Plasenta retansiyonlu olgularında histeroskopik yaklaşım ve takip sonuçları

Amaç Plasenta retansiyonu olgularında histeroskopik yaklaşım, bulgular ve sonraki gebelik takiplerinin değerlendirilmesi. Materyal ve Metod 2015-2021 yılları arasında plasenta retansiyonu nedeni ile tarafımıza refere edilmiş 19 kadın hastaya histeroskopik tanı ve bipolar koter ile rezeksiyon uygulandı. Olguların obstetrik hikayeleri, preoperatif, intraoperatif bulguları ve sonrasında gebelik sonuçları takip edildi. Bulgular Olguların ortalama yaşı 31.75.4 yıl idi. Gravida 2.71.4 olan olguların beşinde (%26.5) tekrarlayan düşük öyküsü vardı. Olguların 17’sinde (%89.6) sevk edilmeden önce iki ve daha fazla terapötik küretaj işlemi uygulanmıştı, 11’inde (%52.6) kanama ve 10’unda (%52.6) anemi vardı. Histeroskopik girişimde 7 (%36.8) olguda uterus anomalisi, üç olguda (%15.8) intrauterin sineşiler bulundu. Postoperatif 15.211 ay takipte üç (%15.8) olguda uterus içi sineşi, dört (%21.1) olguda ince endometriyum ve dört olguda infertilite izlendi. Çalışmamızda takipte gebelik hızını %68.7, eve bebek götürme hızını %56 olarak bulduk. Tartışma Gebelik materyalinin alınamadığı veya tekrarlayan küretaj denemelerine bağlı plasenta retansiyonu bulgusu devam eden olgularda histeroskopik yaklaşım plasenta retansiyonu eksizyonu ve ek patolojilerin tanı ve aynı anda tedavisi için etkili bir şeçenektir.

Anahtar Kelimeler:

plasenta retansiyonu, opertatif histeroskopi, rest plasenta

Hysteroscopic Approach and Follow-up Results in Cases with Placenta Retention

Objective Evaluation of hysteroscopic approach, findings and subsequent pregnancy follow-ups in cases of placental retention. Methods Between 2015 and 2021, 19 female patients who were referred to our clinic due to placental retention underwent hysteroscopic diagnosis and resection with bipolar cautery. Obstetric histories, preoperative and intraoperative findings of the cases and pregnancy outcomes were followed up. Results The mean age of the cases was 31.7 ±5.4 years. Gravida was 2.7 ±1.4, five (26.5%) of the cases had a history of recurrent miscarriage. Two or more therapeutic curettage procedures were performed in 17 of the cases (89.6%) in the cases before referral, 11 (52.6%) had bleeding complaints and 10 (52.6%) had anemia. During the hysteroscopic intervention, uterine anomaly was found in 7 (36.8%) cases and intrauterine synechiae were found in three cases (15.8%). After hysteroscopy during follow-up intrauterine synechia was observed in three (15.8%) cases and thin endometrium was observed in four (21.1%) cases. in the postoperative 15.2±11 months follow-up period infertility was observed in four cases. The follow-up pregnancy rate was 68.7% and take home baby rate was 56% in this study. Conclusion In cases of failed removal of conception material despite repeated endometrial aspiration, hysteroscopic approach is an effective one step diagnostik and treat option for removal of conceptus material and correction of accompanying pathologies.

Keywords:

