loader image
HYSTEROSCOPY-Its-types-diagnosis-and-complications

HYSTEROSCOPY: Its types, diagnosis and complications

 It is a method that lets your physician look inside your uterus to diagnose and deal with the reasons for abnormal bleeding. It comprises a rigid telescope having a wide viewing angle and fibre optic illumination cable.

Types of Hysteroscopy:

  • Microhysterosocpe provide magnification of 30-150 times. 
  • Contact hysteroscope is a diagnostic tool without distending medium. It enables assessment of the normality of the endometrial tissue lining and helps to diagnose any early neoplastic change. 

Technique: Hysteroscopy should be performed in the preovulatory phase when the endometrium is thin, and bleeding is less likely to occur. Diagnostic hysteroscopy can be performed under local anaesthesia and sedation, but the therapeutic procedure mandates general anaesthesia. 

Precaution: gas inflating machine used in laparoscopy should not be employed in hysteroscopy since high pressure of the former can cause a gas embolism.

As the distension medium distends the cervical canal and uterine cavity under direct vision, this precaution avoids perforation.

Distension media in Hysteroscopy:

Several distension media are in the recent usage for hysteroscopy. The medium depends on its availability, safety, effectiveness and cost. The popular liquid media includes standard saline 5% dextrose and ringer’s lactate solutions. The media in common usage include carbon dioxide gas delivered through hysteroscopy at a maximum rate of 70%. This will give a clear view of its lining and the opening of fallopian tubes. More sophisticated pressure systems are available for use during prolonged hysteroscopic operative procedures like myomectomy, septum cutting or endometrial ablation.

Typical appearance of the Endometrium:

It looks thin and pale with a smooth surface and minimal vascularisation: the glands are not easily seen. 

At ovulation, the endometrium appears oedematous, and the glands are seen. 

Increased vascularity causes oedema, and the endometrium looks pink with glands seen in the luteal phase.

Diagnostic Indications: 

  • A biopsy can be taken from suspicious areas. Endocervical polyp can also be identified and removed. 
  • The presence of the fundus seen laparoscopically indicates it is a septate uterus. In a bicornuate uterus, the fundus is absent. 
  • Selective biopsies are required for endometrial tuberculosis to confirm the diagnosis or curettage done – the presence of caseous areas, ulcers on the endometrial lining.
  • Hysteroscopy confirms the uterine synechiae and extent of adhesions.
  • Though ultrasound can locate a misplaced IUCD, a hysteroscope determines whether it is embedded in the endometrium and allows safe retrieval.
  • A fibroid polyp is firm, permanent and of various size paler than a mucus polyp usually sessile, immobile and is caused by folds of endometrium in hyperplasia. 
  • The decision regarding the feasibility of tubal surgery can be taken cannulation, and adhesiolysis is also possible.
  •  When hysterosalpingography shows blockage of the corneal end of the tube, the hysteroscope enables the fallscope to be inserted into the cornual end.

Complications:

  • Sepsis usually occurs with myomectomy
  • An allergic reaction is noted with dextran and glycine
  • Bleeding occurs in 1 – 2%, and it can be minimised by performing the surgery in the preovulatory phase
  • organ injury to the bowel and intestine is rare.
  • Anaesthesia complication, more with co2 used as a distending medium.
  • Uterine perforation

Late Complications:

  • Haematometra following cervical stenosis
  • Unwanted pregnancy
  • Cancer endometrium may go unnoticed for a long term
  • Infection may lead to PID

If you have abnormal vaginal bleeding and are seeking a test and diagnosis, you can consult with Dr Sarah Hussain, the leading Female Gynaecologist in London. Request a call for treatment.