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Hysteroscopy: Test Overview, Indication, Procedure, Normal Findings, Complication

Hysteroscopy test allows direct visualization of the endometrial cavity. It is indicated for women with an abnormal Papanicolaou (Pap) test, dysfunctional uterine bleeding, or postmenopausal bleeding.

NORMAL FINDINGS OF HYSTEROSCOPY

Normal structure and function of the uterus.

TEST EXPLANATION OF HYSTEROSCOPY

Hysteroscopy is an endoscopic procedure that provides direct visualization of the uterine cavity. Hysteroscopy can be used to identify the cause of abnormal uterine bleeding, infertility, and repeated miscarriages. It is also used to evaluate and diagnose uterine adhesions (Asherman syndrome), polyps, and ibroids and to detect displaced intrauterine devices (IUDs).

In addition to diagnosing and evaluating uterine problems, hysteroscopy can also correct uterine problems. For example, uterine adhesions and small fibroids can be removed through the hysteroscope, thus avoiding open abdominal surgery. Hysteroscopy can also be used to perform endometrial ablation, which destroys the uterine lining to treat some cases of heavy uterine bleeding.

Hysteroscopy may confirm the results of other tests, such as hysterosalpingography. Depending on the amount of surgery and time associated with hysteroscopy, general, spinal, or light sedative anesthesia is used. It takes only about 30 minutes for simple hysteroscopy. This test isusually performed by a gynecologist in the operating room. The patient receiving local anesthesia or only light sedation may feel some cramping during the procedure. In general, it is not a painful procedure.

CONTRAINDICATIONS OF HYSTEROSCOPY

 • Patients with pelvic inlammatory disease

 • Patients with vaginal discharge

POTENTIAL COMPLICATIONS OF HYSTEROSCOPY

 • Uterine perforation

 • Infection

Heavy Menstrual Bleeding (Menorrhagia): Causes Diagnosis Treatment 

PROCEDURE AND PATIENT CARE OF HYSTEROSCOPY

Before

 Explain the procedure to the patient.

 • Obtain informed consent for this procedure.

 • Schedule the procedure ater menstrual bleeding has ceased and before ovulation. his allows better visualization of the inside of the uterus and avoids damage to a newly formed pregnancy.

 Inform the patient that hysteroscopy may be performed with local, regional, or general anesthesia. If general anesthesia will be given, the patient should be on nothing by mouth (NPO) status for at least 8 hours before the test. his test may also be performed without anesthesia.

 Tell the patient to void before the procedure because a distended bladder can be more easily perforated.

During

 • Note the following procedural steps:

 1. Hysteroscopy may be performed in the operating room or in the doctor’s oice. Local, regional, general, or no anesthesia may be used. (he type of anesthesia depends on other procedures that may be done at the same time.)

 2. he patient is placed in the lithotomy position. he vaginal area is cleansed with an antiseptic solution.

 3. he cervix may be dilated before this procedure.

 4. he hysteroscope is inserted through the vagina and cervix and into the uterus.

 5. A liquid or gas is released through the hysteroscope to expand the uterus for better visualization.

 6. If minor surgery will be performed, small instruments will be inserted through the hysteroscope.

 7. For more detailed or complicated procedures, a laparoscope may be used to concurrently view the outside of the uterus.

 8. Ater the desired procedure is performed, the hysteroscope is removed.

After

1. Tell the patient that it is normal to have slight vaginal bleeding and cramps for a day or two ater the procedure.

2. Inform the patient that signs of fever, severe abdominal pain, or heavy vaginal discharge or bleeding should be reported to her physician.

3. If the patient has any discomfort from the gas inserted during the hysteroscopy or laparoscopy, assure her that this usually lasts less than 24 hours.

TEST RESULTS AND CLINICAL SIGNIFICANCE OF HYSTEROSCOPY

Endometrial cancer, polyps, or hyperplasia: Cancer appears as thickened endometrium in one or multiple portions of the uterus. Hyperplasia looks similar but is not as isolated and seems more difuse. Polyps appear as pedunculated mucosal tissue protruding from the endometrium.

Uterine ibroids: Small ibroids are easily seen because they distort the endometrium.

Asherman syndrome: Intrauterine adhesions may be associated with previous uterine infections and can be lysed through hysteroscopy.

Septate uterus: This and other developmental abnormalities can be visualized by hysteroscopy.

Displaced IUD: The location of a displaced IUD is easily seen.

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