Best Examination Tips: Medcase, Interesting Medical Cases and Pictures

  • Sunday, July 7th, 2013

Case 2/Picture 1 (16.07.2013.) Could you identify the picture?

Venus

Answer

This was taken on a 41-year old woman who had spontaneous miscarriage and underwent evacuation of the retained products. The process was repeated as the first one was incomplete evacuation. She failed to become pregnant subsequently. She developed amenorrhoea and had gone to the hospital for advice. Both the progestogen challenge test and estrogen-progestogen combination failed to start menstrual periods. She was told by a junior doctor that she might need IVF. She was confused and had searched the internet. She was quite upset about her situation and wanted to sue both the Gynaecologists who had performed the evacuations (done by two separate Gynaecologists). She wanted to consult an Infertility Specialist to clarify the situation. Therefore she was referred to me. Given the sensitivity of the issue I had to be very careful while counselling her as she was planning to sue both the Gynaecologists who had performed the evacuations in the past. This was no longer only a difficult clinical case, there was a strong element of medico-legal aspect as well. I explained to her regarding the possible diagnosis of Asherman’s syndrome. I also explained that it could happen after evacuations and that does not mean that the procedures were done badly. She was satisfied with the explanation and had decided not to sue the Gynaecologists. She opted for hysteroscopy + adhesiolysis of intra-uterine adhesions, laparoscopy & dye test. This picture (Asherman’s sydrome) was taken at hysteroscopy. The laparoscopy & dye test revealed fimbrial block due to adhesions in the right tube and fimbriolysis was performed. The left tube was patent. Otherwise, both the tubes appeared normal externally. The operative findings were exlained to her including, given her age and clinical problems, the very low chance of getting pregnant. She opted  to try naturally for few months. She became pregnant spontaneously within 6 months, but unfortunately miscarried around 8 weeks’ gestation.

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