[Office hysteroscopy - management and results]. / Management a výsledky ambulantní hysteroskopie.

OBJECTIVE: Sum up the knowledge about office hysteroscopy. TYPE OF STUDY: Review of literature and our own experience. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague. METHODS: Data from scientific literature and 10 years of our own experience with office hysteroscopy. CONCLUSIONS: Hysteroscopy provides optical evaluation of uterine cavity. Most of the benign intrauterine organics pathologies could be managed in a outpatient setting with a vaginoscopic approach without any anaesthesia and analgesia. Using that approach we can recommend to perform endometrial target biopsy, resection of endometrial polyps up to 1.5 cm and pedunculated submucous myomas up to 1 cm as well as resection of filmy intrauterine adhesions. Method is comfortable for well managed patients and practically complication-free.

[Is the hysteroscopy the right choice for therapy of placental remnants?]. / Je hysteroskopie správná volba pro resení reziduí tehotenských tkání?

OBJECTIVE: The evaluation of the effectiveness and safety of hysteroscopic management of residual trophoblastic tissue and to verify the miniinvasivity with the second-look hysteroscopy. DESIGN: Prospective study. SETTING: Department of Gynecology and Obstetrics, First Faculty od Medicine, Charles University and General Teaching Hospital, Prague. METHODOLOGY: From 11/2007 to 6/2011, 58 patiens with abnormal uterine bleeding longer than 6 weeks after delivery or abortion underwent ultrasound examination with fading of hyperechogenic content larger than 15mm in AP projection. There was the bipolar resectoscopic system used under general anestesia. Second-look office hysteroscopy was recommended to all patiens 4-6 weeks after a primary procedure. RESULTS: Median operative time was 15 (7-36) minutes, median time of hospitalisation was 7.1 hours. In four patients was necessary to divide the procedure into two phases (after 14 days). There was no serious uterine bleeding or inflamation in our study group. Only one serious surgical complication was registered: an uterine perforation in patient after 2 cesarean sections, there was the laparoscopic suture provided. The second-look hysteroscopy was provided in 45 patients (77.6%). There was normal intrauterine finding in 16 (35.6%) patients, in 29 patients (64.4%) a small residual trophoblastic tissue was resected. There was no secondary intrauterine adhesive process described. CONCLUSION: Hysteroscopic resection is a safe and efficient operative technique, which is suitable for management of larger trophoblastic tissue left after delivery or abortion.

[Asherman's syndrome I--history, prevalence, histopathology, classification, ethiology, symtomatology and investigations]. / Ashermanuv syndrom I--historie, prevalence, histopatologie, klasifikace, etiologie, symptomatologie a vysetrovací metody.

OBJECTIVE: To describe the current knowledge of Ashermanes syndrome--its history, prevalence, histopathology, classification, ethiology, symtomatology and investigations. DESIGN: Review article. RESULTS: There is presented the history of definition of Asherman's syndrome. The origin of Asherman's syndrome is in a fibrotisation of endometrium--the ethiologic factors are: an intrauterine trauma in connection with pregnancy, the trauma on nongravid uterus is in minority. There is not certificated that the inflammation without trauma can cause Asherman's syndrome, exception the cases with genital TBC and schistosomiasis. The prevalence of Asherman's syndrome depends on various factors: number of therapeutic and illegal abortions, on incidence of genital inflammation and TBC, on criteria used for diagnosis of IUA and etc. The typical symptomatology of this syndrome consisted of: menstrual abnormalities (hypomenorrhea, amenorrhoea), infertility, repeated pregnancy loss and pregnancy complications. There were described a lot of classifications developed in relation with chosen diagnostic method. The gold standard in diagnosis and therapy is the hysteroscopy, the sonohysterography is very promissing diagnostic method. CONCLUSION: The Asherman's syndrome is very complicated and severe disease that can significantly influence a possibility of woman conceive and give birth to a healthy child.

[Asherman's syndrome II--therapy, methods of guidance, prevention of readhesion processs, complications and results of therapy]. / Ashermanuv syndrom II--terapie, asistencní metody, prevence readhezí, komplikace a výsledky lécby.

OBJECTIVE: To describe the current knowledge about Asherman's syndrome: methods of therapy and guidance, preventions of readhesion process, complications and results of therapy. DESIGN: Review article. RESULTS: There are presented historic and recent methods for therapy of Asherman's syndrome and their postoperative results. The hysteroscopy is the gold standard in diagnostics and therapy in this time. For prevention of perforation there are used several methods of guidance. The most frequent methods are laparoscopic and ultrasound asistence. The most actual question in this time is using of antiadhesion products for preventing of readhesion process. Between described complications belong peroperative complications and complications of consecutive pregnancy. Every patient is endangered by abortion, premature delivery, IUGR and placenta accreta or increta. The results of therapy depend on degree of intrauterine finding and previous pregnancy anamnesis. CONCLUSION: The Asherman's syndrome is very complicated and severe disease that can significantly influence a possibility of woman conceive and give birth to a healthy child.

[Thermachoice thermal balloon therapy--a 10-year-experience]. / Termoablace endometria systémem Thermachoice-- 10 let zkuseností.

