RESUMEN
AIM: This study was designed to evaluate feasibility and effectiveness of hysteroscopic intervention in the management of symptoms related to the displaced levonorgestrel-releasing intrauterine system (LNG-IUS). MATERIAL AND METHODS: One hundred and thirteen patients with displaced LNG-IUS presenting with irregular uterine bleeding, pelvic pain or asymptomatic displacement were recruited for hysteroscopic examination. Displaced LNG-IUS was relocated by hysteroscopic intervention and the effect on symptoms and LNG-IUS position was followed. RESULTS: The displaced LNG-IUS was successfully relocated by hysteroscope in 112 (99.1%) of 113 cases. Following LNG-IUS relocation, 71 (79.8%) patients of 89 with preoperative irregular uterine bleeding had amenorrhea or vaginal spotting, and 14 of 15 (93.3%) patients with preoperative pelvic pain became asymptomatic. LNG-IUS expulsion was recorded in two patients 7 and 21 days after hysteroscopy. CONCLUSION: Displaced LNG-IUS can cause clinical symptoms (e.g. irregular bleeding, pain). Hysteroscopic relocation of displaced LNG-IUS is a feasible method in the management of these symptoms. Risk of spontaneous expulsion associated with hysteroscopy is low.
Asunto(s)
Remoción de Dispositivos/métodos , Histeroscopía , Migración de Dispositivo Intrauterino/efectos adversos , Dispositivos Intrauterinos Medicados/efectos adversos , Levonorgestrel/administración & dosificación , Adulto , Estudios de Cohortes , Remoción de Dispositivos/efectos adversos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Metrorragia/etiología , Metrorragia/prevención & control , Persona de Mediana Edad , Dolor Pélvico/etiología , Dolor Pélvico/prevención & control , Adulto JovenRESUMEN
We investigated the frequency of pathology, especially intrauterine adhesions, after instrumental evacuation within 24 h of delivery in a prospective observational intervention study on 100 women where a 'see and treat' hysteroscopy was performed after three to four months. There were two possible etiology groups: intrauterine adhesions [classified according by European Society for Gynaecological Endoscopy (ESGE) grades I-IV] and residual tissue (classified as minimal and considerable). Adhesions were found in 18% of patients, as follows: ESGE I-II in 13% and ESGE III-IV in 5%. Residual tissue was present in 33%, as follows: minimal in 23% and considerable in 10%. There were 6% who had both mild adhesions and minimal residual tissue, while 43% of the women had normal intrauterine findings. Of the women, 32% were symptomatic (spotting, bleeding). Only residual tissue correlated with symptoms (r=0.376; p<0.001). There is a high prevalence of acquired intrauterine pathology (57%) in women who require early instrumental evacuation.
Asunto(s)
Dilatación y Legrado Uterino , Histeroscopía , Retención de la Placenta/cirugía , Complicaciones Posoperatorias/diagnóstico , Enfermedades Uterinas/diagnóstico , Adulto , Femenino , Humanos , Complicaciones Posoperatorias/epidemiología , Embarazo , Prevalencia , Estudios Prospectivos , Adherencias Tisulares/diagnóstico , Enfermedades Uterinas/epidemiología , Enfermedades Uterinas/etiologíaRESUMEN
A prospective study was conducted on the incidence of intrauterine pathology after missed abortion diagnosed and treated by hysteroscopy. A hysteroscopy was performed in 100 women four to 12 weeks after a dilatation and curettage for missed abortions. Uterine malformations were found in 12 patients, intrauterine adhesions in seven and submucous myoma in two cases. As a side finding four cases of asymptomatic retained products of conception were found. Most cases of the intrauterine pathology were treated instantly by hysteroscopy, "see and treat" regimen was preferred. Post-missed abortion-hysteroscopy is a simple and useful method for early diagnosis and treatment of congenital and acquired intrauterine pathology.