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The Role of Hysteroscopy in Diagnosis and Management of Recurrent Pregnancy Loss (RPL)

  • Marco Gergolet
  • Michael KamravaEmail author
Chapter
  • 66 Downloads

Abstract

Recurrent pregnancy loss (RPL) causes a significant psychological burden on couples trying to have a successful pregnancy. It has been associated with congenital or acquired uterine abnormalities such as various forms of uterine horn fusion defects, uterine myomas, uterine septums, polyps, intrauterine adhesions, and retained products of conception. Other etiologies include genetic abnormalities, thrombophilias, immunologic problems, endocrinopathies, as well as environmental causes. Results provided by evidence-based medicine along with availability of modern hysteroscopic instruments utilizing narrower diameter scopes with improved optics and more compact units, have provided less invasive, safer, more efficient, and more convenient techniques for both diagnosis and treatment of RPL due to uterine origins in contrast to older alternatives of laparoscopic and open laparotomy procedures.

Keywords

Hysteroscopy Repeated pregnancy loss Uterine polyps Uterine fibroids Uterine adhesions 

Supplementary material

Movie 18.1

Incision of the fundus (minimal) and of the lateral walls in a patient with a dysmorphic (T-shaped) uterus, class U1 according to ESHRE/ESGE classification. The patients suffered from severe Asherman syndrome after a spontaneous miscarriage, curettage, and a failed attempt of metroplasty in another center. In Movie 18.7 the first part of the operation is shown (MP4 536047 kb)

Movie 18.2

Resection of a small and bigger but subtotal septum class U2a according to ESHRE/ESGE classification After dilatation of both cervices using Hegar dilators and creating a blunt opening in the lower, thinner part of the septum, the resectoscope has been introduced in one of the two cervical channels to perform the metroplasty (MP4 28281 kb)

Movie 18.3

Resection of a small and bigger but subtotal septum class U2a according to ESHRE/ESGE classification. After dilatation of both cervices using Hegar dilators and creating a blunt opening in the lower, thinner part of the septum, the resectoscope has been introduced in one of the two cervical channels to perform the metroplasty (MP4 51797 kb)

Movie 18.4

Patient with complete septate uterus, double cervix, and nonobstructive longitudinal vaginal septum (U2bC2V1). After dilatation of both cervices using Hegar dilatators and creating a blunt opening in the lower, thinner part of the septum, the resectoscope was introduced in one of the two cervical channels to perform the metroplasty (MP4 457327 kb)

Movie 18.5

Incision of a bicorporeal septate uterus with double cervix and non-obstructive longitudinal vaginal septum (U3cC2V1). Such as in the case of septate uterus, we proceeded with dilatation of both cervices using Hegar dilators and creating a blunt opening in the lower, thinner part of the septum the resectoscope has been introduced in one of the two cervical channels to perform the metroplasty. The resection stopped 1 cm below the interostial line in order to conserve the fundal myometrial wall thickness (MP4 227301 kb)

Movie 18.6

Myomectomy in a patient with G0 myoma and a thin asymmetric septum. The tool is a shaver (intrauterine Bigatti Shaver). Only mechanical energy is used and due to the blunt tip perforation is less probable (courtesy of G. Bigatti, Cremona) (MP4 19972 kb)

Movie 18.7

Subendometrial, adenomyotic cyst. Soon after opening by cold scissors, chocolate content is visible. Complete enucleation by scissors (Courtesy of J. Ferro, Valencia) (MP4 160785 kb)

Movie 18.8

Completely obliterated uterine cavity after a spontaneous miscarriage, curettage due to RPOC, and metroplasty attempt in another center. The same case of Movie 18.1. After blunt dissection using the tip of the hysteroscope are visible the two cornual parts of the uterus and fibrotic, similar septate tissue in the middle. After the dissection of the midline adhesions, lateral wall incision will be performed (see Movie 18.1, T-shaped uterus) (MP4 205154 kb)

Movie 18.9

Endometrial polyp removed by a shaver (intrauterine Bigatti Shaver). Only mechanical energy is used and due to the blunt tip perforation is less probable (courtesy of G. Bigatti, Cremona) (MP4 10577 kb)

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Studio Gergolet Via ValloneDoberdò del LagoItaly
  2. 2.West Coast Ivf Clinic, Professional Medical Corp.Beverly HillsUSA

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