Objective. To study the efficacy of different treatment options for patients with intrauterine synechia. Patients and methods. The results of the observation and treatment of 1218 patients of reproductive age with intrauterine synechia and Asherman’s syndrome were analyzed. Patients were retrospectively divided into 4 groups depending on the treatment option (mechanical dissection of synechiae, laser destruction without or under ultrasound or laparoscopic control). Results. The role and diagnostic value of office hysteroscopy for determining treatment tactics were defined; high efficacy of complex treatment (laser surgery, anti-adhesion gels, postoperative care and rehabilitation) for patients with uterine factor infertility was established: there was no relapse in 98% of patients, and pregnancy occurred in 57% of patients. Intraoperative ultrasound monitoring of patients with Asherman’s syndrome allowed to avoid intraoperative complications in all patients; menstrual cycle was restored in 97.5%, pregnancy occurred in 24%, repeated intervention was necessary in 18%. Conclusion. A comprehensive method including hysteroscopy, laser destruction of synechiae, administration of anti-adhesion gels, postoperative laser therapy, and rehabilitation with the use of chlorophyll-containing medications allows to achieve high efficacy in the treatment of patients with uterine infertility caused by intrauterine synechiae. The results of the analysis indicate the advisability of intraoperative ultrasound monitoring in the surgical treatment of Asherman’s syndrome. Key words: intrauterine synechiae, Asherman’s syndrome, laser destruction, uterine factor infertility
The article aims to assess the possibility of ultrasound scanning and dopplerstudy in the assessment of the condition of the ovaries and endometrial in patients after long intake of COC, predicting the restoration of reproductive function after the abolition of hormonal contraception. Material and methods. In 2018-2019, 37 women were examined after the abolition of oral contraceptives, which they took for a long period of time. At the time of the examination, all the patients stopped taking COC at least 2 months ago due to the fact that they were planning a pregnancy. UW the study was conducted on the apparat Voluson E8 Expert (General Electric), improving the quality of diagnostics used Automatic assessment of follicle condition based on ultrasonic echography (Sono AVCTM follicle) and tomographic ultrasound (TUI). Results. According to the study significant changes recorded 17 patients whose menstrual cycle did not recover within the first 6 months after the cancellation of COC. In a group of 20 patients with a regular menstrual cycle, the results of the study were within normal limits, pregnancy within 6 months occurred on their own in 8 of them. Conclusion. The possibilities of 3 dimensional reconstruction and programs for evaluating the follicular apparatus significantly improve the quality of ultrasound diagnostics, give more information about the presence of small follicles, blood flow in the ovarian tissue, the structure of the cortical apparatus substances and stroma, whichis the ability of a clinician to obtain a complete understanding of the condition of the ovaries and endometrial and predicting a good health of patients. The article may be of interest to obstetricians-gynecologists, ultrasound specialists, endocrinologists, reproductive specialists.
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