Comprehensive Guide to Hysteroscopy

Indications and symptoms:

• Abnormal Pap Test Result
• Abnormal Uterine Bleeding
• To investigate the cause of infertility
• To investigate repeated miscarriages
• To detect abnormal growth
• To remove a benign growth
• Uterine biopsy, sampling, rule out malignancy
• To locate an Intrauterine device (IUD)
• To implant a birth control device

Hysteroscopy can be either diagnostic or operative. In Diagnostic hysteroscopy, the uterine cavity is visually inspected. Whereas in operative hysteroscopy uterine cavity is inspected and appropriate treatment is performed. 

Preparing for Hysteroscopy: 

A few days before hysteroscopy, the patient may be advised to:

• Get some blood tests & pregnancy test done
• Use Contraception-a hysteroscopy cannot be carried out if the patient is pregnant
• Stop Smoking

On the Day of Hysteroscopy:

• If the procedure is not done under anaesthesia, then the patient is asked to take painkillers about an hour before the surgery.
• If the procedure is done under anaesthesia, then fasting for around 6-8 hours might be advised before the surgery.
   

Procedure Description:

Hysteroscopy can be done as an outpatient procedure or a day procedure under anaesthesia. It only takes 10-30 minutes.

After shifting to the operation theatre and completion of anaesthesia, the surgeon typically gives a lithotomy position (a common position for surgical procedures and medical examinations) and begins the procedure. A speculum is inserted to spread open the walls of the vagina, the cervix is then pulled toward the entry of the vagina. A dilator is inserted to open the cervix. A hysteroscope is then inserted through the vagina into the uterus, the camera transmits the images of the uterus to a screen. Gas or fluid will be released into the uterus to expand it, which helps in inspecting the inner lining of the uterus. If any intervention is needed after inspection it is done by inserting a small tool through the scope (eg Biopsy, removal of Polyp).

Post-Operative Advice:

• Some women may experience cramping which is similar to period pain after the procedure. They may suffer from shoulder pain, which is caused by the fluid, or gas that is used to inflate the uterus, which will gradually subside in a few days.
• There may be some bleeding after the procedure especially when surgery is performed.
• Sexual intercourse should be avoided till bleeding and vaginal discharge stops. 
• In patients who have a higher risk of pelvic infection, for example, patients with tubal block or hydrosalpinx, antibiotics may be given before or after the procedure.
• Severe lower abdominal pain, pain during urination, fever, vaginal discharge that is smelly or unpleasant and heavy bleeding are symptoms that will require the immediate attention of a doctor.

Primary Complications:

• Injury to Uterus
• Excessive Bleeding
• Distention related discomfort
• Air or Gas Embolism

Secondary Complications:

• Infection
• Collection of blood inside the uterus (Hematometra)

Complication rates from diagnostic and operative hysteroscopy are less than 1% (extremely rare).