Hysteroscopic markers for endometrial tuberculosis
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HYSTEROSCOPIC MARKERS FOR ENDOMETRIAL TUBERCULOSIS PowerPoint PPT Presentation


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HYSTEROSCOPIC MARKERS FOR ENDOMETRIAL TUBERCULOSIS. Dr. PAAYAL CHOBE. Dr. Paayal Chobe. MBBS (gold medalist), MD OBGY Clinical fellowship in Gynae -Laparoscopy-Mumbai BEAMS Diploma in Gynae Laparoscopy KIEL & GIESSEN GERMANY Presented poster in AICOG 2003 BANGALORE

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HYSTEROSCOPIC MARKERS FOR ENDOMETRIAL TUBERCULOSIS

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Hysteroscopic markers for endometrial tuberculosis

HYSTEROSCOPIC MARKERS FOR ENDOMETRIAL TUBERCULOSIS

Dr. PAAYAL CHOBE


Dr paayal chobe

Dr. Paayal Chobe

  • MBBS (gold medalist), MD OBGY

  • Clinical fellowship in Gynae -Laparoscopy-Mumbai BEAMS

  • Diploma in Gynae Laparoscopy KIEL & GIESSEN GERMANY

  • Presented poster in AICOG 2003 BANGALORE

  • Presented paper use of Misoprostol prior to hysteroscopy AMOGS 2009-Aurangabad

  • Faculty in state conference AMOGS 2009


Hysteroscopic markers for endometrial tuberculosis

GENITO URINARY TUBERCUOSIS

Always secondary to Tuberculosis elsewhere in the body usually in the Lungs, Peritoneum, Lymph Glands and Bone.

1st case was recorded by Morgagni on autopsy.


Incidence

INCIDENCE:

  • Involvement of organs –Norries

    Site %

    Fallopian tubes 85-90

    Endometrium 35-50

    Ovaries 5-6

    Cervix 3

    Vagina & vulva 2


Hysteroscopic markers for endometrial tuberculosis

  • Involvement of Endometrium

  • Extensive

  • The Endometrium is replaced by hyalanized connective tissue thereby --------obliterating the cavity.

  • Patients present as Oligomenorrhoea to Amenorrhoea.


Hysteroscopy

HYSTEROSCOPY-

  • Purely visual method of investigation.

  • Gives better overall view of all the pathological conditions and changes of the

    endometrium.

  • Better tissue perception as compared to hysterosalphingography(HSG)

  • Should ideally be coupled with laparoscopy


Pre requisites

Pre-Requisites

  • Proper counseling

  • Detailed history taking and P/S P/V examinations

  • Pre-menstrual

  • Role of Misoprostol prior to hysteroscopy

  • Paper presented at AMOGS 2009 study conducted at Gauravi Centre For Laparoscopy by Dr. Paayal Chobe


Diagnostic hysteroscopy

Diagnostic Hysteroscopy

  • Distension medium-normal saline

  • Sites to look for markers-endocervix

  • Uterine cavity

  • Endometrium

  • Tubal ostium


Hysteroscopic pictures

Hysteroscopic Pictures

Normal endometrial cavity on hysteroscopy


Normal ostium and endometrium

Normal ostium and endometrium


Normal findings on hyteroscopy

Normal findings on hyteroscopy


Hysteroscopy markers

Hysteroscopy Markers

  • Usually os stenosed –so difficulty in passing hysteroscope---misoprostol can be used prior

  • Endocervical canal-narrow

  • Endometrial cavity-obliterated,adhesions and distorted.

  • Endometrial lining-pale,patchy

  • Advanced cases tubal ostia not visualised.


Scanty endometrium

Scanty Endometrium


Obliterated endometrial cavity

Obliterated Endometrial Cavity


Fibrosed endocervical canal cavity

Fibrosed Endocervical canal & Cavity


Obliterated cavity due to adhesions

Obliterated cavity Due to adhesions


Narrow endocervical canal

Narrow endocervical canal


Confirmatory test

Confirmatory test

  • Endometrial biopsy-

  • However negative endometrial biopsy is not an indication for discontinuing AKT as HPE of endometrium does not necessarily reflect the state of fallopian tubes


Endometrial biopsy

Endometrial biopsy


Other confirmatory tests

Other confirmatory tests

  • TB PCR-polmerase chain reaction

  • Senitivity 80-90%


Newer horizons

Newer horizons

  • TB Interferon-gamma release assays

  • Most recent available test


Summary

Summary-

  • Endometrial tuberculosis-important cause of infertility

  • Hysteroscopy better than HSG to diagnose

  • Hysteroscopy should ideally be coupled with laparoscopy

  • Endometrial biopsy-confirmatory test


Hysteroscopic markers for endometrial tuberculosis

THANK YOU!!


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