Currently, clinical, laboratory, instrumental and endoscopic methods of research are used for complete diagnosis in gynecological practice. All this helps specialists to determine the condition of the female body, identify serious pathologies and provide timely assistance that can save the patient's life.
Any patient encountered the examination with the help of gynecological mirrors, but endoscopic examination methods can cause a number of questions in women. Thus, a woman may be puzzled by what hysteroscopy is, how hysteroscopy is performed and what complications it can bring.
The procedure involves the following actions:
- in the process there is a visual inspection of the uterine cavity,
- examines the state of the uterine mucosa,
- sampling of biological material for histological examination is carried out,
- small surgical manipulations are performed (removal of polyps, dissection of adhesions and partitions).
- local anesthesia is used or completely dispensed with,
- procedure duration - 10–15 minutes,
- After hysteroscopy, a woman does not need to stay in a medical facility for a long time.
The main actions in hysteroresectoscopy are: removal of pathological formations of various nature (large polyps, myoma nodes, commissural cords), ablation of the endometrium (excision of the entire thickness), elimination of abnormal bleeding from the uterus. Special features of the procedure: they are performed under general anesthesia (intravenous anesthesia), the duration of the procedure is from 30 minutes to 3 hours, the hospitalization of the patient can last for 2-3 days. The position of the patient during diagnostic (office) hysteroscopy does not differ from the position during hysteroresectoscopy. In both cases, manipulations are performed on the gynecological chair.
Indications and Contraindications
Hysteroscopy is used against the background of such pathologies:
- with endometrial hyperplasia,
- benign proliferation of glandular tissue of the endometrium,
- neoplasms arising in myometrium,
- adhesions in the uterus,
- malformations of the body and cervix.
Surgical hysteroscopy allows such manipulations to be performed: excision and removal of connective tissue strands, elimination of the pathology of the two-horned uterus, removal of benign growths of the glandular tissue of the endometrium and myometrial neoplasms, removal of the IUD uterus, remnants of an incompletely evacuated fetal egg, as well as of a baby, biopsy specimen .
Office hysteroscopy allows you to diagnose the impossibility of carrying a child, malformations of the genital organs, perforation of the uterine wall after abortion and cleaning. In addition, office hysteroscopy is performed with an unstable menstrual cycle, gynecological bleeding of a different nature, and also, if necessary, to confirm or deny any diagnosis.
There are a number of serious contraindications for hysteroscopy:
- inflammatory infectious diseases of the reproductive organs during the period of exacerbation,
- carrying a child
- cervical oncopathology,
- marked narrowing of the cervical canal,
- the overall serious condition of the patient on the background of serious somatic diseases.
During the preparatory period, the patient must do a number of studies:
- Standard gynecological examination using a mirror, as well as palpation of the uterus and its appendages.
- Vaginal smear. Due to the collection of biomaterial in the urethra, cervical canal and vagina, the state of the flora can be determined.
- CBC, group and RH, blood count for RW, hepatitis and HIV. Determine blood clotting (coagulogram).
- Macroscopic and microscopic examination of urine, which allows to identify renal failure.
- Ultrasound of the pelvic organs (through the anterior abdominal wall or transvaginally).
- Electrocardiogram and photofluorogram.
Before the planned hysteroscopy, the patient will be required to consult with related specialists: therapist, cardiologist, anesthesiologist. In addition, she should inform her doctor about the presence of any drug allergic reaction, the suspicion of pregnancy and the drugs taken on a regular basis.
Before performing hysteroscopy, a woman should adhere to the following recommendations: 2 days prior to the study, exclude sexual contacts, a week before the intended procedure, do not douche and do not use store gels and scouring foam.
A week before hysteroscopy, do not use medicinal vaginal suppositories (except for those prescribed by the gynecologist), for persistent constipation the day before, before cleansing, clean the intestines with an enema. 2 days before the procedure, start taking sedatives, if prescribed by a doctor, 5 days before hysteroscopy, start taking antibiotics, if prescribed by a gynecologist.
In the morning of the procedure, you should refuse to eat and drink. The patient should perform hygienic procedures, shave the pubic and groin area, and just before entering the examination room, empty the bladder. All excess items (jewelry, mobile phone) remain in the ward. In the hospital, the patient must take with her slippers, socks, removable underwear, a bathrobe, as well as sanitary napkins that will be needed after the procedure due to abundant vaginal discharge.
Carrying out the procedure
What day hysteroscopy is of great importance. Planned hysteroscopy is optimally done from the 5th to the 7th day of the cycle. At this time, the endometrium is thin and weakly blooded. But sometimes they assess the state of the endometrium in the luteal phase (after ovulation), about 3-5 days before the end of the cycle. In mature patients, as well as in emergency situations, the time of hysteroscopy can be anything.
After laying the patient on the gynecological chair, her hips, external genitals and vagina are treated with an antiseptic. A two-handed vaginal examination is conducted to determine the location of the uterus and its size. The lower segment of the uterus is fixed uterine single-toothed forceps, which delay the body of the uterus, align the direction of the cervical canal and determine the length of the uterine cavity. And then make the dilation of the cervical canal dilator Gegar.
The hysteroscope is treated with an antiseptic and gently injected into the uterine cavity, enlarged with the help of gas or liquid. During the inspection, its contents and the size, shape and topography of the walls, the state of the tubal inlet area are examined. If any foreign bodies are detected, they are removed using instruments inserted through the channel of the hysteroscope. If necessary, carried out targeted biopsy. The tissue sample taken is sent for histology.
According to the indications at the end of the procedure, the inner layer of the cervical canal and the uterine cavity can be removed. The anesthesiologist produces the final phase of anesthesia - brings the patient to consciousness. If there are no complications, the patient is under the supervision of specialists for another 2 hours, and then she is transferred to the general ward. Hysteroscopic surgery lasts an average of 30 minutes, and if laparoscopy is performed, the manipulation can last up to 3 hours.
Patients are often interested in - after how after hysteroscopy can you do IVF? Experts say that these dates vary and depend on the data obtained during hysteroscopy. Someone is prescribed IVF for 10 days after hysteroscopy, and someone must wait for this moment for another six months. It all depends on the identified pathology, requiring varying degrees of surgical intervention and therapeutic interventions.
