Hysteroscopic Management of Residual Trophoblastic Tissue Is Superior to Ultrasound-Guided Curettage

Rein, Daniel T.; Schmidt, Torsten; Hess, Alexandra P.; Volkmer, Anne Kathrin; Schöndorf, Thomas; Breidenbach, Martina

doi:10.1016/j.jmig.2011.08.003

Cited by 137 publications

(132 citation statements)

References 12 publications

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…The results of a recent systematic review of IUA after miscarriage are in line with previous findings [11]. In a cohort study, hysteroscopic cold loop resection of placental remnants showed a lower rate (4.2 %) of IUAs at routine second-look hysteroscopy as compared with ultrasound-guided curettage using a metal curette (30.8 %) [12]. A similar rate of IUAs (4.4 %) was found in a retrospective series on hysteroscopic morcellation of placental remnants, where routine second-look hysteroscopy was performed in part of the patients [13].…”

Section: Clinical Significance Of Postoperative Adhesions Hysteroscopysupporting

confidence: 82%

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Verguts

Bosteels

Roberta³

et al. 2015

Gynecol Surg

View full text Add to dashboard Cite

Intrauterine and intraabdominal adhesions are a major cause for infertility. The most recent investigations have demonstrated the potential of intraperitoneal adhesion barriers combined with good surgical technique to reduce adhesion formation. For intrauterine adhesions we suggest to minimize unipolar and bipolar instrumentation whenever possible. We advocate the use of estrogens for 10 days after adhesiolysis: 2dd two tablets of estradiol 2 mg. Instillation of Hyalobarrier Gel Endo actually is not reimbursed but may have a beneficial effect after myomectomy or adhesiolysis. Concerning laparoscopic and laparotomic prevention of adhesion also, meticulous surgical technique is of the utmost importance. Residual blood should be avoided by careful hemostasis and rinsing with Ringer's lactate with heparin. Preferably braided sutures are not to be left in the abdominal cavity. We advise to avoid unipolar and bipolar cauterization when possible and to replace with ultrasonic or laser energy. The use of floatation barriers does not seem to add substantial benefit in the prevention of adhesions. Gel barriers (Hyalobarrier Gel Endo® or Intercoat®) are proven to have a significant effect on adhesion prevention. As for sheets, there is enough evidence that they prevent adhesions. The use of NSAID in the prevention of pain and/or corticosteroids in the prevention of postoperative nausea is already mainstay after surgery and can be further endorsed in the prevention of adhesions.

show abstract

Section: Clinical Significance Of Postoperative Adhesions Hysteroscopysupporting

confidence: 82%

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Verguts

Bosteels

Roberta³

et al. 2015

Gynecol Surg

View full text Add to dashboard Cite

show abstract

“…This suggestion is in line with a retrospective, multicenter study about conservative management of placenta accreta, which revealed that spontaneous placental resorption occurred in 75% [7]. Thus, although a majority of studies deal with surgical management of residual trophoblastic tissue [2,3,4,8], it seems that watchful management is feasible.…”

Section: Introductionsupporting

confidence: 54%

“…However, the above-mentioned report did not provide any information about other postoperative complications [4]. With regard to intrauterine synechia, an incidence of 4.2% of mild intrauterine adhesions was mentioned in another report [8]. Due to the retrospective design of our study, we could neither provide any data about intrauterine adhesions nor provide information about whether patients desired (further) children.…”

Section: Discussionmentioning

confidence: 87%

Ten-Year Experience with the Conservative Management of Abnormally Invasive, Residual Trophoblastic Disease. A Retrospective Case Series

Promberger

Ott²,

Chalubinski³

2016

Gynecol Obstet Invest

View full text Add to dashboard Cite

Conservative management of abnormally invasive, residual trophoblastic disease (AIRTD) is underreported. We aimed at critically reviewing our experience with such conservative management. We conducted a retrospective cohort study that included 24 women. The median completed week of gestation at delivery (20/24, 83.3%)/2nd trimester miscarriage (4/24, 16.7%) was 35 (range 17-41). Two women initially chose a surgical treatment (dilatation and curettage), but AIRTD remained sonographically visible afterward. Five patients developed a fever >38.0°C for ≥2 days (5/24, 20.8%). Due to heavy vaginal bleeding, 2 patients then underwent dilatation, diagnostic hysteroscopy, and curettage (2/24, 8.3%). One of these women also had to undergo hysterectomy (1/24, 4.2%). The 23 patients without hysterectomy underwent regular sonographic follow-up examinations. Regression of AIRTD was found after a median of 74 days (range 36-323). In conclusion, our data suggest that a conservative, observational treatment is feasible in AIRTD, with low rates of secondary surgical interventions. The long time intervals until regression require perseverance by these patients.

show abstract

“…[35,[37][38][39][40][41][42][43][44] Otro enfoque para la conservación uterina con resección placentaria es el procedimiento triple P [43]. Consiste en realizar una devascularización pélvica, así como la resección de parte del útero con percretismo si es posterior o fundica.…”

Section: Presentación Del Casounclassified