Hysteroscopy For Intrauterine Embryo Residual Materials And Unusual Parts Of The Adverse Outcome Of Pregnancy Diagnosis And Treatment Of Clinical Research

Objective:Intrauterine embryos were abnormal site residues and adverse pregnancy outcomes include a variety of pregnancy due to incomplete abortion organizations residues,cervical pregnancy,comual pregnancy,cesarean section incision scar after the pregnancy,and so on.At home and abroad for the diagnosis and treatment is limited to a small number of cases reported,there is no standardized system of diagnosis and treatment.In recent years,with several women,the increase in abortion,medical abortion,as well as the wider use of the number of uterine surgery,intrauterine and abnormal embryos were residual parts of pregnancy the incidence of adverse outcomes significantly higher than before, clinical awareness of such diseases insufficient,leading to early diagnosis more difficult,often easy to misdiagnosis.If the diagnosis is not timely or appropriate treatment to patients can be adversely affected,caused bleeding or irregular vaginal bleeding due to persistent anemia,caused severe pelvic,abdominal infections,intrauterine adhesions,such as secondary infertility.Over the past problems of this sort are often blind curettage,but sometimes it will not be effective,not only to patients with serious physical and psychological damage, but also damage the uterus wall,the increase of uterine perforation,postoperative infection,intrauterine adhesions and infertility the chance of complications such as.However,hysteroscopy can be observed in the uterus under direct vision, determine the specific location of pregnancies parallel organizations Qing gong positioning can reduce the number of cavity operation,thus avoiding complications related to reduce the suffering of patients.Based on the intrauterine and abnormal embryos were residual adverse pregnancy outcome in patients with site research,application hysteroscopy B ultrasonic examination techniques for diagnosis,with mifepristone(mifu), adjuvant therapy drugs such as methotrexate,in B Ultra Care downlink hysteroscopy surgery.Explore the joint B-hysteroscopy in the diagnosis and treatment of intrauterine embryos were abnormal site residues and the outcome of pregnancy in the role of non-performing.Clinical data and method:Clinical data During November 2007 to November 2008 from the Second Hospital of Jilin University of obstetrics and gynecology hospital site of 46 cases of intrauterine abnormalities site residues and the adverse outcome of pregnancy in patients with embryos.Organization of intra-uterine pregnancy of which 40 cases of residues,four cases of cervical pregnancy,one cases of cornual pregnancy,one cases of cesarean section incision pregnancy.Treatment:Method:1:Direct line after hysteroscopy endoscopic removal Organization: hysteroscopy,residual volume,not machines,and direct positioning curettage hysteroscopy surgery again to observe whether there is any residue,to remove residues,pregnancy or organizations under the direct removal.Method:2:Hysteroscopy bleeding or more active bleeding,pregnancy residues a long time organizations,organizational machine,and work closely with the uterine wall adhesion,firm,and given drug treatment(mifepristone (mifu) 20mg / times,2 times a day,the total mount of 100mg or methotrexate 50 mg/m~2,intramuscular injection),can be softened tissue machine to make it easier to spin-off,to be fully softened residue after hysteroscopic removal of residues. Electric knife to cut electricity consumption at the same time,such as electric coagulation to stop bleeding and complete method to intraoperative and postoperative bleeding decreased significantly,this law is a matter of effective diagnosis and treatment of residual means,with shorter operative time,security, easy and effective satisfaction can be to avoid hysterectomy.Method:3:Hysteroscopic surgery:from bladder lithotomy position, conventional disinfection Shop towels,disinfecting the vagina,cervix,Hegar Palace expansion device to expand the cervix mouth,connected hysteroscopy, hysteroscopic placement,from as far away as the last observation of intrauterine situation,the location of residual embryos,scope.Smaller organizations are grasping forceps can be used directly out fetal bone residues were removed by foreign body forceps,pregnancy and large area multi-organization,then B-custody first clamp oval residual embryonic tissue,most of the folder,and then straight in hysteroscopy ring as clear-cut under the electric blue violet embryonic tissue,electrocoagulation to stop bleeding at the same time,patients completed the re-insertion of intrauterine hysteroscopic observation to determine whether the situation completely removed.Organizations to send out pathological examination.Results:1,Intraoperative situation:see uterine cavity under hysteroscopic were old dark red,reddish-brown or yellowish-brown mass organizations highlighted in the uterine cavity,respectively,attached to the ministry of uterine horn,uterine wall,at the end of the uterus,cervical canal,the lower uterine segment near the mouth department.Residues endoscopic fetal bone bar is white,reflective,and sometimes trabecular structure can be seen.With infected persons,organizations, the surface often covered with a layer of moss septic sallow,and the rest of endometrial hyperemia showed punctate red,oozing,old hematocele;intrauterine adhesions can be seen in some patients,endometrial scar wall of the Palais. Organizations ranging from pregnancy size.Combined one cases of uterine cavity adhesion.All patients were first removed residues,among which 35 cases removed under direct vision,four cases of dense adhesions were removed after cutting power,and the remaining oval clamp clamp or curettage surgery,and endoscopic separation of adhesions.After successful surgery,the average operation time(15.8±5.7) min,bleeding(13±3.5) ml,no complications occurred.2,Pathological diagnosis:scraped off all remnants of the palace sent to pathological examination.The pathology report:necrotic degeneration of the villi, decidual tissue or from the hysteroscopy of membranes with the diagnosis and pathological diagnosis.3,Treatment results:46 cases of which 35 cases of patients with outpatient treatment,more than 11 cases due to bleeding or residual length of hospitalization. Admitted to hospital after taking mifepristone(mifu) 20mg / times,2 times a day, a total of 100mg.10 cases of drug 1 week trip in hysteroscopy.1 cases in the drug two weeks,bilateral uterine artery embolization 24 hours after surgery.In 46 cases of hysteroscopy in patients with open residual pregnancy the next time will be cleared away organizations,clearance rate was 100%after 11 cases of patients were given routine prophylactic antibiotics three days,after nonoccurrence of high fever.Bleeding,the use of electrocoagulation to stop bleeding Patients with less vaginal bleeding,vaginal bleeding within 1 week to stop,1 week after the review organizations hysteroscopy no residual pregnancy and no bleeding,cervical canal and uterine cavity shape returned to normal.1 month after patients resume normal menstruation.Conclusion:1,Hysteroscopy for intrauterine embryo residual materials and unusual parts of the adverse outcome of pregnancy diagnosis can accurately direct observation of the nature of residues organization,size,shape and location to ensure the complete removal of intrauterine residues,to the effect of diagnosis and treatment of the perfect one.2,Hysteroscopic treatment before surgery may facilitate embryonic tissue necrosis,reduce bleeding hysteroscopy hand,increasing the safety of surgery.3,Hysteroscopic treatment of intrauterine joint B-residues and abnormal embryos were non-performing part of the outcome of pregnancy can reduce the risks and complications of surgery,and preservation for young patients with the integrity of the reproductive system,the effect is better than blind curettage surgery again.