After a hysteroscopic examination or surgical procedure has been performed, complications are not excluded. In the postoperative period, the uterine mucosa and the natural volume of this reproductive organ, which was disturbed by an artificial increase during hysteroscopy, must be restored. Against this background, after hysteroscopy, a woman can observe the following symptoms.
Pain syndrome. The pain is usually felt mainly above the pubis. Sensations expressed slightly and somewhat reminiscent of pain during menstruation. In the first hours after the manipulation, the woman experiences pain, as during labor pains, as the uterus contracts and returns to its former size.
Vaginal discharge. Due to damage to the endometrium, in the first hours after the procedure, abundant blood-mucous discharge may occur. After the diagnostic procedure, excretions can be observed for 5 days, and after surgical procedures - up to 2 weeks.
A woman may experience general weakness and malaise. If there is a feverish state, then it is necessary, without delay, to seek medical help. How long the period of complete recovery after hysteroscopy lasts can vary greatly from patient to patient. As a rule, on average it takes up to 3 weeks. There are those who become pregnant naturally after hysteroscopy - it happened against the background of the removal of a polyp or atrophied endometrium.
If the patient adheres to simple recommendations, the recovery period can be significantly reduced:
- In order not to provoke bleeding, the patient should refrain from intimacy with the man for 14 days.
- Monitor the body temperature during the week, so as not to miss the complications that have arisen.
- From water procedures allowed only hygienic shower. Take a bath, go to the baths, saunas, swimming pool is contraindicated.
- In good faith to take, prescribed by a doctor, drugs - antibiotics, analgesics, sedatives, vitamins.
- Observe the mode of the day, eat right, limited exercise.
When a patient has severe pain, bleeding opens and the body temperature rises sharply - this is all a serious reason to immediately seek medical help.
Despite the fact that the doctor is ready to explain in detail to the patient what it is - hysteroscopy and how the procedure goes, but for greater reliability, women are looking for real feedback from those who have already decided to make such a manipulation.
Diagnostic and therapeutic hysteroscopy is effective and performed with minimal risk for the patient manipulations, which are widely used and are considered the “gold standard” in gynecological practice.
Hysteroscopy - what is it?
Modern medicine knows many different diseases of the sexual sphere. And in some cases, for the decision of the final diagnosis, the doctor needs to carefully examine the inner wall of the uterus. This is the opportunity given by hysteroscopy.
What is this procedure? Its essence is quite simple - an inspection is carried out using a special hysteroscope apparatus. It is equipped with optical fiber, which allows the doctor to carefully study the structure and, if available, the pathology of the inner wall of the uterus, viewing them on the big screen.
In fact, obstetrics and gynecology widely use this technique for both diagnostic and therapeutic purposes.
Types of hysteroscopy
Today there are several basic types of this procedure. The technique of conducting in this case depends primarily on the purpose of the hysteroscopy.
- A diagnostic procedure involves the examination of the uterus using optical equipment. This procedure is used to detect various pathologies and neoplasms in the uterus. In this case, the integrity of the tissue is not broken.
- Surgical hysteroscopy involves the use of not only optical, but also surgical equipment. The procedure is used for low-impact treatment of various pathologies of the uterus. For example, there are some procedures with which the hysteroscopy of the uterus is perfectly combined - removal of a polyp, elimination of some other benign tumors, curettage of the cavity, etc. In such cases, general anesthesia is already required.
- There is also a so-called control hysteroscopy of the uterine cavity. Such a procedure is carried out if the doctor needs to carefully monitor the treatment process, evaluate the effectiveness of the effects of drugs or procedures, as well as determine in time the development of complications or relapses of the disease.
It should be noted that modern equipment allows us to consider the tissue under a significant increase, which makes hysteroscopy extremely valuable both for diagnosis and for treatment.
When is research required?
Of course, today many women are interested in information about what is a hysteroscopy of the uterus. Consequences, patient reviews - I want to know about all this to those who expect such an intervention. But first you need to deal with the indications for this procedure. Diagnostic inspection is required:
- If you suspect the presence of uterine fibroids or endometriosis.
- In order to detect the remains of the membranes of the fetus in the uterus, which can lead to the development of a mass of complications.
- Hysteroscopy is indicated for women who suffer from prolonged and heavy menstruation, as well as uncharacteristic intermenstrual discharge and bleeding during menopause.
- The procedure is carried out to detect certain malformations of the uterus.
- Indication for carrying out is infertility, as well as spontaneous abortion.
- In addition, hysteroscopy is prescribed to women who have recently undergone serious hormonal treatment. In this case, the procedure is a control character.
What is a hysteroscope and how it works
Brief information about this helps to understand the essence and possibilities resulting from the use of the method. The hysteroscope is a small rectangular body with two cranes connected to the hoses for supplying liquid or gas under pressure, and their outlet. These environments make it possible to solve certain tasks: improve visibility, increase the possibility of manipulation by increasing the uterine cavity, wash mucus and blood clots.
The body is connected to an external tube (hollow tube), into which the internal tube is placed with an eyepiece, lighting and telescopic systems, which allow the examination of the uterine cavity with an “eye”. In some models there is a channel for insertion of tools (scissors, rigid and flexible biopsy and exciting forceps, electrodes, laser light guide), designed for small manipulations - removal of small polyps, taking material for biopsy.
Depending on the used optical systems of the device, it is possible to carry out a general (without magnification) or panoramic view with a magnification of 20 times. With the help of the first, the doctor can get a general idea of the internal state of the uterus and identify the areas to be examined in more detail with the help of magnification. There are tubes with an optical system of magnification of 60 and 150 times (microhysteroscopes), allowing to see changes in the structure of the mucous membrane and its cells, to specify the degree of development and nature of pathological areas, to carry out differential diagnostics of cells suspected of cancer.
Types of hysteroscopes and their application
According to the degree of functionality, two main types of hysteroscope are produced, intended both for diagnostic studies and for small-scale surgical operations - elastic, or flexible (hysterofibroscope) and hard. Hysterofibroskop more convenient in the implementation of the manipulation, but fragile and relatively expensive.
