Hysteroscopy

Published on 30/05/2015 by admin

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Last modified 30/05/2015

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Chapter 245 Hysteroscopy

DESCRIPTION

Hysteroscopy allows direct visual inspection of the uterine cavity. This may also serve as a portal for other diagnostic or therapeutic measures. (The hysteroscope may be used to perform vaginoscopy in young girls or infants. When used in this way, distending media are generally not required or indicated.)

INDICATIONS

Dysfunctional uterine bleeding, postmenopausal bleeding, menorrhagia, infertility (selected cases) or recurrent abortion, endometrial or pelvic infections (e.g., tuberculosis), missing intrauterine contraceptive device, or other situations where viewing the endometrial cavity can establish a diagnosis. Hysteroscopy may be used as the vehicle for transcervical sterilization, polypectomy, myomectomy, resection of intrauterine septa or adhesions, the retrieval of contraceptive devices, and other procedures.

CONTRAINDICATIONS

Acute bleeding (if carbon dioxide is used), acute pelvic infection, known uterine or cervical cancer, pregnancy (known or suspected), recent uterine perforation, uncooperative patient, vaginitis (relative).

REQUIRED EQUIPMENT

• Sterile gloves

• Operating vaginal speculum (open sided)

• Skin preparation materials (generally an iodine-based antibacterial solution such as Betadine)

• Single tooth tenaculum

• Blunt uterine sound (optional)

• Hysteroscope (flexible or rigid, 3 to 5 mm diameter, 0-, 12-, 30-, or 70-degree viewing angle; 10 mm or greater devices are available for operative procedures but are better suited to the ambulatory surgery setting)

• Insufflator (carbon dioxide, constant flow type) and light source (both compatible with the brand and type of hysteroscope chosen). (Other distending media, such as 32% dextran or 5% dextrose and water, may be used but CO₂ offers the most suitable medium for office use. Media such as dextran are preferred in the ambulatory surgery setting when operative procedures are likely to be performed.)

• Lidocaine (1%) without epinephrine, syringe and 22- to 25- gauge spinal (4″) needle or lidocaine spray

• Video or photographic equipment may be attached to the hysteroscope as desired (optional)

TECHNIQUE

Hysteroscopy is most easily performed during the early follicular phase when the endometrium is thinnest. Because of the nature and risks of hysteroscopy, informed consent should be obtained prior to initiating the procedure. The discomfort of hysteroscopy may be decreased by premedicating with a single oral dose of a nonsteroidal anti-inflammatory agent given in doses usually used to treat dysmenorrhea.

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