Maria Chiara De Angelis, Danilo Borrelli, Brunella Zizolfi, Alessandra Gallo, Sardo Attilio Di Spiezio, Jose Carugno
{"title":"对一名子宫中隔的妇女进行胚胎镜检查,然后在宫腔镜下进行清宫术,以解决一胎流产失手的问题。","authors":"Maria Chiara De Angelis, Danilo Borrelli, Brunella Zizolfi, Alessandra Gallo, Sardo Attilio Di Spiezio, Jose Carugno","doi":"10.1016/j.fertnstert.2024.10.050","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To describe the technique of embryofetoscopy performed with 5Fr instruments with targeted evacuation of the gestational sac followed by a visual dilatation and curettage (D&C) using the hysteroscopic tissue removal system for the management of first trimester missed abortion in a patient with uterine septum.</p><p><strong>Design: </strong>Video case-report.</p><p><strong>Setting: </strong>University tertiary-care hospital.</p><p><strong>Patient(s): </strong>A 32-year-old nulliparous (G3P0020) woman with septate uterus and a 7-week missed abortion. Written informed consent was obtained from the patient.</p><p><strong>Intervention(s): </strong>Transvaginal pelvic ultrasound revealed a 7-week missed abortion. A 3D-ultrasound confirmed the presence of a partial uterine septum. Operative hysteroscopy under spinal anesthesia was performed using a vaginoscopic approach. A partial septum was observed, and a dysmorphic gestational sac was visualized in the left hemicavity.A small incision was made in the amniotic sac using a 5Fr-bipolar electrode allowing direct visualization of the embryo. The entire embryo was removed, and selective biopsies of the chorionic villi using the hysteroscopic \"grasp biopsy\" technique were obtained. The residual gestational sac was removed using a 6.25 mm tissue retrieval system. No cervical dilation was required.The patient was discharged on the same day of the procedure. No intraoperative bleeding was encountered. The overall operation time was 21 minutes. A postprocedure ultrasound confirmed the presence of an empty cavity. It was determined that further evaluation of the septum was needed before proceeding with hysteroscopic metroplasty.</p><p><strong>Main outcome measure(s): </strong>Step-by-step demonstration of the technique and some tips and tricks for bleeding management.</p><p><strong>Result(s): </strong>Complete evacuation of the uterine cavity under direct visualization.</p><p><strong>Conclusion(s): </strong>Embryofetoscopy with miniaturized instruments allows selective targeting of trophoblastic and fetal tissues, avoiding the risk of maternal tissue contamination of the specimen. As reported in the literature, the visual D&C using tissue retrieval system could be a safe and innovative alternative for the treatment of early pregnancy loss. Compared with the use of hysteroscopic resection, tissue removal devices offer the advantage of not requiring cervical dilation and do not involve the use of electrosurgery, thus reducing damage to the uterine cavity. The combination of embryofetoscopy with visual D&C offers several advantages, especially in patients with congenital uterine anomalies, in which performing a blind D&C has a higher risk of complications.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Embryofetoscopy followed by hysteroscopic evacuation of a first trimester missed abortion in a woman with septate uterus.\",\"authors\":\"Maria Chiara De Angelis, Danilo Borrelli, Brunella Zizolfi, Alessandra Gallo, Sardo Attilio Di Spiezio, Jose Carugno\",\"doi\":\"10.1016/j.fertnstert.2024.10.050\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To describe the technique of embryofetoscopy performed with 5Fr instruments with targeted evacuation of the gestational sac followed by a visual dilatation and curettage (D&C) using the hysteroscopic tissue removal system for the management of first trimester missed abortion in a patient with uterine septum.</p><p><strong>Design: </strong>Video case-report.</p><p><strong>Setting: </strong>University tertiary-care hospital.</p><p><strong>Patient(s): </strong>A 32-year-old nulliparous (G3P0020) woman with septate uterus and a 7-week missed abortion. Written informed consent was obtained from the patient.</p><p><strong>Intervention(s): </strong>Transvaginal pelvic ultrasound revealed a 7-week missed abortion. A 3D-ultrasound confirmed the presence of a partial uterine septum. Operative hysteroscopy under spinal anesthesia was performed using a vaginoscopic approach. A partial septum was observed, and a dysmorphic gestational sac was visualized in the left hemicavity.A small incision was made in the amniotic sac using a 5Fr-bipolar electrode allowing direct visualization of the embryo. The entire embryo was removed, and selective biopsies of the chorionic villi using the hysteroscopic \\\"grasp biopsy\\\" technique were obtained. The residual gestational sac was removed using a 6.25 mm tissue retrieval system. No cervical dilation was required.The patient was discharged on the same day of the procedure. No intraoperative bleeding was encountered. The overall operation time was 21 minutes. A postprocedure ultrasound confirmed the presence of an empty cavity. It was determined that further evaluation of the septum was needed before proceeding with hysteroscopic metroplasty.