Uterine balloon therapy is presented as an alternative to hysterectomy for treating heavy menstrual bleeding. It is a minimally invasive outpatient procedure that uses heated saline solution in a balloon catheter to ablate the endometrial lining in 10 minutes. Studies show it has success rates of 90-97% in reducing bleeding, with 38% of women becoming hypomenorrheic and 36% becoming amenorrheic or experiencing only spotting. It provides an effective treatment option that preserves the uterus and avoids major surgery and complications for those who do not want or medically should not have a hysterectomy.
Lecture by Dr. Patrick Treacy to the London Aesthetic Conference in 2008 about UltraShape, which uses the new process of therapeutic ultrasound to remove unwanted fat.
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
Lecture by Dr. Patrick Treacy to the London Aesthetic Conference in 2008 about UltraShape, which uses the new process of therapeutic ultrasound to remove unwanted fat.
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer
A. Revelli, V. Rovei, P. Dalmasso, G. Gennarelli, C. Racca, F. Evangelista, C. Benedetto
Volume 48, Issue 3, Pages 289–295
Read the free-access article:http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study
R. Romero, K. H. Nicolaides, A. Conde‐Agudelo, J. M. O'Brien, E. Cetingoz, E. Da Fonseca, G. W. Creasy, S. S. Hassan
Volume 48, Issue 3, Pages 308–317
Read the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
Ability of a preterm surveillance clinic to triage risk of preterm birth: a prospective cohort study
J Min, HA Watson, NL Hezelgrave, PT Seed and AH Shennan
Volume 48, Issue 1, pages 38–42
Slides prepared Dr Joel Naftalin (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15925/full
Dydrogesterone versus progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials
M. W. P. Barbosa, L. R. Silva, P. A. Navarro, R. A. Ferriani, C. O. Nastri and W. P. Martins
Volume 48, Issue 2, Pages 161–170
Slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15814/full
A brief awareness and knowledge about the insertion of NGT nasogastric Tube and feeding through it.
It contains an introduction, procedure, equipment needed, method of feeding etc
Mimosa pudica; Lajjalu treatment of uterine prolapseindudhartm
Mimosa pudica was found very useful in uterine prolapse treatment with bleeding. the condition for more than 45 years, and treating hundreds of such cases of uterine prolapse. Hysterectomy has
been avoided up to this date, and is not now expected to be recommended.
Surgical treatment for hydrosalpinx prior to in‐vitro fertilization embryo transfer: a network meta‐analysis
A. Tsiami, A. Chaimani, D. Mavridis, M. Siskou, E. Assimakopoulos, A. Sotiriadis
Volume 48, Issue 4, Pages 434–445
Slides prepared by Dr Shireen Meher (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15900/full
Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open‐label, randomized controlled trial
S Kehl, A Schelkle, A Thomas, A Puhl, K Meqdad, B Tuschy, S Berlit, C Weiss, C Bayer, J Heimrich, U Dammer, E Raabe, M Winkler, F Faschingbauer, MW Beckmann, M Sutterlin
Volume 47, Issue 6, Date: June (pages 674–679)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14924/full
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
Prevention of pre-eclampsia by low-molecular-weight
heparin in addition to aspirin: a meta-analysis
S. Roberge, S. Demers, K. H. Nicolaides, M. Bureau, S. Côté and E. Bujold
Volume 47, Issue 5, Pages 548–553
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15789/full
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
Large randomized trial comparing transabdominal ultrasound-guided embryo transfer with a technique based on uterine length measurement before embryo transfer
A. Revelli, V. Rovei, P. Dalmasso, G. Gennarelli, C. Racca, F. Evangelista, C. Benedetto
Volume 48, Issue 3, Pages 289–295
Read the free-access article:http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study
R. Romero, K. H. Nicolaides, A. Conde‐Agudelo, J. M. O'Brien, E. Cetingoz, E. Da Fonseca, G. W. Creasy, S. S. Hassan
Volume 48, Issue 3, Pages 308–317
Read the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15899/full
Ability of a preterm surveillance clinic to triage risk of preterm birth: a prospective cohort study
J Min, HA Watson, NL Hezelgrave, PT Seed and AH Shennan
Volume 48, Issue 1, pages 38–42
Slides prepared Dr Joel Naftalin (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15925/full
Dydrogesterone versus progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials
M. W. P. Barbosa, L. R. Silva, P. A. Navarro, R. A. Ferriani, C. O. Nastri and W. P. Martins
Volume 48, Issue 2, Pages 161–170
Slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15814/full
A brief awareness and knowledge about the insertion of NGT nasogastric Tube and feeding through it.
