CASE #2 32 year old woman who has had one first trimester pregnancy loss presents with secondary...
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CASE #2 • 32 year old woman who has had one first trimester pregnancy loss presents with secondary infertility of three years duration. She has periods every 27-30 days that have become so heavy in the last year that she has become anemic and now has a hematocrit of 31. She has a normal semenanalysis, serum progesterone, clotting studies, prolactin and TSH.
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Transcript of CASE #2 32 year old woman who has had one first trimester pregnancy loss presents with secondary...
CASE #2
• 32 year old woman who has had one first trimester pregnancy loss presents with secondary infertility of three years duration. She has periods every 27-30 days that have become so heavy in the last year that she has become anemic and now has a hematocrit of 31. She has a normal semenanalysis, serum progesterone, clotting studies, prolactin and TSH.
CASE #2
• WHAT WOULD YOU DO NEXT?– Hysterosalpingogram?– Sonogram?– Sonohysterogram?– Office hysteroscopy?– MRI?
RIGHTUP
CERVIX
An office hysteroscopy was performed
OSTIUM
POLYP
RIGHT UTERINE HORN
FIBROID
SEPTUM
LEFT UTERINE HORN
CASE #2
• HOW WOULD YOU PREPARE HER FOR SURGERY?– No special preparation?– Oral contraceptives?– GnRH-agonist? Antagonist?– Progestin?– Danazol?– Bowel prep?
CASE #2
• WHAT SURGICAL PROCEDURE(S) WOULD YOU PERFORM?
– LAPAROTOMY? – LAPAROSCOPY?– HYSTEROSCOPY?
UTERUS
BLADDER
WHAT IS THIS?
cul de sac
U/S ligaments
uterus
CASE #2
• AFTER OBSERVING THESE FINDINGS WHAT ADDITIONAL PROCEDURES WOULD YOU PERFORM?– NONE?– ELECTROSURGERY?– LASER ABLATION?– EXCISION?
CASE #2
• HOW WOULD YOU APPROACH THE INTRA-UTERINE FINDINGS?
– HYSTEROSCOPIC REMOVAL OF FILLING DEFECTS AND INCISION OF THE SEPTUM
OR
– METROPLASTY AT LAPAROTOMY WITH REMOVAL OF FILLING DEFECTS
CASE # 1
• After removal of the septum, a polyp and a fibroid she conceived and delivered a baby girl at 39 weeks. Two years later she again developed menorrhagia and had a hysteroscopic resection of a fibroid. She conceived a second time and delivered at 41 weeks.
