, smaller diameter scopes, and tissue removal systems, along with improved training have contributed to improving the safety and efficiency of hysteroscopic myomectomy.
Topics: Female; Pregnancy; Humans; Uterine Myomectomy; Uterine Neoplasms; Hysteroscopy; Leiomyoma; Infertility
PubMed: 36422166
DOI: 10.3390/medicina58111627 -
Fertility and Sterility Oct 2022
Topics: Female; Humans; Hysteroscopy; Pregnancy
PubMed: 36182265
DOI: 10.1016/j.fertnstert.2022.08.855 -
Romanian Journal of Morphology and... 2022Endometrial polyps (EPs) are a frequent gynecological condition. EPs often arise in the common womanly patients and are appraised to be about 25%. Advancing age,...
Endometrial polyps (EPs) are a frequent gynecological condition. EPs often arise in the common womanly patients and are appraised to be about 25%. Advancing age, hyperestrogenism, hypertension, and Tamoxifen use are acknowledged as ordinary risk elements for the development of EP. The etiopathogenesis of EP is not accurately elucidated, but certain considerations such as diabetes mellitus, hormonal factors or arterial hypertension are considered to perform a significant contribution. The diagnosis of EPs is essentially by imaging. Transvaginal ultrasound is the primary investigation in EPs. Hysteroscopic resection is now the "gold standard" to treat to treat this disease. Hysterectomy is the definitive treatment for EPs, but it requires a judicious indication and an adequate counseling of the patient. Currently, a certain histological pattern is found in different sequences in EPs. Even if the vast majority EPs are benign, they may reach hyperplastic, with malignant alteration. The purpose of this pictorial review is the integrated approach to this type of abnormal endometrial proliferation from the perspective of natural history, diagnosis, management, morphological aspects, risk of malignancy, recurrence and last but not least, clinical outcome.
Topics: Humans; Pregnancy; Female; Hysteroscopy; Polyps; Uterine Neoplasms; Hysterectomy; Hypertension; Endometrial Neoplasms; Endometrium
PubMed: 36374138
DOI: 10.47162/RJME.63.2.04 -
JAMA Apr 2023Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur,...
IMPORTANCE
Vacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility.
OBJECTIVE
To assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy.
DESIGN, SETTING, AND PARTICIPANTS
The HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio.
INTERVENTIONS
Surgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286).
MAIN OUTCOMES AND MEASURES
The primary outcome was a pregnancy of at least 22 weeks' duration during 2-year follow-up.
RESULTS
The intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, -4.8% [95% CI, -13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups.
CONCLUSIONS AND RELEVANCE
Surgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02201732.
Topics: Pregnancy; Humans; Female; Adult; Abortion, Spontaneous; Vacuum Curettage; Single-Blind Method; Pregnancy, Ectopic; Hysteroscopy
PubMed: 37039805
DOI: 10.1001/jama.2023.3415 -
Ginekologia Polska 2023Chronic endometritis is a persistent, low-intensity inflammation of endometrial mucosa, characterized by the infiltration of plasma cells into the endometrial stroma... (Review)
Review
Chronic endometritis is a persistent, low-intensity inflammation of endometrial mucosa, characterized by the infiltration of plasma cells into the endometrial stroma This immunological alteration is thought to be a consequence of a bacterial infection. For a long time, chronic endometritis was poorly investigated and rarely considered in clinical practice because it is either asymptomatic or presents with no specific symptoms. Its association with adverse effects on fertility and retrospectively reported effectiveness of antibiotic treatment were the main reasons for a growing interest in this endometrial pathology. Chronic endometritis is now a hot topic in recurrent pregnancy loss and recurrent implantation failure research. Nevertheless, there are still no recommendations to include chronic endometritis investigation in a clinical evaluation of infertile patients. The uncertain role of this condition is an effect of significant differences in study results presented by different research groups. One important reason for these inconsistent findings is a lack of standardised chronic endometritis diagnostic methods. We present a review of the literature, focusing on the currently available chronic endometritis diagnostic techniques. The review is subdivided into three parts concerning the diagnostic accuracy of three main diagnostic modalities. Histopathological examination of endometrial tissue, hysteroscopic evaluation of uterine cavity and identification of the bacterial factor. In conclusion, it is of great importance to establish a consensus on the diagnostic criteria for chronic endometritis. This is the only way to enhance international cooperation and create well-design multicenter studies to evidence the role of this endometrial pathology in infertility.