</p><p><strong>Main outcome measure(s): </strong>Step-by-step demonstration of the technique and some tips and tricks for bleeding management.</p><p><strong>Result(s): </strong>Complete evacuation of the uterine cavity under direct visualization.</p><p><strong>Conclusion(s): </strong>Embryofetoscopy with miniaturized instruments allows selective targeting of trophoblastic and fetal tissues, avoiding the risk of maternal tissue contamination of the specimen. As reported in the literature, the visual D&C using tissue retrieval system could be a safe and innovative alternative for the treatment of early pregnancy loss. Compared with the use of hysteroscopic resection, tissue removal devices offer the advantage of not requiring cervical dilation and do not involve the use of electrosurgery, thus reducing damage to the uterine cavity. The combination of embryofetoscopy with visual D&C offers several advantages, especially in patients with congenital uterine anomalies, in which performing a blind D&C has a higher risk of complications.</p>\",\"PeriodicalId\":12275,\"journal\":{\"name\":\"Fertility and sterility\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.6000,\"publicationDate\":\"2024-11-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Fertility and sterility\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.fertnstert.2024.10.050\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Fertility and sterility","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.fertnstert.2024.10.050","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Embryofetoscopy followed by hysteroscopic evacuation of a first trimester missed abortion in a woman with septate uterus.
Objective: To describe the technique of embryofetoscopy performed with 5Fr instruments with targeted evacuation of the gestational sac followed by a visual dilatation and curettage (D&C) using the hysteroscopic tissue removal system for the management of first trimester missed abortion in a patient with uterine septum.
Design: Video case-report.
Setting: University tertiary-care hospital.
Patient(s): A 32-year-old nulliparous (G3P0020) woman with septate uterus and a 7-week missed abortion. Written informed consent was obtained from the patient.
Intervention(s): Transvaginal pelvic ultrasound revealed a 7-week missed abortion. A 3D-ultrasound confirmed the presence of a partial uterine septum. Operative hysteroscopy under spinal anesthesia was performed using a vaginoscopic approach. A partial septum was observed, and a dysmorphic gestational sac was visualized in the left hemicavity.A small incision was made in the amniotic sac using a 5Fr-bipolar electrode allowing direct visualization of the embryo. The entire embryo was removed, and selective biopsies of the chorionic villi using the hysteroscopic "grasp biopsy" technique were obtained. The residual gestational sac was removed using a 6.25 mm tissue retrieval system. No cervical dilation was required.The patient was discharged on the same day of the procedure. No intraoperative bleeding was encountered. The overall operation time was 21 minutes. A postprocedure ultrasound confirmed the presence of an empty cavity. It was determined that further evaluation of the septum was needed before proceeding with hysteroscopic metroplasty.
Main outcome measure(s): Step-by-step demonstration of the technique and some tips and tricks for bleeding management.
Result(s): Complete evacuation of the uterine cavity under direct visualization.
Conclusion(s): Embryofetoscopy with miniaturized instruments allows selective targeting of trophoblastic and fetal tissues, avoiding the risk of maternal tissue contamination of the specimen. As reported in the literature, the visual D&C using tissue retrieval system could be a safe and innovative alternative for the treatment of early pregnancy loss. Compared with the use of hysteroscopic resection, tissue removal devices offer the advantage of not requiring cervical dilation and do not involve the use of electrosurgery, thus reducing damage to the uterine cavity. The combination of embryofetoscopy with visual D&C offers several advantages, especially in patients with congenital uterine anomalies, in which performing a blind D&C has a higher risk of complications.
期刊介绍:
Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.