Hard tube with his tube
The most commonly used in the diagnosis of instruments with a rigid tube. For technical specifications, telescopes with an outer diameter of 4 mm and viewing angles of 30 0 and 0 0, 12 0 and 70 0 are offered. For nulliparous and young women, there are devices with a diameter of 3 mm and viewing angles of 30 0 and 0 0. Devices with a diameter of 1 and 2 mm are also produced.
A special group of hysteroscopes consists of hysteroresectoscopes with L-shaped and spherical unipolar electrodes that are connected to an electric generator. Hysteroresectoscopes with an outer diameter of 7 mm are intended for inspection and implementation under visual control of small surgical interventions that do not require a significant expansion of the cervical canal (cervical canal). Hysteroresectoscopes with a diameter of 9 mm are used to remove submucous myomas, multiple large polyps, cauterization of large areas of internal endometriotic foci, separation of coarse fibrous synechia (adhesions), catheterization of the fallopian tubes, etc.
To facilitate intrauterine manipulations and detailed documentation of the procedure, most models of hysteroscopes are supplied with a video camera, with the help of which the high-quality image transfer of the uterine sections under examination and the position of the instruments on the monitor screen is carried out.
В связи с наличием значительного числа пациентов с бесплодием, большое значение приобрела гистероскопия перед ЭКО с проведением биопсии слизистой оболочки. IVF (in vitro fertilization) is the introduction into the uterus of a pre-fertilized egg. To ensure its effective implementation in the endometrium and attachment to the uterine wall, it is necessary to eliminate or eliminate the obstacles in the form of polyps, endometriosis, synechiae, intrauterine septum, ligatures left after cesarean section and left into the uterus, inflammatory processes of the endometrium and tubes, submucous knots, etc.
Thus, depending on the purpose of application, hysteroscopy is conventionally divided into:
- control, conducted to verify the results of treatment,
- as one element of the IVF preparation programs.
How is hysteroscopy performed
The procedure is performed on a gynecological chair in a standard position. After the anesthesiologist establishes a system of drip injections of the necessary solutions and preparations for the introduction of the patient into anesthesia, the gynecologist processes the external genital organs, vagina and cervix with a disinfectant solution. Then produces a gradual expansion of the cervical canal by introducing into it metal dilators of different diameters. This stage is the most painful and can lead to adverse reflex reactions of the body. Therefore, the procedure is carried out necessarily under anesthesia.
Type of anesthesia
Under what kind of anesthesia do hysteroscopy depends only on the decision of the anesthesiologist. This is influenced by many factors:
- the estimated amount and time of the procedure, taking into account the experience of the gynecologist,
- general condition of the patient
- the presence of concomitant diseases
- the possibility of developing allergic and anaphylactic reactions to narcotic and other drugs,
- expected complications in the course of performing hysteroscopy and anesthesia, including bleeding, electrolyte disorders and imbalances in body fluids, due to prolonged washing of the uterine cavity with solutions.
Most often, hysteroscopy is performed under general intravenous anesthesia with individual selection of narcotic and analgesic drugs, and if there are contraindications to it - under mask anesthesia. But in rare cases, with the potential for serious complications associated with the procedure or anesthesia, or the assumption of long-term gynecological manipulations, the decision by the anesthesiologist to conduct endotracheal anesthesia, spinal or epidural anesthesia is not excluded. Regardless of the type of anesthesia or anesthesia, monitoring of respiration, cardiac activity and blood oxygen saturation is constantly carried out using special monitors.
The sequence of the manipulation
After treatment with a disinfecting solution, a hysteroscope under the control of vision or images on the monitor is introduced into the uterine cavity enlarged with liquid or gas, inspect its contents and size, shape and topography of the walls, the state of the entrance area (mouth) into the fallopian tubes. This draws attention to the relief, color and thickness of the uterine mucosa (endometrium), its compliance with the term of the menstrual-ovarian cycle, the presence of any pathological changes and formations.
If foreign bodies are detected (remnants of the ovum, ingrown fragments of the intrauterine device), they are removed by means of a clamp inserted through the channel of the hysteroscope. The area of “suspicious” atypical regeneration of areas is subjected to biopsy with biopsy forceps for subsequent histological examination.
At the end of the procedure, the gynecologist usually performs a “separate” curettage of the cavity and cervix, after which the anesthesiologist removes the patient from the state of anesthesia and observes her in the absence of anesthetic complications for 2 hours.
When is it better to do hysteroscopy and some of its consequences?
The timing of the diagnostic procedure depends on the purpose. For women of reproductive age, the most optimal period is the period from the sixth to the ninth day after menstruation. This is the time when the mucous membrane is the thinnest, which greatly facilitates its examination and diagnosis. In postmenopausal women, during menopause, as well as in the presence of emergency indications, hysteroscopy can be performed at any time in the absence of pronounced bleeding.
If you are planning a pregnancy
When planning a pregnancy, the day of performing hysteroscopy is tentatively considered the first day of the last menstruation. Therefore, pregnancy after hysteroscopy may occur as early as the month following the procedure, especially if it was carried out simply for diagnostic purposes or was accompanied by the elimination of minor pathological changes. However, if serious manipulations were carried out, it is better to abstain from pregnancy for six months.
What does an increased temperature after manipulation indicate?
If there is an increase in temperature after hysteroscopy on the 3rd - 4th day, and sometimes immediately the next day, which occurs in 0.2% of all cases, this may be evidence of an exacerbation of the chronic inflammatory process. Most often, it occurs during exacerbation of saktosalpinks - chronic inflammation in the fallopian tubes, accompanied by the accumulation of fluid serous contents in them.
The temperature may also increase after hysteroscopic removal of multiple polyps or submucous myoma node, as well as curettage of the uterus. This occurs as a result of the formation of natural aseptic inflammation. The removed remnants of the ovum remaining after a spontaneous or medical abortion, foreign bodies in the form of an ingrown intrauterine device or its fragments, which are in the uterine cavity for a long time can also cause an increase in temperature after their removal during hysteroscopy.
