1 / 27

Asherman Syndroom Behandeling in Nederland Het Effect van Centralisatie 2003-2013

Asherman Syndroom Behandeling in Nederland Het Effect van Centralisatie 2003-2013. Mark Hans Emanuel MD PhD Miriam Hanstede MD VVOG maart 2014 Spaarne Ziekenhuis Haarlem/Heemstede/Hoofddorp Universiteit van Amsterdam en Vrije Universiteit.

bowerst
Télécharger la présentation

Asherman Syndroom Behandeling in Nederland Het Effect van Centralisatie 2003-2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Asherman Syndroom Behandeling in Nederland Het Effect van Centralisatie 2003-2013 Mark Hans Emanuel MD PhD Miriam Hanstede MD VVOG maart 2014 Spaarne Ziekenhuis Haarlem/Heemstede/Hoofddorp Universiteit van Amsterdam en Vrije Universiteit

  2. BelangenverstrengelingGeen in relatie tot het onderwerp van de voordracht VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  3. Asherman Syndrome VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  4. Definition 2 criteria • intra-uterine adhesions due to trauma of the endometrium of gravid or non gravid uterus • presence of symptoms VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  5. What do we knowaboutAshermanSyndrome? • rare • highest level hysteroscopic surgery • no RCT’s • high outcome variation VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  6. What do we knowaboutAshermanSyndrome? • rare • highest level hysteroscopic surgery • no RCT’s • high outcome variation VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  7. What do we knowaboutAshermanSyndrome? • rare? • highest level hysteroscopic surgery • no RCT’s • high outcome variation VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  8. Centralized Care in The Netherlands • small geographical area • small language area • only 1000 gynecologists • 16.8 mio citizens • social media /chat sites VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  9. Retrospective Cohort 2003-2013 • total 638 patients • mean age 35 years VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  10. VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  11. Treatment Protocol AshermanExpertise Centre research, treatment and expertise VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  12. Hysteroscopy with Fluoroscopic Control • Wamsteker, de Blok and Emanuel used since 1990 described in 1997 • Broome and Vancaillie 1999 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  13. VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  14. Grade of Intra Uterine Adhesions ESGE Internal cervical os 2 Internal cervical os 2a 3 Uterine cavity Uterine cavity 4 Uterine cavity 5 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  15. VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  16. VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  17. Yu et.al. Fertil Steril 2008 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  18. drop-out 13 (2.1%) drop-out 13 (2.1%) VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  19. Spontaneous Recurrence of Adhesions VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  20. Spontaneous Recurrence of Adhesions Yu et.al. Fertil Steril 2008 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  21. Primary Prevention 1st trimester post-partum VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  22. Recommendations for Future Research VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  23. Secondary Prevention RCT’s • SEPA I • Adjunctive Hormones vs. None • SEPA II • IUD vs. Foley/Cook catheter vs. Hyalobarrier VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  24. Life time Follow up Database I-follow up study database • approximately 1500 patients • starting 1989 VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  25. Take to Work Messages • Best Treatment in our hands Hysteroscopy with Fluoroscopic Control • Centralization for achieving higher Success Rates • Primary Prevention should be focused on Post- partum Procedures • Need for EBM treatment for Secondary Prevention VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  26. Follow us http://www.asherman.nl VVOG 2014 Mark Hans Emanuel m@emanuel.nl

  27. ThankYoum@emanuel.nl VVOG 2014 Mark Hans Emanuel m@emanuel.nl

More Related