It contains an introduction, procedure, equipment needed, method of feeding etc
Mimosa pudica; Lajjalu treatment of uterine prolapseindudhartm
Mimosa pudica was found very useful in uterine prolapse treatment with bleeding. the condition for more than 45 years, and treating hundreds of such cases of uterine prolapse. Hysterectomy has
been avoided up to this date, and is not now expected to be recommended.
Surgical treatment for hydrosalpinx prior to in‐vitro fertilization embryo transfer: a network meta‐analysis
A. Tsiami, A. Chaimani, D. Mavridis, M. Siskou, E. Assimakopoulos, A. Sotiriadis
Volume 48, Issue 4, Pages 434–445
Slides prepared by Dr Shireen Meher (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15900/full
Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open‐label, randomized controlled trial
S Kehl, A Schelkle, A Thomas, A Puhl, K Meqdad, B Tuschy, S Berlit, C Weiss, C Bayer, J Heimrich, U Dammer, E Raabe, M Winkler, F Faschingbauer, MW Beckmann, M Sutterlin
Volume 47, Issue 6, Date: June (pages 674–679)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14924/full
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
Prevention of pre-eclampsia by low-molecular-weight
heparin in addition to aspirin: a meta-analysis
S. Roberge, S. Demers, K. H. Nicolaides, M. Bureau, S. Côté and E. Bujold
Volume 47, Issue 5, Pages 548–553
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15789/full
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
European Hernia Society (EHS) 2014 guidelines : Closure of abdominal wall inc...Jibran Mohsin
This presentation includes the latest(2014) European Hernia Society (EHS) guidelines regarding the optimal technique and suture material for the closure of elective mid-line abdominal incisions in order to decrease the frequencies of complications especially incisional hernia, wound dehiscence and burst abdomen.
Closure of elective midline abdominal incision: European Hernia Society 2014 ...Jibran Mohsin
This presentation includes the latest(2014) European Hernia Society (EHS) guidelines regarding the optimal technique and suture material for the closure of elective mid-line abdominal incisions in order to decrease the frequencies of complications especially incisional hernia, wound dehiscence and burst abdomen.
In this introductory remark at workshop on vaginal hysterectomy where Dr Shirish Seth was operating faculty.
I spoke “lets promote and propagate vaginal hysterectomy which is an indigenous surgery in line with PM Modi’s mission of MAKE IN INDIA.
Vaginal hysterectomy is like Aam admi surgery which is in the best interest of patients and has best scientific evidences in its favour."
Let us not be driven by glamour,gadgets and gimmicks."
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
6. Heavy menstrual bleeding
An important cause of morbidity
• It affects 1 in 5
or 1 in 3 women.
• 30% of women in
reproductive age group
suffer with Menorrhagia
• 60% of these women
will ultimately undergo
HYSTERECTOMY
7. Hysterectomy
• Second most
frequent surgical
procedure in women of
reproductive age group
• 90% for benign reasons
• Promptly offered
following a diagnosis.
8. Value Study(BJOG - 2004)
survey of outcomes of 37,000 hysterectomies
• Operative and
postoperative major
complication rate of
3.5% and 9 %
respectively were reported
• Postoperative
mortality of 0.38 /
1000.
• Psychological
implications 35-45%
•
Hysterectomy should not be taken up
9.
10. We have to give- up herd following of
Uterus Removal
11. Dilemma!! of Treatment
Aim - Quality Personal life
- Family life
- Preserve the feminity of a women
- ↓ Frequent leave from office
Age
Severity
Fertility
12. Treatment of Heavy Periods
Individualized
• age
• need for contraception
• desire to retain uterus
• Nature and severity of complaints
• presence of any pelvic pathology
• outcome of previous treatment
• cost of treatment
• time away from work
16. NICE guideline (Jan 2007)
management of heavy menstrual bleeding
• If future childbearing is desired
LNG – IUS is the first line intervention
• If future child bearing is not
desired
Endometrial ablation
19. Day Care Procedure
• Definitive solution for patients
• Minimally Invasive
• High safety profile
• Requires minimal training
• Clinically proven (90-97%)
• Can be performed under LA
• COST EFFECTIVE
See to Believe it
UBT
20. • Long learning curveLong learning curve
•Succes rate 85%Succes rate 85%
• Re-surgery up to 30%Re-surgery up to 30% ..
•LO
FEAT
FIRST GENERATION ENDOMETRIAL ABLATIONFIRST GENERATION ENDOMETRIAL ABLATION
TECHNIQUESTECHNIQUES
(Hysteroscopic Techniques)(Hysteroscopic Techniques)
Given upGiven up by most expertsby most experts
21. No Ideal global endometrial
ablation technique - so far !!
