All you need to know about Diagnostic Hysteroscopy

Hysteroscopy is a gynaecological procedure performed to assess the functioning of the uterus. Specifically, diagnostic hysteroscopy is performed to visualize the endometrial cavity by a licensed gynaecologist. It is an outpatient procedure conducted under general or local anaesthesia. However, certain patients may not require anaesthesia.

There are two types of diagnostic hysteroscopy, namely, panoramic and contact. The procedures are used for the following purposes:

  • To evaluate the cervical canal
  • To evaluate fallopian tube openings
  • To visualize the endometrial cavity

Diagnostic hysteroscopy has a distinctive advantage of combining a comprehensive diagnostic procedure along with treatment and is frequently paired with biopsy or curettage for pathological assessment.

How does diagnostic hysteroscopy work?

Panoramic hysteroscopy, or direct optical hysteroscopy, is a procedure in which the uterus is evaluated by distending it with a gas such as carbon dioxide or a liquid such as normal saline.

Contact hysteroscopy, also known as microhysteroscopy, is a procedure where the uterus is evaluated by distending it with distending media. A hysteroscope is then passed into the uterus for a clear magnification of the uterine cavity. Contact hysteroscopy can only inspect the tissue that is in direct contact with the distal tip of the uterus.

The pain experienced during the procedure is typically proportionate to the outer diameter of the hysteroscope and extent of cervical expansion. Hence, anaesthesia may or may not be an option depending on the type of hysteroscopy and type of anaesthesia used.

Who should not opt for diagnostic hysteroscopy?

There are certain conditions where the patient should not opt for diagnostic hysteroscopy. The doctor assesses these contraindications for each individual patient. Some of them are as follows:

  • Several comorbid conditions

    • Some other medical conditions can increase the risk of failure of the procedure

  • Possible intrauterine pregnancy

    • A pregnancy test should be done for all the premenopausal women prepped for diagnostic hysteroscopy

  • Female genital tract cancer

    • Especially in cervical and uterine cancer, there is a possibility of cancer cells getting dispersed into the peritoneal space by the pressure of hysteroscopy

  • Active pelvic infection

    • It is vital that pelvic infections be treated prior to hysteroscopy to avoid the risk of spreading infections

  • Inexperienced surgeon

    • You might want to choose wisely when it comes to the surgeon to decrease the risk of complications during or after the procedure.

What are the risks associated with diagnostic hysteroscopy?

Overall, hysteroscopy is an extremely safe and well-tolerated procedure. Complications during and after the procedure are uncommon, but if left untreated, it can become life-threatening. Some complications that have been reported are as follows:

The complication rate of a diagnostic hysteroscopy is less than 0.5%  with uterine tear being the most common risk. However, it is important to talk to your doctor about the procedure and complications and have a plan of action in place.

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