Alanis-Fuentes J, Muñoz-Arteaga V

Language: Spanish
References: 10
Page: 886-892
PDF size: 220.77 Kb.

ABSTRACT

Objectivo: To propose an effective, safe and outpatient procedure for patients with retained chorioplacental remnants and risk of arteriovenous fistula formation.
Materials and Methods: Retrospective case series study of patients attended at the Gea González Hospital from January to May 2022. A Bettocchi equipment was used, 5 mm continuous flow, 2.9 mm cylindrical lens and 30°. In specific cases a surgical procedure was scheduled with a Richard Wolf Princess resectoscope, 7 mm outer diameter, 2.7 mm optical system, 30° visual direction.
Results: We reviewed 642 files from which we obtained a series of 31 cases that were included according to the Gutenberg classification, with biopsy by postabortion protocol and resection with Grasper for types 0 and 1; two patients were sent to the ER for heavy bleeding for immediate MVA; two patients were categorized as type 3; in the first one we opted for medical treatment with methotrexate with which we achieved complete resolution and the second one ended the pregnancy with laparoscopic hysterectomy.
Conclusions: In patients with ultrasound images suggestive of retained chorioplacental debris or arteriovenous malformation, direct vision procedures avoid immediate and future complications. Diagnosis by Gutenberg classification allows to define the type of access with cold extraction with Grasper forceps for types 0 and 1, or the application of a pharmacological test with methotrexate and hysteroscopic resection for types 2 and 3 in hemodynamically stable patients.

REFERENCES

1. Foreste V, Gallo A, Manzi A, Riccardi C, Carugno J, SardoADS. Hysteroscopy and retained products of conception: anupdate. Gynecol Minim Invasive Ther 2021; 10 (4): 203-9.doi: 10.4103/GMIT.GMIT_125_20

2. Capmas P, Lobersztajn A, Duminil L, Barral T, PourcelotAG, Fernandez H. Operative hysteroscopy for retainedproducts of conception: Efficacy and subsequent fertility.J Gynecol Obstet Human 2019; 48 (3): 151-4. https://doi.org/10.1016/j.jogoh.2018.12.005

3. Hooker AB, Aydin H, Brölmann HAM, Huirne JAF. Long-termcomplications and reproductive outcome after the managementof retained products of conception: a systematicreview. Fertility and Sterility 2016; 105 (1): 156-164.e2.https://doi.org/10.1016/j.fertnstert.2015.09.021

4. Timor-Tritsch IE, Haynes MC, Monteagudo A, KhatibN, Kovács S. Ultrasound diagnosis and management ofacquired uterine enhanced myometrial vascularity/arteriovenousmalformations. Am J Obstet Gynecol 2016;214 (6): 731.e1-731.e10. https://doi.org/10.1016/j.ajog.2015.12.024

5. Alessandrino F, di Silverio E, Moramarco LP. Uterine arteriovenousmalformation. J Ultrasound 2013;16 (1): 41-4.doi: 10.1007/s40477-013-0007-z

6. Alonso Pacheco L, Nieto Pascual L, Garcia Mourin B, RodrigoOlmedo M. Hysteroscopy and retained products ofconception. In: Hysteroscopy. Cham: Springer InternationalPublishing, 2018; 181-91. https://doi.org/10.1007/978-3-319-57559-9_19

7. Habte R, Yosef A, Bedaiwy M. Medical Management ofUterine Arteriovenous Malformation: A Case Series. EurJ Obstet Gynecol Reprod Biol 2022; 274: 48-55. https://linkinghub.elsevier.com/retrieve/pii/S0301211522003335

8. Connor ME. Diagnostic and Operative Hysteroscopy. ConnorM, Clark J, editors. Cambridge University Press, 2020.

9. Mitwally MF, Hozayen WG, Hassanin KMA, AbdallaKA, Abdalla NK. Aromatase inhibitor letrozole: a noveltreatment for ectopic pregnancy. Fertility and Sterility2020; 114 (2): 361-6. https://doi.org/10.1016/j.fertnstert.2020.04.001

10. Catena U, D’Ippolito S, Campolo F, Dinoi G, Lanzone A,Scambia G. Hysteroembryoscopy and hysteroscopic uterineevacuation of early pregnancy loss: A feasible procedurein selected cases. Facts, Views and Vision in ObGyn 2022;14 (2): 193-7. doi:10.52054/fvvo.14.2.020