Diagnostic Hysteroscopy: Its Overview, Indications, Process and Complications

Overview

Hysteroscopy is a procedure to examine inside of the uterus. This is used to diagnose and treat uterine problems. It can be used to confirm results of other tests like uterosalpingography or hysterosalpingography (hsg).

If there is any uterine abnormality detected by diagnostic hysteroscopy, it can be followed by operative hysteroscopy in which minor surgery is performed within the uterus to correct the abnormality.

A hysteroscopy is a simple process and can be performed in a doctor’s clinic or obstetrics medical center. It takes around 5 – 10 minutes only.

This is performed by a obstetrician or gynecologist using a hysteroscope, which is a thin tube having a light source and a camera at the end.

This instrument is inserted into the vagina to view cervix and inside of the uterus.

Images recorded by the camera are sent to a monitor in which the doctor view the images and examine them.

Here in this article we are talking about diagnostic hysteroscopy only which is used to evaluate endometrial cavity. It  is meant to be used to diagnose uterine problems.

In this procedure Hysteroscope is inserted through the vagina i.e unlike other surgical procedures, it do not require any cut or incisions on the skin. It is minimal invasive procedure.

Hysteroscopy can be used along with the other processes like, laparoscopy, Dilation and Curettage (D&C) etc.

Indications

Hysteroscopy is used to diagnose the possible cause or the uterine problems or in cases when the doctor wants to examine the reproductive tract. Diagnostic hysteroscopy is performed in those who are dealing with following problems:

  • Heavy menstrual period and severe abdominal crampings.

  • Longer menstrual period or abnormal uterine bleeding between two successive periods.

  • Bleeding after menopause

  • Before sterilisation i.e. tubectomy

  • Problem in conceiving or more than one miscarriage

  • Displacement of IUD (Intrauterine Device), which are used to prevent pregnancy.

  • Symptoms of fibroid and polyps

Process

The best time to perform hysteroscopy is the proliferative phase i.e. 4th to 14th day of menstrual cycle.

Pain during the procedure varies from person to person. Some may feel mild or no pain while some may feel severe pain.

Generally anesthesia is not required, but in some cases regional or general anesthesia is used.

If general anesthesia is not being used, in such cases medications are given to relax the patient.

Sometimes regional anesthesia may be given to numb the cervix.

Before starting the procedure, vagina is prepared by applying Povidone iodine to kill any bacteria, fungs, protozoa, fungus etc present on the skin.

Dilator tools or medications are used to dilate or open the cervix. This is done to get access to the cervix. A speculum is used to keep the vagina open.

After this hysteroscope is gently inserted into the uterus through the cervix.

A diagnostic sheath is required to transfer the distention media into the uterine cavity. The telescope fits into this sheath. The diameter of diagnostic sheath could be 4 to 5 mm. There is a 1mm clearance between inner wall and telescope through which distention media is delivered.

Uterine walls are close to each other hence, to get a panoramic view these walls must be separated. To do this uterus is expanded using distention media. It is filled into the uterus to get clear and visible images in hysteroscopy.

Distention media is classified as gas or liquid distention media.  For e.g. carbon dioxide (CO2)

After inserting the hysteroscope, gas or liquid saline is injected through the hysteroscope into the uterus. This is done to expand the uterus to have a clear view of linnings and openings of fallopian tubes.

The images of inside the uterus, are sent by the camera in hysteroscope to the monitor through which the doctor view and analyse the images.

Examination of all uterine linings and the tubal openings is carried out by axial movement of the telescope.

Any abnormality, scar tissue, fibroid etc. are recognizable by the gynecologist. Hysteroscopy provides accurate assessment of genital tract and can diagnose the cause of uterine problems.

Complications

Hysteroscopy is a safe procedure but like any medical procedure there are some complications associated with this. Complications and risks of hysteroscopy are:

  • Excess Bleeding: Excess bleeding may be seen during or after the procedure. It can be treated by medications or in rare case might require another process.

  • Infection: Symptoms of infection are smelly vaginal discharge, fever and heavy bleeding. This can be treated or prevented by use of antibiotics.

  • Accidental damage to cervix and uterus: This happens rarely in diagnostic hysteroscopy. This can be easily treated with antibiotics or in rare cases may require another operation.

  • Over Distension Of Uterus: Most frequent complication seen in hysteroscopy is overdistension of uterine cavity. This happens due to use of inappropriate instrument or technique .

  • Uterine Perforation: This is rare but possible complication in diagnostic hysteroscopy. It might occur during dilation, when the dilator passes to more depth than the length of the uterine cavity.

  • Gas Embolism: Gas embolism is rare but fatal complication of hysteroscopy. It could be air (atmospheric air) or carbon dioxide (CO2) embolism. This has mostly been seen in cases where gas distention media is used. This is the reason why gas distention was replaced by saline distention media.

  • Vaginal Bleeding: After hysteroscopy vaginal bleeding with abdominal pain and crampings occur. This usually lasts for about two weeks.

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