Highlight - when is it worth sounding the alarm?
After the procedure, bloody spotting and then mucous discharges are considered normal for 2-3 days if the procedure was diagnostic or was accompanied by the removal of a polyp and even a submucous site.
Bleeding for 4-6 days, comparable to menstrual bleeding, is possible if diagnostic curettage was performed simultaneously. Longer and heavy bleeding, as well as mucopurulent discharge after hysteroscopy, especially accompanied by fever, are a sign of complications. In these cases, an immediate appeal to the attending physician is necessary.
Diagnostic or office hysteroscopy is performed on an outpatient basis to diagnose or confirm a diagnosis. The procedure takes from 5 to 25 minutes, and for the patient to conduct it there is no need to go to the hospital. As a rule, the whole procedure is recorded on video, so that later it will be possible to review the material again. When diagnosing a hysteroscope, the integrity of the tissues of the uterus is not broken. Office diagnostic procedure is carried out without the use of anesthesia, sometimes under local anesthesia.
Surgical hysteroscopy is an intrauterine surgery, when the integrity of the tissue is compromised. The condition for its implementation is the stretching of the uterus in order to create the opportunity to carefully inspect the walls. Surgical hysteroscopy of the uterus is divided into gas and liquid, depending on the method of applying cavity stretching. And the time difference of the procedure involves the division into postoperative, intraoperative, preoperative, urgent, emergency, planned. An operation is performed under short-term general anesthesia.
Indications for performing hysteroscopy
Hysteroscopy of the uterine cavity is performed in the following cases:
- If a woman can not bear the pregnancy and there is no other way to identify the cause.
- With uterine abnormalities.
- For postpartum control and extraction of residual ovum.
- If you suspect endometriosis.
- In case of violation in women of childbearing age of the menstrual cycle.
- When suspected nodes fibroids.
- With endometrial pathology.
- With suspected cancer.
- Before IVF.
- To determine the obstruction of the fallopian tubes.
- When bleeding with menopause.
- To remove intrauterine contraceptives.
However, there are contraindications for this procedure:
- infectious diseases,
- cervical stenosis,
- inflammatory processes
- uterine bleeding.
Where and how is hysteroscopy performed?
Most gynecological departments in hospitals have the opportunity to carry out diagnostics or surgical intervention using a hysteroscope. You can find through the Internet numerous clinical diagnostic centers, in which hysteroscopy of the uterus is performed, and read reviews about the professionalism of doctors. After the choice of the clinic has been made, it is necessary to wait for the gap between the 7th and the 10th day of the menstrual cycle, since these days ideal conditions for the appearance of the endometrium are created in the uterus.
An important feature of this manipulation is that the doctor does not make a single incision - the insertion of tools is carried out through the patient's vagina. Before starting the operation, the external genitals and the internal surface of the thighs are treated with an alcohol solution. Then, with the help of vaginal mirrors, the neck is exposed and treated with alcohol. After the probe is inserted, it measures the length of the uterine cavity, and then Geger dilators are introduced, which gradually open the cervical canal to allow free flow of fluid when the uterus begins to bleed.
A hysteroscope is inserted through the cervical canal, connected to a light source, a video camera, and a fluid delivery system. Repeated enlargement of the uterus on the monitor gives the doctor the opportunity to accurately carry out surgical treatment, including curettage, removal of polyps or other necessary procedures. After the operation, the hysteroscope is removed from the cavity, and the closure of the cervix occurs spontaneously. For details on this operation, see the video:
Recovery after hysteroscopy
The postoperative period involves the presence of the patient in a hospital from two hours to four days, depending on the complexity of the surgery. After surgery, the woman is recommended a sparing regimen, exclusion of sex life, increased physical exertion. It is forbidden to take a bath until the next menstrual bleeding, which should occur without delay. Within 3-5 days after hysteroscopy of the uterus, the patient may experience slight bleeding.
Complications and consequences after surgery
The consequences of hysteroscopy completely depend on the physiological characteristics of the patient's body, but complications, as a rule, do not take more than 5 days. During this period, there is flatulence in the gastrointestinal tract, which is caused by the ingress of gas that affects the internal organs, and the flow of blood, coupled with spasms resembling menstrual pain.
After diagnostic hysteroscopy, discharge from the uterus is insignificant. If a medical abortion was performed, then a first discharge will be observed in the first part, and in the next 3-5 days - yellow or blood. After removal of the fibromatous node or endometrial polyp, the bleeding is also insignificant, if there are no complications, otherwise uterine bleeding may be abundant.
In this case, doctors prescribe repeated surgery, hemostatic drugs or drugs that reduce the uterus. If, after hysteroscopy of the uterus, the patient has a blood-purulent discharge, which is accompanied by fever, this means that the woman after the procedure developed inflammation that requires immediate treatment.
Rehabilitation after hysteroscopy of the uterus lasts for a maximum of 10 days in the patient, during which she feels pain of a yaw-pulling character. They are localized in the lumbosacral region or lower abdomen, are of moderate or low intensity. If the pain after surgery is very disturbing, then doctors prescribe medication from the non-steroid group, which stop acute pain. If the soreness of the lower abdomen does not go away within 10 days, then you need to consult a doctor - this is an inflammatory process.
Contraindications to the operation
Hysteroscopic examination of the uterine cavity is considered the safest operation in microsurgery, but it also has a number of contraindications. First of all, it concerns the timeliness and technique of the surgical operation. Lateness can cause many serious complications. For example, the presence in the patient's uterus of a cancer tumor is a contraindication against hysteroscopic examination, because it can only harm the woman.
Developing pregnancy also does not allow such an intervention, because the hysteroscope is inserted deep into the uterus and can harm the fetus or even terminate the pregnancy. Risk factors include patients with infectious and inflammatory diseases, and girls who do not want to lose their virginity or have not reached childbearing age (15-16 years).