OBJECTIVE: To evaluate the effectivness of a global method of endometrium ablation--Thermachoice (Gynecare; Johnson & Johnson) baloon therapy in treatment of excessive uterine bleeding. Our 10-year-long-experience is presented. DESIGN: Retrospective study. SETTINGS: Department of Gynecology and Obstetrics, First faculty of Medicine, Charles University and General Teaching Hospital, Prague. METHODOLOGY AND RESULTS: 109 patients were treated in our depatment from November 1997 till the end of the year 2007. The pacients were contacted personally, over the phone and by sending questinnaires. 92 women (84.4%) were included into the evaluation group after twelve month and after 5 years there were 54 women. The group was mostly formed by seriously polymorbid patients. The average age was 41.6 years. In the twelve-month-follow-up there were 38 percent amenorrheic, five years later there were 63 percent of them. 13 women (14%) ended with hysterectomy--two pacients without any connection with the operation. In 3 cases there was a therapeutic cycle failure, because the acquired intrauterine pressure was not reached. In one case of the monstrous obese woman, after a longer period form the operation there was a carcinoma of the endometrium found out. Two women after the termoablation became pregnant: the first one non-voluntarily, she decided for the arteficial abortion and then the hysterectomy, the second one, despite the fact, that she had been fully informed, underwent the IVF therapy and at the age of 37 she delivered by the Cesarian section in the 36-week-old pregnancy the healthy girl weighing 2900 gramms. With one patient--a young woman the operation was combined with uterine artery embolisation (UAE)--and that is why she was excluded. 51.5% of all operations were perfomed without general anestesia. There was no serious complication in the observed group. CONCLUSION: The big advantage of the second generation ablation methods is the possibility to realise the operation without the general anestesia and with the minimum discomfort for the patient. Another favourable circumstance was the shorter determined operating time and lower percentage of complications in comparison with the first generation methods. The big benefit is mainly for the seriously polymobid pacients.

[Prenatal intracranial hemorrhagie--diagnosis and follow-up]. / Prenatálne vzniklé intrakraniální krváicení--diagnostika a sledování.

AIM: We present a case of difficult prenatal diagnosis and follow-up of severe fetal intracranial hemorrhage. With an analysis of the available literature that is related to this topic, we would like to bring attention to the necessity of accurate evaluation of fetal brain morphology even during routine ultrasound examination in the late third trimester. TYPE OF STUDY: Case report. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague. METHODS AND RESULTS: Four cases of prenatal intracranial hemorrhage are presented. All cases were diagnosed during ultrasound examination during the third trimester of pregnancy and the findings were clarified using nuclear magnetic resonance imaging. The etiology of the hemorrhage was determined in only two cases. Postnatal follow-up of the affected children over a range of one to two years of age shows a very severe prognosis of the described hemorrhagic conditions. CONCLUSION: Prenatally diagnosed fetal intracranial hemorrhage is a rare but severe complication in pregnancy associated with fetal and neonatal morbidity and mortality. A detailed description and precise image documentation of the damaged fetal structures have a fundamental forensic significance. Postnatal estimation of the time of hemorrhage using analysis of the cerebrospinal fluid and ultrasound findings (echogenicity of the lesions) is not always unified.

["See and treat" hysteroscopy: limits of intrauterine pathology bulk]. / "See and treat" hysteroskopie: limity velikosti intrauterinní patologie.

OBJECTIVE: To evaluate bulk limits of intrauterine pathology for "see and treat" hysteroscopy. TYPE OF STUDY: A retrospective observational study. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague. METHODS: 200 mg of Indomethacin was administered to the patients by rectum 2 hours before procedure. "See and treat" procedures were performed with "Versascope" in awake patients without any peroperatively admistered analgesia or anaesthesia. As a "see and treat" were managed 796 endometrial polyps, 125 submucous myomas, as well as 62 cases of intrauterine synechias. CONCLUSIONS: endometrial polyps up to 1,5 cm, pedunculated submucous myomas up to 1,0 cm as well as fibroid adhesiones obliterated no more than 1/3 of uterine cavity can be managed as "see and treat" procedures with a high compliance of the patients.

[Office hysteroscopy--state of the art]. / Soucasný stav ambulantní hysteroskopie.

OBJECTIVE: Sum up the knowledge about office hysteroscopy. TYPE OF STUDY: Review of literature and our own 5 years of experience. SETTING: Department of Gynaecology and Obstetrics, First Faculty of Medicine, Charles University Prague and General Teaching Hospital Prague, Prague. METHODS: Compilation of data from scientific literature and 5 years of our own experience with office hysteroscopy. CONCLUSIONS: Hysteroscopy provides optical evaluation of uterine cavity. Most of the benign intrauterine organics pathologies could be managed in an outpatient setting with a vaginoscopic approach without any anaesthesia and analgesia. Using that approach we can recommend to perform endometrial target biopsy, resection of endometrial polyps up to 1.5 cm and pedunculated submucous myomas up to 1 cm as well as resection of filmy intrauterine adhesions. Method is comfortable for well managed patients and practically complication-free.