Hysteroscopy

Hysteroscopy

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).

 

INDICATIONS

 

  1. Abnormal uterine bleeding, whether premenopausal or postmenopausal

 

  1. Infertility

 

  1. Retained or lost intrauterine device (IUD)

 

  1. Abnormal radiologic studies, i.e., hysterosalpingogram or sonogram

 

 

CONTRAINDICATIONS

 

1 Infection of cervix or vagina

 

  1. Known cervical or uterine malignancy

 

  1. Suspected pregnancy

 

  1. Hemodynamically unstable patient (hemorrhage)

 

 EQUIPMENT

 

  1. Hysteroscope (0.12 degree or 30 degree) 2. Uterine distention media

 

  1. Carbon dioxide (CO2): diagnostic procedures

 

  1. Solutions: diagnostic as well as therapeutic advantage. Hyskon (32% dextran), nonelectrolyte (3% sorbitol or glycine), electrolyte (saline or Lactated Ringer’s)

 

  1. Equipment to monitor inflow and outflow of distention media

 

  1. May be done in office or hospital-based setting

 

 

PROCEDURE

 

  1. Ascertain position of uterus.

 

  1. Dilate cervix to accommodate hysteroscope; if 5-mm diagnostic scope is used, may not need to dilate.

 

  1. Pass scope to fundus under direct visualization

 

  1. Observe shape of cavity, ostia, thickness of endometrium, presence or absence of septa, adhesions, myomas, polyps, and irregular surface contour.

 

  1. Observe cervical canal as scope is slowly withdrawn.

 

  1. 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.

 

 

BENEFITS

 

Diagnosis and treatment of polyps, myomas, septa, adhesions, adenomyosis, polypoid endometrial hyperplasia, carcinoma, and IUDs 2.; Directed tissue sampling.

 

COMPLICATIONS

 

  1. Infection

 

  1. Bleeding

 

  1. Uterine perforation

 

  1. Malabsorption of fluid distention media

 

  1. Cervical laceration (by tenaculum or dilator)

 

  1. Note: D&C has the same complications but also results in a missed diagnosis 10% to 35% of the time.

 

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