How much is the hysteroscopy of the uterus
The price for hysteroscopy of the uterine cavity depends on the level of complexity of the procedure, the qualifications of the doctor, the quality of the equipment used. For example, diagnostics in an average hospital can cost 4-6 thousand rubles, and surgery (when removing polyps or scraping the uterus) will cost a woman from 15 to 30 thousand rubles. Hysteroscopy in the hospital is also more expensive, but it has its advantages: the patient will be under the supervision of a doctor around the clock.
Natalia, 28 years old, Tolyatti: I went to the doctor about pains in the lower abdomen, after the ultrasound diagnosed polyp endometrium. After several courses of antibiotic treatment, the neoplasm has not disappeared anywhere or decreased. The doctor suggested hysteroscopy. The procedure took 10 minutes, and after 2 hours I was at home. I am very pleased that I agreed, because I quickly got rid of a polyp without complications.
Alexandra, 32 years old, Nizhny Novgorod: After giving birth, my menstrual cycle changed and every monthly began with a large amount of discharge. I was prescribed diagnostic curettage and sent for hysteroscopy. After several tests, I was given intravenous anesthesia and scraped, after which the heavy bleeding stopped.
Ekaterina, 35 years old, Kaliningrad: I was prescribed a hysteroscopy of the uterus to clarify the diagnosis. It was carried out under a medical policy for free, so I waited for her in turn for 2 weeks. At the appointed time, I was brought into the operating room, anesthesia was administered and I disconnected, and I came to myself in the ward. Half an hour later, they gave me a confirmation of the diagnosis, and I went home without feeling any weakness.
Diagnostic and surgical hysteroscopy
Diagnostic hysteroscopy allows you to explore the uterus and make a conclusion about the presence or absence of pathologies. For diagnostic hysteroscopy, a hysteroscope with a diameter of 3-4 mm is used. Carbon dioxide or saline can be injected through the tube into the uterine cavity to provide space for inspection. Using diagnostic hysteroscopy, the presence of septa and adhesions in the uterus, polyps of the uterus, uterine fibroids can be detected, and thus the cause of uterine bleeding or infertility is established.
Surgical hysteroscopy combines examination with the correction of identified pathologies. For this purpose, a hysteroscope with a diameter of 8-10 mm is used, the lumen of the tube of which allows the introduction of the necessary surgical instruments. During operative hysteroscopy, you can cut the septum, remove adhesions and polyps. Hysteroscopy allows targeted diagnostic curettage of the uterus.
Indications for hysteroscopy
Indications for hysteroscopy are:
- menstrual disorders,
- postmenopausal bleeding,
- suspected endometriosis by ultrasound or hysterosalpingography,
- suspicion of education in the uterus,
- suspected uterine malformations (intrauterine septum),
- pelvic pain,
- problems with the intrauterine device.
The diagnosis made by hysteroscopy is confirmed in more than 90% of cases. In almost half of the cases, hysteroscopy, carried out in order to diagnose some diseases, makes it possible to detect other, previously undetected pathologies, the signs of which were not recognized against the background of the symptoms of the underlying disease.
Contraindications to hysteroscopy
The main contraindications for hysteroscopy are:
- inflammatory processes of the pelvic organs in acute form,
- heavy uterine bleeding,
- cervical stenosis,
- cervical cancer,
- common infectious diseases in acute form.
How to make hysteroscopy
Surgical hysteroscopy is performed under general anesthesia. Время, затрачиваемое на вмешательство, зависит от заболевания и решаемых в ходе гистероскопии задач. В среднем, плановое время – 1,5 часа.After hysteroscopy, it is desirable to be under medical supervision for 3-4 hours.
Small bleeding and cramps are possible within 1-2 days after surgery. To avoid infection, do not use tampons at this time. It is also recommended to abstain from sex for some time (recommendations are given by the doctor after the operation).
You can make a hysteroscopy in Moscow at JSC "Family Doctor". You can also use the office hysteroscopy service (performed under local anesthesia at an outpatient reception by a gynecologist).
Medical hysteroscopy and indications for its use
Medical or surgical hysteroscopy involves not only the examination, but also the treatment of various diseases of the uterus. What is the indication for this procedure?
- This procedure is widely used to treat patients who have been diagnosed with thickening of the endometrium, which is observed in case of hyperplasia of the mucous membrane.
- There is another common problem for which hysteroscopy of the uterus is used - the removal of a polyp. With the help of special tools you can completely remove the neoplasm and process the uterine tissue with appropriate medications.
- The indication for the surgical procedure is fibroids, located in the tissues under the mucous membrane of the uterus.
- In some cases, combined hysteroscopy of the uterus and curettage. A similar procedure is performed for bleeding from the uterus of unknown origin, for missed abortion and other pathologies.
- With the help of hysteroscopic equipment, it is possible to quickly dissect the accreted walls of the uterus or partitions in its cavity.
- In some cases, intrauterine contraceptives are removed during the procedure.
Are there any contraindications to the procedure?
Although hysteroscopy is considered one of the safest procedures, it has some contraindications:
- For a start it is worth noting that the inspection or operation is not carried out in the presence of inflammatory diseases of the external genital organs. In such cases, you must first conduct a course of treatment.
- Also, an absolute contraindication to the procedure is pregnancy, as this may lead to its interruption.
- Patients suffering from any acute infectious diseases are not given hysteroscopy. First you need to carry out appropriate treatment and wait for the disappearance of the main symptoms.
- Contraindications also include heavy uterine bleeding and cervical stenosis.
- Hysteroscopy is contraindicated in women with advanced cervical cancer.
Do I need special training?
Despite the fact that this procedure is relatively easy to carry out and safe for health, some measures will still be needed before its implementation. Do not forget that this is a minimally invasive, but still a surgical procedure, so you should not ignore the recommendations of a doctor.
So what does the preparation for uterine hysteroscopy look like? First, the patient must be carefully examined for contraindications. For this purpose, a general analysis of blood and urine, as well as the delivery of a smear for bacteriological seeding on the microflora. You must also be tested for HIV infection and syphilis. Sometimes an extra smear from the cervical canal is performed.
In addition, before conducting hysteroscopy, a woman must inform the doctor about the drugs she takes, the presence of certain complaints about her health.
No special training is required in this case. But before performing hysteroscopy, it is recommended to clean the intestines (this can be done in the evening with a cleansing enema or laxative), as well as to empty the bladder and remove hair on the external genitals.
