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البريد الالكتروني :

HYSTEROSOPY

Dr. Safia doing HYSTEROSOPY

What is hysteroscopy?

Why is hysteroscopy done?

How is hysteroscopy performed?

What should I expect during recovery?

What are the risks of hysteroscopy?

What are the operative challenges?

Glossary

 

 

What is hysteroscopy?

 

Hysteroscopy is used to diagnose or treat problems of the uterus. A hysteroscope is a thin, lighted telescope-like device (for the office or diagnostic purpose an outer diameter of 4mm or less of 3.1mm, versus operative procedures of an outer diameter of >5mm and 10mm or less).

It is inserted through your vagina into your uterus. The hysteroscope transmits the image of your uterus onto a screen. Other instruments are used along with the hysteroscope for treatment.

Why is hysteroscopy done?

 

One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less often or more often than normal. Bleeding between menstrual periods also is abnormal.

 

Hysteroscopy also is used in the following situations:

Remove adhesions that may occur because of infection or from past surgery

Diagnose the cause of repeated miscarriage when a woman has more than two miscarriages in a row

Locate an intrauterine device

Perform sterilization, in which the hysteroscope is used to place small implants into a woman’s fallopian tubes as a permanent form of birth control

How is hysteroscopy performed?

 

Pre operative evaluation and preparation:

Informed consent — Women considering hysteroscopy should be counseled about alternative diagnostic or treatment approaches, and informed consent regarding expected treatment success and possible complications.

Patients should be informed of possible need to abandon or prematurely stop a procedure due to fluid overload. Also, since uterine perforation is a possible complication, patients should consent to a possible laparoscopy or laparotomy if it becomes necessary to rule out visceral or vascular injury.

 

Before the procedure, you may be given a medication to help you relax, or general anesthesia or local anesthesia may be used to block the pain. If you have general anesthesia, you will not be awake during the procedure.

 

Hysteroscopy can be done in a doctor’s office or at the hospital. It will be scheduled when you are not having your menstrual period. To make the procedure easier, your health care provider may dilate (open) your cervix before your hysteroscopy. You may be given medication(self-administer oral or vaginal misoprostol (200 to 400 mcg) the night before the procedureor special dilators may be used under anesthesia.

 

patient is positioned in dorsal lithotomy position.The vaginoscopic,or "no touch," technique  which avoids the use of a speculum or tenaculumand without anesthesia (the classic initial approach) is the method used by our unit, particularly for diagnostic procedures. This technique is associated with a significant decrease in operative pain and operative time.

Prepare the vaginal introitus with saline or povidone iodine. The hysteroscope is inserted and gently moved through the cervix into your uterus. Carbon dioxide gas or a fluid, such as saline (salt water), will be put through the hysteroscope into your uterus to expand it. The gas or fluid helps your health care provider see the lining more clearly. The amount of fluid used is carefully checked throughout the procedure.

 

Your health care provider can view the lining of your uterus and the openings of the fallopian tubes by looking through the hysteroscope. If a biopsy or other procedure is done, small instruments will be passed through the hysteroscope.

 

Regional or general anesthesia is reserved for patients who cannot tolerate a procedure under local anesthesia, extensive operative procedures, or patients with comorbidities that necessitate intensive monitoring.

Most diagnostic and brief or minor operative procedures can be performed without anesthetic or with a local anesthetic.

 

What should I expect during recovery?

 

You should be able to go home shortly after the procedure. If you had general anesthesia, you may need to wait until its effects have worn off.

 

It is normal to have some mild cramping or a little bloody discharge for a few days after the procedure. You may be given medication to help ease the pain. If you have a fever, chills, or heavy bleeding, call your health care provider right away.

The patient may resume most normal activities within 24 hours

 

What are the risks of hysteroscopy?

 

Hysteroscopy is a safe procedure and the complications are rare, which is in the rate of 0.22 percent. However, there is a small risk of problems.

  • Vasovagal reactions. A prodrome of dizziness, nausea and or a vomiting.

  • The uterus or cervix can be punctured by the hysteroscope (0.12 percent)

  • bleeding may occur (0.03 percent)

     

  • excess fluid may build up in your system(0.06 percent)

  • bladder or bowel injury (0.02 percent)

  • endomyometritis i.e. infection (0.01 percent).

  • In rare cases, hysteroscopy can cause life-threatening problems.

 

What are the operative challenges?

 

There are several reasons for hysteroscopic failure.

In the office setting, pain, cervical stenosis, and poor visualization are the most common reasons for terminating a procedure.

the overall rate of failure was 3.6 percent, and was similar in ambulatory and hospitalized patients and pre- and postmenopausal women.

Glossary

 

Adhesions: Scars that bind together affected surfaces of the tissues inside the abdomen or uterus.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Cervix: The opening of the uterus at the top of the vagina.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Intrauterine Device: A small plastic device inserted in the uterus to prevent pregnancy.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Miscarriage: Early pregnancy loss.

Sterilization: A permanent method of birth control.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.