RESUMO
Transvaginal ultrasound-guided oocyte retrieval has gained universal acceptance with an excellent safety record overall. However, even with contemporary ultrasound resolution, the aspiration needle can injure adjacent pelvic organs and blood vessels and result in external and internal bleeding. Although the idea that Doppler ultrasound might reduce the risk of blood vessel injury during follicular aspiration seems to be plausable, measurement of peritoneal blood loss and the validity of this opinion has never been appropriately tested. Using a proposed classification method in an IVF programme, it was estimated that a significant peritoneal bleeding occurred in 56/898 (6%) of IVF patients. Although Doppler ultrasound was routinely used in all patients, it did not predict 24/53 (45%) of the patients with moderate peritoneal bleeding. In 8/53 cases (15%) with moderate peritoneal bleeding, vaginal bleeding was also detected and correctly predicted during oocyte aspiration using colour Doppler vaginal vessel imaging. Colour Doppler ultrasound guidance is an easily accessible technology with a theoretical promise to improve IVF safety and, with proper usage, has the potential to reduce haemorrhagic complications.
Assuntos
Recuperação de Oócitos/métodos , Ultrassonografia Doppler em Cores , Biópsia por Agulha/efeitos adversos , Feminino , Fertilização in vitro/métodos , Humanos , Recuperação de Oócitos/efeitos adversos , Hemorragia Uterina/diagnóstico por imagem , Hemorragia Uterina/etiologiaRESUMO
Demostrar que la migración de la burbuja de aire postransferencia embrionaria es un evento al azar que no depende de la posición del paciente. Estudio prospectivo multicéntrico. Se practicó transferencia embrionaria a 69 pacientes bajo guía ultrasonográfica. Se cargó el catéter de transferencia con una o dos burbujas junto con el medio conteniendo los embriones usando catéter de Frydman o catéter de Wallace y luego se les hizo seguimiento ecográfico en posición horizontal, 20-25 minutos más tarde y luego a los 90 minutos postransferencia en posición vertical para verificar movimiento y configuración de las burbujas. Centro Médico Docente La Trinidad, Caracas. Nortwestern University Feimberg School of medicine, Chicago, IL. EE.UU. En 50 (72,46 por ciento) de las pacientes se observó movimiento de las burbujas. En posición de pie se demostró una distribución al azar sin efecto visible de la gravedad. Las burbujas de aire se mueven y dividen frecuentemente posterior a la transferencia con la paciente en posición horizontal y de pie, lo que sugiere actividad contráctil uterina. No fue común observar movimiento de burbujas relacionada con la gravedad, lo que sugiere que el descanso horizontal postransferencia embrionaria puede ser innecesario.
To demonstrate that air bubble migration is a random event after embryo transfer regardless of the position of patient. Multicenter prospective study. Sixty nine embryo transfers were performed under ultrasound guidance. Transfer catheter was loaded with one or two air bubbles and medium containing embryos, either Wallace catheter or Frydman catheter were used, ultrasound tracking of air bubble was performed to verify movement and configuration inmediately, 20-25 minutes in horizontal position and 90 minutes on standing position after embryo transfer. Centro Medico Docente La Trinidad, Caracas. Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. Movement was observed in 50 (72,46 percent) of the patients. Movement was not observed related to gravity while standing up. Air bubbles move and split frequently after embryo transfer with the patient in the horizontal position and on standing, suggestive of active uterine contractions. Gravity related bubble motion was uncommon, suggesting that horizontal rest post embryo transfer may be unnecessary.