How is the procedure?
Naturally, patients are primarily interested in the question of how to do hysteroscopy of the uterus. In this case, it all depends on the purpose of the procedure. For example, a diagnostic examination does not require anesthesia. But the procedure looks different if the doctor has to remove tumors, for example, polyps in the uterus - in such cases, hysteroscopy is performed under general anesthesia.
The last meal should be no later than six hours before the procedure. Four hours before hysteroscopy is not allowed to drink.
As a rule, in the ward, women are offered to change into hospital clothes. Here the nurse gives the patient an injection of a sedative. After that, you need to move to the gynecological chair. General anesthesia provides for the presence of an anesthesiologist during the procedure - the doctor selects the appropriate anesthetic agent and its dosage, injects the drug and monitors the patient's condition throughout the procedure. Hysteroscopy begins only with the destruction of the anesthesiologist.
First, the gynecologist gently expands the cervical canal, and then introduces a hysteroscope into the uterine cavity. This device is either a flexible hollow tube or a thin rigid wiring. In any case, its end is equipped with an optical device and a light source - the image is displayed on the screen, which gives the doctor the opportunity to carefully examine and study the characteristics of the uterine wall.
Through a special channel, either a gas mixture or saline solution is injected into the uterine cavity - this makes it possible to expand the uterine cavity and improve visibility. First of all, the gynecologist will examine the uterine walls, the cervical canal, as well as the mouth of the fallopian tubes.
Surgical hysteroscopy, which is performed to remove polyps, curettage, etc., requires the use of special surgical equipment that is inserted into the uterine cavity through a hysteroscope.
After completion of all manipulations, the uterus is cleaned of the remnants of saline, after which the anesthesiologist brings the patient to her senses.
Many women are interested in questions about how painful the hysteroscopy of the uterus is. Reviews of patients indicate that the pain in this case is absent. Naturally, in the surgical treatment of this issue is not relevant, since the woman is under anesthesia. But diagnostic hysteroscopy is most often carried out without anesthesia (sometimes the doctor may apply local anesthesia). Nevertheless, even without it, inspection is rarely painful, although discomfort may still be present.
Most often, hysteroscopy is performed on the 6-10th day of the menstrual cycle, since the lining of the uterus during this period is the thinnest, which improves visibility. On the other hand, in critical conditions, the procedure is carried out regardless of the phase of the monthly cycle.
What happens after hysteroscopy?
Before carrying out the procedure, the woman must be informed about what awaits her after hysteroscopy. After the surgical treatment, the patient first feels nagging pain in the lower abdomen, which somewhat resembles the sensations that occur during menstruation. If the pain is intense, then you can take an anesthetic or antispasmodic drug that will help alleviate the condition.
Small bleeding after hysteroscopy of the uterus is also considered normal. But, again, in this case it is worth listening to your body. Over the next 2-4 days, the amount of discharge should be gradually reduced to complete disappearance.
Some women are interested in questions about whether this procedure affects the menstrual cycle. Diagnostic examination, as a rule, does not affect the monthly, but the surgical procedure can cause a small failure, which you should definitely tell your doctor.
Complications and consequences of unsuccessful hysteroscopy
In fact, with a properly and accurately carried out procedure, the consequences are reduced to a slight discomfort that goes away on its own. But there are some more serious complications that may be associated with hysteroscopy. What are the consequences?
Perhaps most often in gynecological practice, uterine bleeding is diagnosed, which appear after examining the uterus with a hysteroscope. The danger is that many patients do not pay attention to the discharge of blood, perceiving it as a normal phenomenon after the procedure. If the discharge with blood impurities is present for two days and their number does not decrease, you should definitely consult a doctor.
There are some other consequences of hysteroscopy of the uterus. In particular, some patients develop endometritis - inflammation of the inner layer (endometrium) of the uterus. Most often, the appearance of the inflammatory process is associated with infection of the tissues during the procedure. As a rule, the symptoms of this disease appear after a few days. The main symptoms include pulling pain in the lower abdomen, fever, and uncharacteristic vaginal discharge with admixture of pus. In the presence of such disorders, it is worth immediately contacting a doctor - in the early stages, endometriosis is easily treated with medication and rarely causes any complications, which cannot be said about the advanced form of the disease.
There is another fairly common complication with which hysteroscopy is associated. What is it and how is it dangerous? Sometimes during the procedure, the uterus is damaged by a hysteroscope, which leads to perforation of its wall. It should immediately be noted that such a complication is entirely the fault of the attending physician. The main signs of uterine perforation include severe sharp lower abdominal pain, as well as dizziness, nausea, vomiting, a sharp decrease in blood pressure, which is associated with loss of blood. The patient in this condition urgently requires surgery.
Some useful recommendations
There are some rules to follow after. Uterine hysteroscopy is still a surgical procedure. In particular, women can not take hot baths - the best option would be a warm shower. It is also strictly forbidden to visit saunas, baths and tanning beds, as this can lead to uterine bleeding and some other complications.
For some time, it is worth refusing vaginal tampons, replacing them with sanitary pads. Douching is also prohibited. And, of course, in the first week you should not have sex.
Carefully monitor the condition of your body. Any deterioration in health, fever, abdominal pain are the reason for the visit to the doctor. It is necessary to sound the alarm in the presence of abundant bloody and purulent discharge - in such cases, a gynecological examination is also required.
Where can I carry out a similar procedure?
Of course, today many patients are interested in questions about exactly where hysteroscopy is performed. Reviews and statistical surveys confirm that the procedure can be carried out both in the hospital and on an outpatient basis.
On an outpatient basis, today exclusively diagnostic examinations are carried out that do not require special training or anesthesia. After hysteroscopy, the patient receives the results of the study with further recommendations and can be sent home.
But all medical and surgical procedures are carried out exclusively in the hospital. After removal of polyps, curettage, or other activities, the patient should stay in the clinic for several days, as the doctor is obliged to monitor her condition.