Placental retention, operative hysteroscopy, rest placenta,

PDF

___

1. Dombrowski MP, Bottoms SF, Saleh AA, Hurd WW, Romero R. Third stage of labor: analysis of duration and clinical practice. Am J Obstet Gynecol. 1995 Apr;172(4 Pt 1):1279-84.
2. Weeks AD. The Retained Placenta. Best Pract Res Clin Obstet Gynaecol 2008; 22:1103.Modified from: Management of the Third Stage of Labour: (For the Optimal Intrapartum Care Series Edited by Mercedes Bonet, Femi Oladapo and Metin Gülmezoglu). Best Pract Res Clin Obstet Gynaecol 2020; S1521-6934; 30044.
3. Wolman I, Altman E, Faith G, Har-Toov J, Amster R, Gull I, Jaffa AJ. Combined clinical and ultrasonographic work-up for the diagnosis of retained products of conception. Fertil Steril. 2009 Sep;92(3):1162-1164.
4. McEwing RL, Anderson NG, Meates JB, Allen RB, Phillipson GT, Wells JE. Sonographic appearances of the endometrium after termination of pregnancy in asymptomatic versus symptomatic women. J Ultrasound Med. 2009 May;28(5):579-86.
5. Levinsohn-Tavor O, Feldman N, Svirsky R, Smorgick N, Nir-Yoffe A, Maymon R.Ultrasound criteria for managing postpartum patients with suspicion of retention of conception products. Acta Radiol. 2020 Feb;61(2):276-281.
6. Abbasi S, Jamal A, Eslamian L, Marsousi V. Role of clinical and ultrasound findings in the diagnosis of retained products of conception. Ultrasound Obstet Gynecol. 2008 Oct;32(5):704-7.
7. Akiba N, Iriyama T, Nakayama T, Seyama T, Sayama S, Kumasawa K, Komatsu A, Yabe S, Nagamatsu T, Osuga Y, Fujii T. Ultrasonographic vascularity assessment for predicting future severe hemorrhage in retained products of conception after second-trimester abortion. J Matern Fetal Neonatal Med. 2021 Feb;34(4):562-568.
8. Wolman I, Jaffa AJ, Pauzner D, et al. Transvaginal sonohysterography: a new aid in the diagnosis of residual trophoblastic tissue. J Clin Ultrasound 1996; 24:257.
9. Rein DT, Schmidt T, Hess AP, et al. Hysteroscopic management of residual trophoblastic tissue is superior to ultrasound-guided curettage. J Minim Invasive Gynecol 2011; 18:774.
10. Klingberg-Allvin M, Cleeve A, Atuhairwe S, et al. Comparison of treatment of incomplete abortion with misoprostol by physicians and midwives at district level in Uganda: a randomised controlled equivalence trial. Lancet 2015; 385:2392.
11. Hamerlynck TW, Blikkendaal MD, Schoot BC, et al. An alternative approach for removal of placental remnants: hysteroscopic morcellation. J Minim Invasive Gynecol 2013; 20:796.
12. Milman N. Postpartum anemia I: definition, prevalence, causes and consequences. Ann Hematol 2011;90(11): 1247-53.
13. Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann H, Gianaroli L, Campo R. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 2013: 28(8): 2032-44
14. Valle RF, Sciara JJ. Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment and reproductive outcome. Am J Obstet Gynecol 1988; 158: 1459-70.
15. Papanikolaou EG, Pados G, Grimbizis G, Bili E, Kyriazi L, Polyzos NP, Humaidan P, Tournaye H, Tarlatzis B. GnRH agonist versus GnRH antagonist IVF cycles: is the reproductive outcome affected by the incidence of progesterone elevation on the day of hCG triggering? A randomized prospective study. Hum Reprod 2012;27: 1822-1828.
16. Faivre E, Deffieux X, Mrazguia C, Gervaise A, Chauveaud-Lambling A, Frydman R, Fernandez H. Hysteroscopic management of residual trophoblastic tissue and reproductive outcome: a pilot study. J Minim Invasive Gynecol. 2009 Jul-Aug;16(4):487-90.
17. Goldenberg M, Schiff E, Achiron R, Lipitz S, Mashiach S. Managing residual trophoblastic tissue. Hysteroscopy for directing curettage. J Reprod Med. 1997 Jan;42(1):26-8.
18. Golan A, Dishi M, Shalev A, Keidar R, Ginath S, Sagiv R. Operative hysteroscopy to remove retained products of conception: novel treatment of an old problem. J Minim Invasive Gynecol. 2011 Jan-Feb;18(1):100-3.
19. Istre O, Jellum E, Skajaa K, Forman A. Changes in amino acids, ammonium and coagulation factors after transcervical resection of the endometrium with a glycine solution used for uterine irrigation. Am J Obstet Gynecol 1995; 172(3):939-945
20.Umranikar S, Clark JT, Sarıdogan E et al. British Society for Gynaecological Endoscopy/European Society for Gynaecological Endoscopy Guideline Development Group for Management of fluid Distention Media in Operative Hysteroscopy. Gynecol surg 2016; 13(4): 289-303
21. Hooker AB, Lemmers M, Thurkow AL, Heymans MW, Opmeer BC, Brölmann HA, Mol BW, Huirne JA. Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long-term reproductive outcome. Hum Reprod Update. 2014 Mar-Apr;20(2):262-78.
22. Schenker JG. Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol. 1996 Mar;65(1):109-13.
23. Cohen SB, Kalter-Ferber A, Weisz BS, Zalel Y, Seidman DS, Mashiach S, Lidor AL, Zolti M, Goldenberg M. Hysteroscopy may be the method of choice for management of residual trophoblastic tissue. J Am Assoc Gynecol Laparosc. 2001 May;8(2):199-202.
24. Capmas P, Lobersztajn A, Duminil L, Barral T, Pourcelot AG, Fernandez H. Operative hysteroscopy for retained products of conception: Efficacy and subsequent fertility. J Gynecol Obstet Hum Reprod. 2019 Mar;48(3):151-154.
25. Sonnier L, Torre A, Broux P, Fauconnier A, Huchon C. Evaluation of fertility after operative hysteroscopy to remove retained products of conception. Eur J Obstet Gynecol Reprod Biol. 2017 Apr;211:98-102.
26. Westendorp IC, Ankum WM, Mol BW, Vonk J. Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Hum Reprod. 1998 Dec;13(12):3347-50.