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CASE #2

CASE #2 .

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CASE #2

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  1. 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.

  2. CASE #2 • WHAT WOULD YOU DO NEXT? • Hysterosalpingogram? • Sonogram? • Sonohysterogram? • Office hysteroscopy? • MRI?

  3. UP RIGHT CERVIX

  4. An office hysteroscopy was performed

  5. RIGHT UTERINE HORN POLYP OSTIUM

  6. LEFT UTERINE HORN FIBROID SEPTUM

  7. CASE #2 • HOW WOULD YOU PREPARE HER FOR SURGERY? • No special preparation? • Oral contraceptives? • GnRH-agonist? Antagonist? • Progestin? • Danazol? • Bowel prep?

  8. CASE #2 • WHAT SURGICAL PROCEDURE(S) WOULD YOU PERFORM? • LAPAROTOMY? • LAPAROSCOPY? • HYSTEROSCOPY?

  9. BLADDER UTERUS

  10. uterus U/S ligaments cul de sac WHAT IS THIS?

  11. CASE #2 • AFTER OBSERVING THESE FINDINGS WHAT ADDITIONAL PROCEDURES WOULD YOU PERFORM? • NONE? • ELECTROSURGERY? • LASER ABLATION? • EXCISION?

  12. 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

  13. 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.

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