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
Notas del editor
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