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HYSTEROSCOPIC MARKERS FOR ENDOMETRIAL TUBERCULOSIS

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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  1. HYSTEROSCOPIC MARKERS FOR ENDOMETRIAL TUBERCULOSIS Dr. PAAYAL CHOBE

  2. 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

  3. 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.

  4. INCIDENCE: • Involvement of organs –Norries Site % Fallopian tubes 85-90 Endometrium 35-50 Ovaries 5-6 Cervix 3 Vagina & vulva 2

  5. Involvement of Endometrium • Extensive • The Endometrium is replaced by hyalanized connective tissue thereby --------obliterating the cavity. • Patients present as Oligomenorrhoea to Amenorrhoea.

  6. 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

  7. 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

  8. Diagnostic Hysteroscopy • Distension medium-normal saline • Sites to look for markers-endocervix • Uterine cavity • Endometrium • Tubal ostium

  9. Hysteroscopic Pictures Normal endometrial cavity on hysteroscopy

  10. Normal ostium and endometrium

  11. Normal findings on hyteroscopy

  12. 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.

  13. Scanty Endometrium

  14. Obliterated Endometrial Cavity

  15. Fibrosed Endocervical canal & Cavity

  16. Obliterated cavity Due to adhesions

  17. Narrow endocervical canal

  18. 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

  19. Endometrial biopsy

  20. Other confirmatory tests • TB PCR-polmerase chain reaction • Senitivity 80-90%

  21. Newer horizons • TB Interferon-gamma release assays • Most recent available test

  22. Summary- • Endometrial tuberculosis-important cause of infertility • Hysteroscopy better than HSG to diagnose • Hysteroscopy should ideally be coupled with laparoscopy • Endometrial biopsy-confirmatory test

  23. THANK YOU!!

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