Hysteroscopy – what is it and how is it performed in gynecology?

 

Women’s health is the most valuable and carefully protected, not only in our country but around the world. This is not surprising because only a woman can procreate and give birth to healthy children. Modern gynecology now offers a wide range of diagnostic methods. One of the most effective and common techniques can rightly be called the examination of the uterus. What is a hysteroscopy of the uterus?

The concept of hysteroscopy

Scopy in gynecology is a method of examination of the uterine cavity by a special device with a camera designed to detect various pathologies and performing minimally invasive procedures. Hysteroscopes can be tough (most often used) and fibrohysteroscopy with a flexible tube. The device has a video camera with high magnification, lighting component, it is also possible to supply water or air. Some devices inside the tube have a channel for holding tools in case of surgical intervention.

The procedure may be recommended by your doctor gynecologist for the diagnosis of diseases of the genital organs on the basis of complaints or additionally to confirm the diagnosis. Of the uterus hysteroscopy can also be therapeutic, when carried out the removal of some small formations in the cavity of the organ, which is very convenient.

Be sure method used before in vitro fertilization (IVF). In addition, hysteroscopy endometrial prescribed for the following diseases:

  • Pronounced endometriosis on the ultrasound results.
  • Fibroids submucosal layer.
  • Polyps of the cervical canal and uterus.

  • The suspicion of cancer.
  • Irregular menstrual cycle in the form of heavy and frequent bleeding.
  • Congenital abnormalities of the internal genital organs.
  • In the diagnosis of female infertility.
  • Adhesions in the uterus (synechia).

Do I need to do a hysteroscopy before conception? No, a pregnancy does not involve endoscopic examination of the uterine cavity.

Contraindications

Not recommended examination during an exacerbation of any chronic somatic diseases, and in acute inflammatory processes of genital organs (colpitis, cervicitis, endometritis, salpingoophoritis). It is also impossible to do a hysteroscopy in cases, where obviously there is a poor prognosis for life and health (terminal cancer of the uterus).

Preparation for the procedure

Standard hysteroscopic examination – this is a small surgery with the use of intravenous anesthesia. To prepare a woman, you need to take a blood test (total, biochemistry, HIV, syphilis, hepatitis C and b), urine, ECG, General vaginal flora, it is necessary to consult physician and other specialists. If it is not revealed major deviations in the results of the examination, the gynecologist will determine the time according to the menstrual cycle, when is the best time to do a hysteroscopy. Usually, this 6-9 day from the beginning monthly. In women, menopause, the procedure may be performed at any time. Necessarily performed ultrasound examination of small pelvis organs the day before.

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The detection of inflammation in the smears, or the results of ultrasound requires prior treatment of the woman. A sexual way before hysteroscopy should be fully sanitized. During the procedure, the cervical barrier is broken between the uterus (a sterile part of the body) and vagina, where there is a lot of conditionally pathogenic microorganisms. It is fraught with the penetration of infection into the uterus and the development of serious complications of hysteroscopy.

As a rule, the gynecologist has to appoint douching and vaginal suppositories with antiseptics for 10 days. After treatment re-take swabs from the vagina and with good results you can start to prepare for the hysteroscopy of the uterus.

The technique of hysteroscopy

How is it performed? Investigate the uterus in gynecological chair. Immediately before administration of the instrument the doctor washes the vagina and vulva with antiseptic solution, after which the anesthesiologist will introduce the patient to General anesthesia.

Outpatient (office) hysteroscopy apply local anesthesia! General anesthesia is not done!

Intravenous anesthesia is needed to numb the pain of the procedure of cervical dilatation, as it is extremely unpleasant and painful. After all the desired stages, the doctor proceeds to the introduction of the hysteroscope into the uterus through the vagina and cervix.

Upon inspection of the mucosa on assess:

  • surface and relief;
  • the structure of the tissue;
  • the color of mucous;
  • the presence of formations, lesions, adhesions;
  • anomalies of structure (partitions, doubling).

Gradually under high magnification looks around the cervical canal of uterus, cavity and the uterine fundus, the mouth of the pipe. The study displayed on the colour screen in real time and written to disk. Upon detection of entities biopsy for further histological examination. According to the decision of a doctor, possibly a hysteroscopy with minimally invasive intervention (e.g., dissection of adhesions, the operation is removal of a polyp or cauterization of endometriotic lesion). This is called operative hysteroscopy.