Today, hysteroscopy is performed in almost any state clinic, where the necessary equipment is available in the gynecological department. In addition, a similar procedure is offered by private clinics and medical offices. Be sure to ask for more information from the doctor who prescribed you this procedure.
How much is?
Of course, today, many patients are interested in the question of how much hysteroscopy costs the uterus. There is no unequivocal answer to this question, since the prices in this case depend on the purpose of the procedure and the level of complexity of the procedure, as well as the quality of the equipment used, the financial policy of the clinic and the qualifications of the doctor.
So how much does uterine hysteroscopy cost? The price fluctuates within wide enough limits. For example, the usual diagnostic procedure will cost you about 4000-6000 rubles. But surgical measures (for example, removal of a polyp, curettage) will cost more - from 15 to 30 thousand rubles, depending on the complexity of the procedure. Of course, stationary hysteroscopy costs more, but this service has its advantages. In particular, after the procedure, the patient remains under medical supervision and, if necessary, receives appropriate assistance.
Uterus hysteroscopy: patient reviews
Today, this procedure is considered highly demanded, as it helps in time to diagnose and treat a number of diseases of the reproductive system. By the way, the examination must be prescribed for the treatment of infertility, as well as before in vitro fertilization.
Naturally, many patients are sent to a procedure called "hysteroscopy of the uterus." The reviews on this technique are mostly positive. Of course, a diagnostic examination without anesthesia is associated with some discomfort, but the procedure lasts no more than 20 minutes, and the results of the study are very accurate.
As for surgical hysteroscopy, all the complaints of the patients are most often associated with anesthesia - many women feel tired, fatigued, nauseous and other unpleasant symptoms that occur after the administration of the anesthetic. Of course, in the first days after curettage and removal of the polyp there is pain in the lower abdomen, which, however, can be easily removed with the help of painkillers.
The undoubted advantage of the procedure is low tissue invasiveness along with high therapeutic effect. In addition, in most cases, surgery of this type does not require prolonged hospitalization - the patient can return to the usual rhythm of life (albeit with some restrictions) after a few days. And, again, it is worth understanding that it depends on the experience, skills and qualifications of the attending physician how the hysteroscopy will be performed. Reviews that are negative, as a rule, are associated with inaccurate actions of a specialist.
The essence of the method
What is this uterine hysteroscopy? Instrumental examination with minimal surgical intervention, allowing you to perform diagnostic and surgical manipulations in the uterus, is called hysteroscopy. The functionality of this method is quite wide: from identifying and eliminating uterine pathology to tissue biopsy and removal of foreign bodies and various neoplasms. It is considered one of the most informative studies for direct assessment of the state of the uterus, endometrium and myometrium, which, if necessary, can also be used in treatment.
Whoever performed a hysteroscopy of the uterus, knows that the procedure itself is quite tolerant and not particularly painful.
Without the need for endoscopic examination is never carried out, because this diagnostic method is not so simple to perform and requires special preparation of the patient. What are the indications for hysteroscopy:
- Menstrual dysfunction (in particular, menorrhagia). In about 20% of cases with uterine bleeding, hysteroscopy helps to supplement the diagnosis, which was established on the basis of other research methods. Quite often, polyps, fibroids, chorionic fragments, an intrauterine septum, etc. become the cause of heavy bleeding from the uterus.
- Postmenopausal bleeding. It should be noted that this is an absolute indication for hysteroscopy.
- Contact bleeding. Occur directly after physical exposure (for example, during sex, douching, vaginal examination, etc.). It is considered a fairly frequent symptom of endometrial polyps.
- If pathological echo signals are detected during transvaginal echography, which, in turn, helps to diagnose preclinical forms of gynecological diseases.
- Substantiated suspicions of endometrial and myometrial pathology. If less invasive methods of examination do not make it possible to finally determine the diagnosis, one has to resort to hysteroscopy. Similar clinical situations can occur in uterine myoma, adenomyosis, endometrial hyperplastic processes, etc.
- Complication of pregnancy. As a rule, the need for hysteroscopy appears when a delay of fragments of the chorion or fetus after an abortion, parts of the placenta, inflammation in the endometrium after pregnancy.
- It is impossible to remove the intrauterine contraceptive. If all attempts to remove the intrauterine contraceptive in the usual way were unsuccessful, then the extraction is performed endoscopically.
- Monitoring the effectiveness of treatment of endometriosis and uterine fibroids. Динамическое наблюдение необходимо независимо от вида терапии (гормонального или хирургического).
Идеальный метод для выскабливания
Как показывает клинический опыт, выскабливание полости матки – это одна из самых распространённых гинекологических манипуляций. Why many experts recommend curettage under the control of hysteroscopic research:
- It will allow to assess in detail the condition of the uterus, the initial parts of the fallopian tubes, identify pathological tumors (fibroids, polyps, tumors of the mucous membrane, parts of the chorion, etc.), as well as determine developmental abnormalities.
- According to statistics, with classical curettage, only 40% of patients can completely remove the endometrium.
- During hysteroscopy, it will be possible to clarify the indications for radical surgical treatment.
- To monitor the effectiveness of treatment of endometrial hyperplasia.
If hysteroscopy is indicated, then on what day of the cycle it is done - this is determined by your gynecologist.
Equally important is the psychological preparation of women for the endoscopic procedure. When consulting a patient, the doctor tries to provide all the necessary information about the method of research used. During the conversation, the woman learns about how the hysteroscopy of the uterus is performed, for what purpose, what complications are possible, etc. The doctor is obliged not only to explain, but also to justify the expediency of applying this particular endoscopic procedure, focusing on its advantages, compared to other methods.
According to common practice, before hysteroscopy, the patient must undergo a number of clinical, laboratory and instrumental examination methods, including:
- Blood tests (clinical, biochemical, group determination, Rh factor, clotting indicators, etc.).
- Examination of vaginal, cervical and urethral discharge.
- Gynecological examination of the vagina.
- Transvaginal ultrasound scan.
The key point in drug preparation is the prevention of infectious and inflammatory diseases. In order not to carry out treatment after hysteroscopy of various complications, antibacterial preparations are prescribed (Ampioks, Cephalosporins, etc.). I would like to note that preventive antibiotic therapy would be very relevant for patients who have high risks of developing infectious complications after endoscopic manipulation. What are these risk factors:
- Chronic infectious pathology.
