This is the gold standard for evaluation of suspected intrauterine pathology, providing both diagnostic as well as therapeutic intervention.
Effectively replaces dilation and curettage (D&C).
- Abnormal uterine bleeding, whether premenopausal or postmenopausal
- Retained or lost intrauterine device (IUD)
- Abnormal radiologic studies, i.e., hysterosalpingogram or sonogram
1 Infection of cervix or vagina
- Known cervical or uterine malignancy
- Suspected pregnancy
- Hemodynamically unstable patient (hemorrhage)
- Hysteroscope (0.12 degree or 30 degree) 2. Uterine distention media
- Carbon dioxide (CO2): diagnostic procedures
- Solutions: diagnostic as well as therapeutic advantage. Hyskon (32% dextran), nonelectrolyte (3% sorbitol or glycine), electrolyte (saline or Lactated Ringer’s)
- Equipment to monitor inflow and outflow of distention media
- May be done in office or hospital-based setting
- Ascertain position of uterus.
- Dilate cervix to accommodate hysteroscope; if 5-mm diagnostic scope is used, may not need to dilate.
- Pass scope to fundus under direct visualization
- Observe shape of cavity, ostia, thickness of endometrium, presence or absence of septa, adhesions, myomas, polyps, and irregular surface contour.
- Observe cervical canal as scope is slowly withdrawn.
- Avoid intrauterine pressure greater than 100 mm Hg .(utermgddisten-sion is achieved at 75 mm Hg) by gauge if using CQ2 or by hanging fluids 1.5 m above patient.
Diagnosis and treatment of polyps, myomas, septa, adhesions, adenomyosis, polypoid endometrial hyperplasia, carcinoma, and IUDs 2.; Directed tissue sampling.
- Uterine perforation
- Malabsorption of fluid distention media
- Cervical laceration (by tenaculum or dilator)
- Note: D&C has the same complications but also results in a missed diagnosis 10% to 35% of the time.