Ultrasound Imaging in Reproductive Medicine by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030166991
Publisher: Springer International Publishing

Role of Ultrasonography in the Treatment

Serial intrauterine device-guided hysteroscopic adhesiolysis of intrauterine synechiae, especially for early intervention, may prevent complications during the treatment of severe intrauterine adhesions and may present a secure and effective alternative for constructive clinical outcomes with spontaneous pregnancy rates of 47.2 and 30% and live birth rates of 28 and 20% in patients who did and did not undergo early intervention of office hysteroscopy, 1 week after insertion of the IUD at hysteroscopic adhesiolysis, respectively [54]. Following echo-controlled hysteroscopic surgical cure of complex and/or recurrent uterine synechiae in 11 patients, Salat-Baroux et al. [38] concluded that intraoperative echography allowed hysteroscopic adhesiolysis of intrauterine adhesions at a controlled and equivalent distance from the uterine walls, enabling better treatment of the uterine cornua since the operator is informed when to limit progression to avoid massive fluid infusion into the abdominal cavity and perforation of the uterus. The intraoperative echographic control was validated in the operating theater radiographically. With this technique normal cavities with bilateral tube permeability were obtained in 72.72% of the patients and normal cycles in 90.9% of the patients [38]. Following hysteroscopic lysis under ultrasound control for significant intrauterine synechiae, Bellingham [55] reported normal menstruation in 61% of the patients and live births in 80% of the patients, of whom 50% had had severe adhesions. They reported that ultrasound control is ideally essential if the adhesions are extensive [55]. However, in both these studies, the number of patients was very small to effectively document the role of ultrasound in the treatment of IUA.

Coccia et al. [56] described a new therapeutic procedure called pressure lavage under ultrasound guidance (PLUG) for selected cases of IUA. This technique is based on sonohysterography to monitor the effects of intrauterine injections of saline solution on the continuous accumulation of saline in the uterine cavity for the mechanical disruption of IUA. In an open clinical investigation with no control group , they reported satisfactory lysis of adhesions and restoration of menses in 71.4% of the patients with mild IUA with a pregnancy rate of 66.63% following the use of the PLUG technique. A second-look hysteroscopy after 1 month showed the persistence of filmy adhesions in two patients with moderate IUA that were removed successfully during hysteroscopy. The authors suggested that PLUG is a safe and ideal in-office procedure that allows complete lysis in mild IUA cases avoiding the need for therapeutic and, possibly, follow-up hysteroscopy and may represent a useful initial step in moderate IUA cases reducing the need for operative hysteroscopy [56]. In a recent study, Taniguchi and Suginami [57] also suggested that sonohysterographic (SHG) lysis for recurrent adhesions following hysteroscopic lysis may be a treatment option for recurrent adhesions in infertile patients, with improved menstrual cycles and restored tubal patency [57].

Tiras et al. [58] demonstrated the value of laparoscopic intracorporeal ultrasound (LIU)-guided hysteroscopic adhesiolysis in a patient with amenorrhea and infertility with total intrauterine synechiae. Adequate intrauterine adhesiolysis was performed by a resectoscope with a wire loop, suggesting that complex

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