Diagnostic and operative hysteroscopy: when is it necessary?

Hysteroscopy is an outpatient endoscopic test that does not require analgo-anesthesia and allows us to investigate inside the uterine cavity using an instrument called a hysteroscope

This is a thin, rigid tube a few millimetres in diameter, equipped with optical fibres through which light travels, which is introduced inside the uterus, through the vagina.

When to undergo hysteroscopy?

Diagnostic hysteroscopy is indicated especially in the presence of abnormal uterine bleeding in the fertile period, in pre- and post-menopause, in patients undergoing post-neoplasm breast drug therapy or undergoing replacement treatment for menopause.

It is important to undergo diagnostic hysteroscopy in cases of couple infertility (which should always be performed prior to any access to AMP techniques), in suspected uterine malformations, for post-surgery hysteroscopic uterine cavity checks, and in cases of post-abortion or post-partum chorioplacental remnants.

Operative hysteroscopy, on the other hand, is used in the presence of

  • intrauterine adhesions
  • uterine malformations such as uterine septum
  • endometrial polyps
  • submucosal uterine fibroids
  • intrauterine foreign bodies, such as an IUD whose filament has ascended into the uterine cavity.

Stages of hysteroscopy: what to do before the test

Diagnostic hysteroscopy requires no special preparation. In the case of operative hysteroscopy, preparation requires fasting from midnight on the day before surgery.

On the day of the operation, antibiotic prophylaxis is carried out and the patient is asked to empty her bladder.

Anaesthesia is necessary. In this case, the patient must have undergone the following investigations: blood tests, electrocardiogram and chest X-ray (if age > 50 years).

Stages of hysteroscopy: what to do during and after

Access to the uterine cavity is by vaginoscopic, atraumatic technique: the hysteroscope is introduced, through the vagina, into the cervical canal until it reaches the uterine cavity, which is distended with a gaseous or liquid medium in order to allow it to be seen.

In the case of surgical hysteroscopy, miniaturised instruments, such as scissors or forceps, can be introduced through the hysteroscope, or the resectoscope is used to cut and coagulate through a source of electrical energy.

The diagnostic hysteroscopy lasts only a few minutes; at the end of the procedure, the hysteroscope is removed and the distention medium flows out of the uterine cavity, which returns to its original size.

No sutures or dressings are required.

The diagnostic hysteroscopy causes no particular discomfort and the patient quickly resumes her activities.

In some cases, she may experience cramp-like pain similar to menstruation and a modest dripping of blood (spotting), both of which quickly disappear.

Treatment following hysteroscopy varies from patient to patient.

In any case, a gynaecological examination is required after one month to assess the advisability of pharmacological treatment or further surgery.

Hysteroscopy: contraindications and risks

Contraindications to performing hysteroscopy are:

  • the presence of an ongoing pregnancy
  • the presence of an ongoing or recent pelvic infection
  • carcinoma of the cervix.

Diagnostic hysteroscopy is almost risk-free and complications are very rare.

Operative hysteroscopy, on the other hand, carries the following risks

  • nausea and vomiting as a result of anaesthesia
  • perforation of the uterus possible, but infrequent;
  • injury to abdominal organs very rare;
  • cardiac arrest and/or pulmonary oedema, very rare occurrences;
  • cardiovascular overload during the operation may be a complication related to the fluid used to distend the uterine cavity, an event that can be serious, but rare and well-predictable.

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