Скачать с ютуб Do polyps stop you getting pregnant & its management? - Dr. Rashmi Yogish в хорошем качестве

Do polyps stop you getting pregnant & its management? - Dr. Rashmi Yogish

Endometrial polyps are the extra growth in the uterine cavity. The polyps can range from 0.5 cms to even 3 or 4 cms. These polyps can be an extra growth in the lining or even be pedicle or sometimes they could have along stand called as pedicle. Peduncuclated polyps are easier to be removed and they can even come out during the cycles, the polyps not pedunculated have broad base and have to be removed with hysteroscopy or a blind curettage. We prefer doing a hysteroscopy guided endometrial polypectomy rather than doing a bind endometrial curettage because we have seen that blind endometrial curettage can damage the basal layer of endometrium and prevent further endometrial proliferation and because of this the endometrial layer can thin out and the pregnancy chances can deteriorate. In endometrial polypectomy we do a hysteroscopy guided resection with either a resectoscope or with scissors and sometimes they can be pulled out with hysteroscopic blunt forceps. The hystereosocpic procedures are much preferred than blind endometrial curettage. The polyps can be detected in a normal ultrasound scans. The transvaginal scan, 2 dimensional one is better than the transabdominal scan. In the transvaginal scans we see an endometrial polyp, we see the vascularity of the polyp whether they are arising for the anterior or the posterior walls of the uterus and accordingly prepare to get them removed . These endometrial polyps will prevent implantation because they are space occupying lesions in the uterus. Sometimes these polyps can develop extra layers of endometrial tissue and result in either premenstrual or intermenstrual bleeding. Women complain of spotting because of the polyps. These polyps can cause uterine contractions and excessive pain during the cycles. Whenever there are polyps, we decide to remove them before the endometrial transfer or an intrauterine insemination. In women with high levels of endogenous estrogen, the endometrial layer could be too thick and polypoidal. Instead of 1 or 2 layers, there could be multiple polyps because of which we call as polypoidal endometrium. In such case it should be curetted with a suction curettage, after which high dose progesterone therapy should be given for a couple of months. Sometimes GnRh analogues should be given so as to ensure that the excessive estrogens on the endometrium is and it is prepared for implantation which is hormone therapy with low dose estrogen for frozen embryo transfer or it could be medications. Some women have a tendency to develop endometrial polyps and one should look for endometrial polyps on a regular basis. On the 2nd or the 3rd day on the cycles these polyps won’t be visible on scan but during he proliferative phase, day 10 to 14 or 15 of the cycle then the endometrium is triple lined, it is this time the endometrial polyps are much visible. That is the reason women with polyps can go for regular screening once in 3 or 6 months. Because of these polyps there can be intermenstrual spotting or premenstrual spotting, or there are some women who don’t have any symptoms.