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Diagnostic Hysteroscopy
Last reviewed: 23.04.2024
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Hysteroscopy can serve to diagnose intrauterine pathology, as well as for surgical interventions in the uterine cavity.
Diagnostic hysteroscopy is the method of choosing the diagnosis of intrauterine pathology. The usual separate diagnostic curettage of the mucous membrane of the walls of the uterus without visual control in 30-90% of observations is inefficient and of little informative.
Preparation of patients for hysteroscopy. Hysteroscopy - surgical intervention, conducted depending on the testimony in an emergency or planned order. Planned hysteroscopy is performed after a clinical examination, including blood, urine, and vaginal smear tests for purity, chest X-ray, and ECG. The elderly, especially obese, it is advisable to determine the sugar content in the blood. Data of bimanual examination of pelvic organs, results of blood test and smears of the contents of the vagina should not indicate the presence of an inflammatory process. Clinical examination makes it possible to form a definite idea of the presence of pathological changes in the uterus, to identify comorbidities, to determine the type of impending anesthesia. If the patient has extragenital pathology (heart disease, lungs, hypertension, etc.), it is necessary to consult a specialist and carry out pathogenetic therapy until the violations are fully compensated. III-IV degree of purity of the vagina - an indication for its sanation.
The above studies can be performed on an outpatient basis before admission to hospital. With planned hysteroscopy, the doctor has enough time for psychological preparation of the patient, as well as correcting the revealed pathological changes.
Before the planned hysteroscopy, the following measures are taken:
- Preparation of the gastrointestinal tract (on the eve of manipulation they put a cleansing enema, the study is performed on an empty stomach).
- Shaving of the external genitalia.
- Emptying the bladder before the test.
According to most foreign researchers, diagnostic hysteroscopy can be performed in outpatient settings without anesthesia or under local anesthesia. According to some doctors, in outpatient conditions hysteroscopy can be performed in the presence of a hospital of one day and the possibility of emergency transfer of a patient to a hospital if necessary. For outpatient diagnostic hysteroscopy, a fibrogysteroscope can be used for examination, and gas can be used to expand the uterine cavity (Lin et al., 1990). Opportunities for outpatient hysteroscopy were extended after the invention of microhysteroscopes having a diameter of 2.4 mm (diameter of the outer casing 3 mm).
Outpatient hysteroscopy is not performed in the post-menopausal and in women suffering from neurasthenia. Some authors recommend that patients in postmenopausal women have a short course of estrogen therapy to prepare the cervix for hysteroscopy.
Estrogens are rarely prescribed for this purpose, since these drugs enhance proliferative processes in the reproductive organs, although it is unlikely that a short course of estrogens can cause endometrial hyperplasia.
The question of the time of the planned diagnostic hysteroscopy remains unchanged. Most surgeons prefer to conduct planned hysteroscopy if possible in the early proliferative phase (the 5th-7th day of the menstrual cycle), when the endometrium is thin, and its bleeding is minimal. It is undesirable to carry out hysteroscopy in the II phase of the menstrual cycle, since with inadequate contraception, it is possible to disrupt the process of transporting a fertilized egg through the fallopian tube, which can lead to an ectopic pregnancy. Also in the II phase, the thickened endometrium interferes with a full-fledged examination: it is possible not to notice the pathological formations located in the myometrium. But there are situations when it is necessary to assess the state of the endometrium during the secretory phase, in these cases hysteroscopy is carried out 3-5 days before the onset of menstruation. The condition of the walls of the uterus can be assessed with control hysteroscopy after removal of the uterine mucosa.
The time of hysteroscopy is not of fundamental importance in the period of peri- or postmenopause, as well as in emergency situations (for example, bleeding).
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