Hysteroscopy

Hysteroscopy is a procedure for direct visualization of the uterine cavity using a telescope connected to a video camera. It is performed immediately after menstruation, when the uterine cavity is easier to assess. It is not performed during pregnancy or in the presence of a genital infection

This procedure is performed for diagnostic purposes, to investigate malformations of the uterine cavity, endometrium, tubal orifices and possible intrauterine formations – fibroids, polyps, scar tissue (synechiae). On the occasion of diagnostic hysteroscopy, small interventions can be performed – removal of a polyp, opening of a synechia or biopsy of the endometrium.
It is indicated in the following situations:
● Abnormal uterine bleeding
● Suspicion of uterine polyp or uterine synechia
● Infertility
● Pre- and postoperative evaluation of the uterine cavity

The risks associated with the procedure are rare:
● Pain during the procedure
● Hemorrhage
● Infection
● Perforation of the uterus and neighboring organs
● Uterine synechia
● Abnormal reaction to medication

Hysteroscopy can help:
● Diagnosed the cause of bleeding or infertility
● Removal of the cause of infertility (removal of a polyp or dissolution of uterine synechia)
● Prevention of complications (bleeding, cancer)

The alternative to diagnostic hysteroscopy is sonohysterography, ultrasound visualization of the uterine cavity, after the introduction of a contrast substance. Hysterosalpingography (HSG) visualizes the uterus and fallopian tubes radiologically. All procedures involve the introduction of a substance into the uterus, but there are differences in the possibilities of visualizing the cavity, fallopian tubes or performing small interventions.

Failure to perform the procedure may lead to persistence or complications: bleeding, infertility.

The visualization is usually very good, and complications are rare.
However, patient particularities and other uncontrollable variables may affect initial estimates.
Hemorrhage, uterine synechia, or certain malformations may make satisfactory visualization impossible.

Investigations:

The following investigations are required before performing the hysteroscopy:

Pap smear performed in the last 12 months
Culture with the uterus
Blood count, transaminases, blood glucose, creatinine, APTT
Serology of communicable diseases: HBs, HCV, HIV, VDRL

Written consent:
To perform the hysteroscopy it is necessary to fill in a consent form, after reading
information and clarification of doubts. Consent may be withdrawn before the procedure is performed.

Medication: Your doctor should be informed of any medications or natural remedies taken regularly.

Lifestyle:
Food and fluids are prohibited 6 hours before surgery, when using general anesthesia.
Sexual contact should be avoided 48 hours before surgery.
It is recommended to epilate and use bactericidal soaps for the genital toilet.
The procedure is easier in some patients with a full bladder.

Hysteroscopy does not require anesthesia, except in the case of dilation of the neck and opening of a uterine synechia. The procedure begins with disinfecting the vagina and cervix. A thin, long telescope is inserted through the neck into the uterine cavity. Through the hysteroscope, a liquid or gas is introduced into the uterus, which will keep the uterine cavity open and will allow the visualization of its walls.
For the insertion of a very thin, diagnostic hysteroscope, it is not necessary to dilate the neck. In case of small interventions, the neck is dilated to allow the use of tools. This maneuver can cause uterine contractions, perceived by the patient, if awake, as menstrual cramps that last a few minutes. The procedure generally takes 5 to 10 minutes.

After general anesthesia:

Driving is not allowed on the day of the intervention.

Medication:

Anti-inflammatory medication may be used before or after hysteroscopy to prevent pain.
The doctor may administer an antibiotic during the procedure to prevent infection.

Lifestyle:

Regular activities can be resumed starting the next day.
Sexual contact will be avoided in the first 48 hours after the intervention.

Possible symptoms:

In the first hours after hysteroscopy, mild cramps or bleeding may occur that may persist for 1-2 days.
Symptoms that require immediate medical attention:
● Fever over 38∘ C
● Intense pain that does not yield to painkillers
● Persistent heavy bleeding