Topics: Female; Pregnancy; Humans; Endometritis; Retrospective Studies; Hysteroscopy; Endometrium; Chronic Disease; Infertility, Female
PubMed: 36511457
DOI: 10.5603/GP.a2022.0147 -
Fertility and Sterility Mar 2019
Topics: Female; Humans; Hysteroscopy; Outpatients; Pain; Pregnancy; Randomized Controlled Trials as Topic; Tramadol
PubMed: 30665676
DOI: 10.1016/j.fertnstert.2018.12.001 -
The Journal of Obstetrics and... Sep 2022To compare the efficacy and safety of in-office hysteroscopy with a see-and-treat approach with that of operative hysteroscopy for the treatment of retained products of...
AIM
To compare the efficacy and safety of in-office hysteroscopy with a see-and-treat approach with that of operative hysteroscopy for the treatment of retained products of conception (RPOC).
METHODS
We retrospectively identified all consecutive patients who underwent hysteroscopic treatment of RPOC between 2015 and 2019. We excluded patients with RPOC larger than 2 cm at preoperative transvaginal ultrasounds. Between 2015 and 2017, all hysteroscopic removals of RPOC were performed by operative hysteroscopy. Between 2018 and 2019, all cases of RPOC less than 2 cm in size were hysteroscopically removed by the see-and-treat approach in the office setting. Sociodemographic, clinical, and procedure characteristics along with complications were retrieved from medical records.
RESULTS
Between 2015 and 2019, 119 women underwent hysteroscopic removal of RPOC equal to or smaller than 2 cm: 53 patients by in-office hysteroscopy, and 66 by operative hysteroscopy. The two groups were similar in preoperative characteristics. Although the time required to complete the RPOC removal was similar, the total procedure and assistant time were significantly higher in the operative hysteroscopy group (p < 0.001). Moreover, operative hysteroscopy was associated with a higher proportion of cases complicated by excessive bleeding, cervical tear, or uterine perforation (p = 0.016). Failure to complete the procedure was similarly reported in the two groups (p = 0.58).
CONCLUSIONS
In-office hysteroscopy with the see-and-treat approach for RPOC equal to or smaller than 2 cm appears as effective as operative hysteroscopy, but safer. In-office hysteroscopy may be considered the first choice for treating RPOC equal to or smaller than 2 cm.
Topics: Female; Humans; Hysteroscopy; Pregnancy; Pregnancy Complications; Retrospective Studies; Ultrasonography; Uterine Diseases
PubMed: 35698805
DOI: 10.1111/jog.15327 -
Fertility and Sterility Aug 2019For humans, the uterus is their first home. Accurate evaluation and effective therapy are central to optimizing the conditions for implantation and sustained pregnancy.... (Review)
Review
For humans, the uterus is their first home. Accurate evaluation and effective therapy are central to optimizing the conditions for implantation and sustained pregnancy. For macroscopic intracavitary disease, hysteroscopy remains the gold standard for diagnosis and treatment. We review the role of hysteroscopy before fertility therapies. We also address intracavitary pathologies and their relevance to procreative outcomes. Controversies in the literature are noted and clarified, and trends in the field of hysteroscopy are identified regarding how they will influence the future of reproductive care and women's health.
Topics: Female; Humans; Hysteroscopy; Infertility, Female; Pregnancy; Risk Factors; Uterine Diseases; Uterus
PubMed: 31352959
DOI: 10.1016/j.fertnstert.2019.06.031 -
Cell Transplantation 2023Intrauterine adhesion (IUA), resulting from pregnancy or nonpregnant uterine trauma, is one of the major causes of abnormal menstruation, infertility, or repeated... (Review)
Review
Intrauterine adhesion (IUA), resulting from pregnancy or nonpregnant uterine trauma, is one of the major causes of abnormal menstruation, infertility, or repeated pregnancy loss. Although a few methods, including hysteroscopy and hormone therapy, are routinely used for its diagnosis and treatment, they cannot restore tissue regeneration. Stem cells, which have self-renewal and tissue regeneration abilities, have been proposed as a promising therapy for patients with severe IUAs. In this review, we summarize the origin and features of endometrium-associated stem cells and their applications in the treatment of IUAs based on animal models and human clinical trials. We expect that this information will help to elucidate the underlying mechanism for tissue regeneration and to improve the design of stem cell-based therapies for IUAs.
Topics: Pregnancy; Female; Animals; Humans; Uterine Diseases; Endometrium; Hysteroscopy; Tissue Adhesions; Stem Cells
PubMed: 36891869
DOI: 10.1177/09636897231159561