Outpatient treatment for uterine polyps

Purpose Official guideline of the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (ÖGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). The aim of this guideline was to standardize the diagnosis and treatment of couples with recurrent miscarriage (RM). Recommendations were based on the current literature and the views of the involved committee members. Methods Based on the current literature, the committee members developed the statements and recommendations of this guideline in a formalized process which included DELPHI rounds and a formal consensus meeting. Recommendations Recommendations for the diagnosis and treatment of patients with RM were compiled based on the international literature. Specific established risk factors such as chromosomal, anatomical, endocrine, hemostatic, psychological, infectious and immunological disorders were taken into consideration.

Section: Guidelinementioning

confidence: 99%

Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry Number 015/050)

Tóth

Würfel²,

Bohlmann

et al. 2018

“…Es finden sich keine randomisierten Studien zum Effekt eine HSK bei Frauen mit Endometriumpolypen oder intrauterinen Synechien [47]. Eine Metaanalyse zeigte, dass die hysteroskopische Resektion im Ultraschall darstellbarer intrauteriner Polypen vor einer intrauterinen Insemination die klinische Schwangerschaftsrate steigern kann [48].…”

Section: Expertenkonsens Konsensusstärke +++unclassified

“…There are no randomized studies on the effect of HSC in women with endometrial polyps or intrauterine synechiae [47]. A meta-analysis showed that hysteroscopic resection of intrauterine polyps visible on ultrasound carried out prior to intrauterine insemination can increase the clinical pregnancy rate [48].…”

Section: Expert Consensusmentioning

confidence: 99%

Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022)

Tóth

Bohlmann²,

Hancke

et al. 2022

Purpose The aim of this guideline is to standardize the diagnosis and therapy of recurrent miscarriage (RM) using evidence from the recent literature. This is done by using consistent definitions, objective evaluations and standardized treatment protocols. Methods When this guideline was compiled, special consideration was given to previous recommendations in prior versions of this guideline and the recommendations of the European Society of Human Reproduction and Embryology, the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, and a detailed individual search of the literature about the different topics was carried out. Recommendations Recommendations about the diagnostic and therapeutic procedures offered to couples with RM were developed based on the international literature. Special attention was paid to known risk factors such as chromosomal, anatomical, endocrinological, physiological coagulation, psychological, infectious and immune disorders. Recommendations were also developed for those cases where investigations are unable to find any abnormality (idiopathic RM).

“…A meta-analysis and a systematic review showed that hysteroscopic resection of intrauterine polyps visible on ultrasound prior to intrauterine insemination can increase the clinical pregnancy rate but a clear benefit with regard to the rate of miscarriage was not shown [23,24]. If there is no other explanation for the cause, resection of persisting polyps can be considered for RM patients according to the DGGG/OEGGG/SGGG guideline.…”

Section: Treatmentmentioning

confidence: 99%

“…Dennoch empfiehlt die deutschsprachige Leitlinie eine Resektion von uterinen Adhäsionen.Es gibt jedoch Hinweise, dass speziell bei Myomen, die das Cavum uteri beeinträchtigen, eine Myomenukleation zu einer verbesserten Schwangerschaftsrate führt. Daher wird sowohl in der DGGG/OEGGG/SGGG als auch in der ASRM-Leitlinie die Erwägung einer Myomresektion in Abhängigkeit der Lage empfohlen[21].Eine Metaanalyse und ein systematischer Review zeigten, dass die hysteroskopische Resektion im Ultraschall darstellbarer intrauteriner Polypen vor einer intrauterinen Insemination die klinische Schwangerschaftsrate steigern kannein klarer Benefit in Bezug auf die Abortrate konnte allerdings nicht gezeigt werden[23,24]. Gibt es keine andere Erklärung für die Ursache, kann die Resektion persistierender Polypen bei RSA-Patientinnen gemäß der Leitlinie der DGGG/OEGGG/SGGG erwogen werden.…”

unclassified

Recurrent Spontaneous Miscarriage: a Comparison of International Guidelines

Vomstein

Aulitzky

Strobel

et al. 2021

While roughly 30% of all women experience a spontaneous miscarriage in their lifetime, the incidence of recurrent (habitual) spontaneous miscarriage is 1 – 3% depending on the employed definition. The established risk factors include endocrine, anatomical, infection-related, genetic, haemostasis-related and immunological factors. Diagnosis is made more difficult by the sometimes diverging recommendations of the respective international specialist societies. The present study is therefore intended to provide a comparison of existing international guidelines and recommendations. The guidelines of the ESHRE, ASRM, the DGGG/OEGGG/SGGG and the recommendations of the RCOG were analysed. It was shown that investigation is indicated after 2 clinical pregnancies and the diagnosis should be made using a standardised timetable that includes the most frequent causes of spontaneous miscarriage. The guidelines concur that anatomical malformations, antiphospholipid syndrome and thyroid dysfunction should be excluded. Moreover, the guidelines recommend carrying out pre-conception chromosomal analysis of both partners (or of the aborted material). Other risk factors have not been included in the recommendations by all specialist societies, on the one hand because of a lack of diagnostic criteria (luteal phase insufficiency) and on the other hand because of the different age of the guidelines (chronic endometritis). In addition, various economic and consensus aspects in producing the guidelines influence the individual recommendations. An understanding of the underlying decision-making process should lead in practice to the best individual diagnosis and resulting treatment being offered to each couple.