•SSAFEAFE
•SSUCCESFULLUCCESFULL
•SSIMPLEIMPLE
•SSAVINGAVING
23. UTERINE BALLOON THERAPYUTERINE BALLOON THERAPY
SYSTEMSYSTEM
““UBT”UBT”
(GynecareThermachoice(GynecareThermachoiceRR
))
First global ablation technology to
receive FDA approval 1997
19971997
26. UBT - Thermocoagulation Principle
3 essential parameters
HEAT
TIME
PRESSURE
PERMANENT
TREATMENT OF DUB
27. UBT - Thermocoagulation Principle
The thermal coagulation principle
Combined action of pressure and heat
applied for a sufficient time
- Pressure: variable in different
machines
- Temperature: 78° C - 87 ° C
- Time: 8 - 10 minutes
5-8 mm of the endometrium
and myometrium will be
destroyed during treatment
Endometrium
Myometrium
Basal
membrane
Functional
layer
31. All Uterine Balloon Therapy
are Same
• 95 % success rate
• 50 % amenorrhic at 1
year
• Affects fertility
Pre-Ablation Post Ablation
Use of effective contraception
following procedure is must
33. Patient Selection
• Unresponsive to medical therapy
• Completed family
• Normal pap smear
• Negative endometrial biopsy
• Cavity depth 6-12 cm thermachoice/
Novasure
• 4-10cm for cavaterm
34. Not fully Evaluated
• Large uterus (> 30 cc, >12 cm)
• Previously failed TCRE
• Repeat Endometrial Ablation
• Post Menopausal Bleeding
36. Factors Affecting
Failure Rate decreases
• Pre- operative medical therapy
Danazol /gnRH - G
• Post Operative therapy with injection
Depo-provera 3 monthly for 4-6 injections
(95 to 99%)
37. INTERNATIONAL MULTI-CENTER STUDY
PATIENTS WITH AT LEAST 24 MONTH FOLLOW-UP
INTERNATIONAL MULTI-CENTER STUDY
PATIENTS WITH AT LEAST 24 MONTH FOLLOW-UP
8 min treatment; >150 mmHg Start Pressure
Hypomenorrhea
38%
Amenorrhea /spotting
36%
Minimal or no
reduction in
menses 4.0%
22%
NormalperiodsNormalperiods
38. OVER 2 million / yr
procedures are done in USA alone
We Have Largest No. of Cases of UBT in India
Updated on 1/8/2014
43. Our Experience
UBT v/s Mirena
Great
Great
Great
4th
Month
Jaan Nikaal
Deta Hai
Really
troublesome
Now we have learnt To overcome the problems
of Mirena in the firs 3 – 6 months
44. KJ Carlson, NEJM 328:856,
1993
HYSTERECTOMY
as Treatment
Should be last resort
45. Uterine Balloon Therapy is thus a newUterine Balloon Therapy is thus a new
horizon to your patient and yourself.horizon to your patient and yourself.
Once family is completedOnce family is completed
BE BOLD, WALK ALONG NEW
PATHS
EXPERIENCE IT YOURSELF
46. UBT - Cavaterm™
Endometrial Ablation Method NOW In INDIA
What is Cavaterm ?
• Minimally invasive therapy for the
treatment of DUB
• Thermal balloon ablation of the
endometrium
• Using pressure and heat for 10 minutes
to treat DUB
• System consisting of a Cavabox and a
single use catheter
The Cavaterm™ System
47. Cavaterm™
Evolution of a successful system
•Quick to learn and easy to use
method to treat DUB
•Used since 1993
• Ongoing product development and
innovations based on users feedback
Now we have 3rd génération
48. UBT - Cavaterm™
Contraindications
Undiagnosed uterine bleeding
Ongoing infection
Pregnancy or desire to become pregnant
Doubts regarding uterine wall strength
Gross uterine abnormalities
Endometrial atypical cells
Uterine cavities > 10 cm and < 4 cm
Cervical canal longer than 6 cm
49. ADDRESS
11 Gagan Vihar, Near Karkari
Morh Flyover, Delhi - 51
CONTACT US
9650588339, 011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com
&
Thank You
Editor's Notes
Mirena
Benefits of hysterectomy. There are women out there who want amenorrhea and will be satisfied with nothing less. After understanding and accepting the balanced risks, benefits, and alternatives, those patients may be more appropriate candidates for hysterectomy than for any type of endometrial ablation, since no type of ablation can guarantee amenorrhea.
WHY SHOULD’NT A HYSTERECTOMY BE AVOIDED IF THE BENEFIT CAN BE PROVIDED TO A GOOD NO, OF PATIENTS BY A SAFER ALTERNATIVE TT MODALITY COZ HYSTERECTOMY DOES CARRY RISKS OF ANAESTHESIA ETC