What
is Hysteroscopy:
A procedure where an endoscope is used to visualize the uterus
and the uterine tubes. Several pathologies of these organs can
be identified and treated. Indeed some of these disorders may be the
cause of infertility in the female. Hence this is a good diagnostic
and therapeutic (operative) tool for female
infertility.
It is normally done immediately after the menstrual periods during
which time the uterine lining is thin and access to uterine cavity is
better.
Common
indications for hysteroscopy:
- Heavy or abnormal uterine (like bleeding in between normal cyclical bleeds) and severe abdominal cramps.
- Unusual vaginal discharge
- To check the size and shape of the uterus during investigation of infertility. Congenital uterine malformations can also be diagnosed
- Diagnosis and evaluation of polyps and fibroids in the uterus. Polyps can be removed through the procedure. Biopsied can be taken through appropriate instruments inserted through the Hysteroscope. Thus malignancies can be diagnosed and appropriate treatment strategies planned in due course.
- Repeated miscarriage
- For routine investigation of infertility
- As a part of a therapeutic procedure like dilatation and curettage, laparoscopy
How
is the procedure performed:
It
is preferable to undergo the procedure in the pre-ovulatory phase as
possibility of an established pregnancy is zero and hence there is no
question of disturbing it, especially if investigating for
infertility. A date is taken immediately after the monthly
menstrual bleed is over. The doctor will ask details of any
medicines being taken, any allergies to specific drugs and if any
anticoagulants like aspirin is being taken. Recent pelvic
infection and the details of the treatment must be brought to the
attention of the doctor. The patient will be advised not to use
any tampons in the vagina for 24
Hours..A
local, regional or general anesthesia can be used for this procedure,
besides a sedative and a painkiller. The doctor will decide which is
best for the case. The patient will change to the OT gown provided in
the operation theatre. The bladder must be emptied before the
procedure. The patient is made to lie on her back with the legs
wide apart and raised and supported by table footrests. This is
called the lithotomy position and offers the doctor the best view and
access to the external and internal genital organs. The external
genitals will be thoroughly cleaned with an antiseptic solution that
will remove all microbes and reduce any local infection. . A speculum
will be inserted into the vagina to provide a clear view of the
cervix. The tip of the hysteroscope is gently inserted into the
cervical opening and guided upwards until it reaches the uterine
cavity. The illuminat or ensures that the interior of the
uterus is clearly visible and the camera transmits real time images
to the TV screen which is viewed by the doctor and team. The
tip of the hysteroscope can be moved in different directions so that
no part of the wall is missed and also the tubal openings are
visualized. The procedure take about half an hour following which the
patient is rested for some three to four hours in the recovery
room and then asked to go home. The exception is when general
anesthesia is used where a post operative stay for a longer duration
is done. Patient is advised to abstain from sex and the use of
vaginal tampons for some days. There may be mild abdominal
cramps and light bleed from the vagina, but this will stop in a few
days.