The entire procedure will depend on the original target. If it was assumed only the diagnosis, hysteroscopy of the uterus takes about 15 minutes. When performing therapeutic manipulation time increases to 40 minutes. After the removal of anesthesia, the anesthesiologist observes the patient for 2 hours in the operating room.

Complications of hysteroscopy

In most cases, complications after this procedure are extremely rare. Normal can be considered a pulling pain in the lower abdomen and slight spotting. All these symptoms pass after a couple of days and do not require any treatment.

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In some cases, you need to go to the doctor?

  1. The appearance of bleeding (discharge longer than 3-5 days, growing in intensity).
  2. During hyperthermia.
  3. In the event of severe cramping abdominal pain.
  4. With the appearance of purulent discharge.

If you suddenly had the above symptoms, it may indicate perforation of the uterus, infection (endometritis), bleeding after therapeutic procedures. Such complications require immediate hospitalisation of the woman and possibly surgery. Part of the unpleasant consequences can be associated with individual reaction to the anesthetic drug (vomiting, nausea, severe headaches, hypersensitivity). To avoid complications to the anesthesia, the anesthesiologist carefully collect allergic anamnesis.

A distant consequence hysteroscopy can be considered isthmic-cervical insufficiency during pregnancy. The neck is due to your muscles securely holds the fetus inside the womb. As soon as her muscles weakened (e.g. because of gross manipulations by extension), the lumen of the cervical canal increases the risk of miscarriage or premature rupture of membranes. In this case, there are indications for the imposition of cerclage (seams) on the neck.

What can be detected during endoscopic manipulation?

Almost all diseases of the uterus can be seen with the help of hysteroscopy. These include chronic inflammation of the endometrium following abortion, childbirth (endometritis). Small growths, which are almost invisible on ultrasound and can be detected endoscopically (polyps, submucous nodes, endometriosis, cancer at initial stage). The doctor is able not only to accurately determine the localization of the lesion, its size, structure, and, if necessary, to take tissue for histological examination or to make the removal of the tumor. Thus, diagnostic hysteroscopy can be therapeutic and will not require additional interventions.

During the procedure, also examine the cervix and the mouth of the pipe. Some modern tools allow you to catheterisable themselves of the fallopian tube. It is necessary to determine their practicability before planning a pregnancy.

Mode after the test

If the procedure was only diagnostic plan, a special regime to stick to is optional. For some time, there may be bloody discharge from the genital tract, but not always. In this regard, should avoid sauna, swimming pool, not to swim in open water, not to take a bath. You can swim only in the shower.

There is no need to use products and medications that increase blood flow to the pelvic organs, so as not to provoke bleeding (red wine, pepper, vascular tools). After the hysteroscopy of the uterus is mandatory assigned on pelvic rest for 7-10 days. This is due to the possibility of infection of the endometrium. To get passed the nagging pain, you can take a pill of drotaverine or spazmalgon.

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In that case, when during survey was carried out any surgical procedures, restrictions on the mode and way of life can be more substantial. In some cases, you may need hospitalization for a few days, the introduction hemostatic drugs, hormones, antibiotics. After hysteroscopy woman discharged under the supervision of doctor in gynecology.

Counterparts hysteroscopy

A female patient on reception at the gynecologist ask, how can I replace this procedure. Is there a similar method of investigation?

Hysterosalpingography

What is it? The essence of the procedure consists in the introduction into the uterus of a contrast agent to make the x-rays and to assess the patency of the fallopian tubes. The downside of this procedure is considered to be the radiation on the body, and a very high informative value in comparison with hysteroscopy. Upon detection of tumors will require additional manipulation to taking a biopsy, removal or dissection, which requires time, mental attitude, training, and other difficulties. Visibility will also be different. Not all pathology can be seen on x-rays, and especially to assess the size, precise localization, the structure of the surface. Decoding results will be ready immediately, it takes time to prepare and the description of the image.

Ultrasound

Its information will depend on the equipment, the experience of the physician, the thickness of the subcutaneous tissue and more. Cons almost the same as that of hysterosalpingography in the fact that when ultrasound no x-ray radiation.

Is it possible not to note that the diagnostic hysteroscopy is the most informative and accurate procedure in gynecology. Doing a hysteroscopy in the direction of a physician in the antenatal clinic. Questions about how much it costs hysteroscopy of the uterus, how it’s performed, what tests are necessary before it can respond to the medical personnel selected clinics. Recently began to appear gynecological centers where you can make office hysteroscopy without the use of anesthesia.

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