- Problems with the circulatory system (anemia, vascular diseases, etc.).
- Chronic diseases of the genitourinary system of inflammatory nature.
When it is better to do hysteroscopy - the doctor decides, given the alleged gynecological diagnosis.
Do not forget about the antiseptic treatment of the vagina with the help of special drugs. For these purposes, it is recommended that a week before the planned endoscopic examination of the uterine cavity, various vaginal suppositories with antiprotozoal, antifungal, or a combined effect be used. The most commonly prescribed drugs are:
For douching the vagina is suitable antiseptic solution Octenisept. Also, this drug is used immediately before the endoscopic procedure. Octenisept practically does not cause adverse reactions, unlike many other antiseptics. Can not be used simultaneously with other drugs for local and external use containing iodine.
Under what anesthesia do uterus hysteroscopy? It can be done under local anesthesia, regional or general anesthesia. If a standard diagnostic examination is planned, then in most cases they are managed with local anesthesia. For this painkiller drug cut around the cervix. As a rule, Lidocaine is used.
For therapeutic hysteroscopy, general anesthesia is used. In such cases, special medications are administered intravenously (for example, Propofol). Alternatively, general anesthesia may be regional anesthesia when the anesthetic is injected into the spinal canal. Depending on the level of administration of painkillers, spinal and epidural anesthesia is distinguished.
The duration of hysteroscopy can vary from 10–15 minutes to an hour. The diagnostic procedure usually does not take longer than 30 minutes. However, if prescribed for therapeutic purposes, it can last up to 40–60 minutes.
Only the attending physician, considering the condition of the patient and the purpose of the endoscopic examination, can determine which anesthesia for hysteroscopy of the uterus will be most appropriate.
On which day of the cycle do they perform hysteroscopy? Mainly endoscopic examination of the uterus is performed on the 6–9th day of the cycle. If they cannot determine the cause of female infertility, they are prescribed for the middle of the second phase (20–23 day). If endometriosis is suspected, the procedure can be performed on any day of the menstrual cycle. With intrauterine adhesions, it is better to be examined before menstruation.
How do uterus hysteroscopy? The external genitals, vagina and cervix are treated with an antiseptic solution. Perform sensing of the uterus and dilate the cervical canal to enter the endoscope. Connect the equipment and enter the hysteroscope. Diagnostic examination includes an examination of the uterus, the initial parts of the fallopian tubes and the cervical canal. If necessary, take a biopsy of the tissue.
Emergency hysteroscopy can be performed during menstruation.
Hysteroscopy allows you to identify and eliminate intrauterine pathology, remove foreign bodies, take a biopsy of tissues, remove endometrial polyps. During the examination, surgical procedures are available to eliminate the uterine causes of infertility - endometrial polyps, submucous myomatous nodes, endometrial hyperplastic foci, intrauterine synechia and septum. It is also possible recanalization of the fallopian tubes and evaluation of their mucous membranes up to the fimbrial section.
For the first time, hysteroscopy was performed by Pantaleoni in 1869 to a woman with uterine bleeding . Since then, hysteroscopy, having undergone a number of significant changes and modifications, is radically improved and is available for the diagnosis and surgical treatment of a significant portion of uterine infertility. In general, the purpose of the procedure is to evaluate the uterus, endometrium, myometrium, endocervix.
Hysteroscopy is performed during the early follicular phase, usually 6–11 days of the menstrual cycle, sometimes 5–13 days m.ts.
- Control 
Indications for the diagnostic procedure are:
- Suspected internal endometriosis of the uterus, submucosal fibroids, synechia (fusion) in the uterus, residues of the ovum, cervical and endometrial cancer, endometrial pathology, perforation of the uterine walls during abortion or diagnostic scraping
- Suspicion of uterine malformations
- Violation of the menstrual cycle in women of childbearing age
- Abnormal development of the uterus
- Postmenopausal bleeding
- Control study of the uterine cavity after surgery on the uterus, with miscarriage, after hormonal treatment
Indications for the surgical procedure are:
- Uterine myoma submucosa
- Intrauterine septum
- Intrauterine synechia
- Endometrial polyp
- Endometrial hyperplasia
- Removal of residual intrauterine contraceptive
- Recently transferred or existing at the time of the study the inflammatory process of the genital organs
- Progressive pregnancy
- Heavy uterine bleeding
- Cervical stenosis
- Common cervical cancer
- Common infectious diseases in the acute stage (influenza, pneumonia, pyelonephritis, thrombophlebitis)
- Severe condition of the patient with a disease of the cardiovascular system, liver, kidneys
A surgical operation using the hysteroscopy method (hysteroresectoscopy) is shown in the following cases:
- if there is a pathological proliferation of the endometrium (hyperplasia),
- it is necessary to remove polyps or internal nodes of fibroids,
- when adhesions or partitions are found in the organ cavity,
- it is required to make separate diagnostic curettage of the uterus (biopsy), to take tissue samples from its various departments,
- endometrium should be completely removed if there is unexplained uterine bleeding.
When removing the intrauterine device, a hysteroscope can also be used.
Hysteroscopy before IVF
IVF is a responsible and expensive procedure. To achieve success, you must first prepare the uterus, since nothing should prevent the embryo from gaining a foothold in it and developing normally. For this purpose, hysteroscopy is performed (endometrial biopsies and a thorough examination of the internal surface of the organ are performed).
Addition: With the help of ultrasound, you can only see larger tumors or notice the defeat of certain parts of the uterus. Therefore, small polyps, scars and adhesions go unnoticed, later because of them pregnancy is often interrupted. When such tumors are found, they are removed or hormone treatment is carried out.
Contraindications for hysteroscopy
Despite all the advantages of this method, the use of hysteroscopy has limitations. For example, it cannot be used to examine pregnant women, since any manipulation of the cervix and uterine cavity during this period is dangerous, leading to damage to the fetus or miscarriage.
Hysteroscopy of the uterus is not performed if the patient has infectious or inflammatory diseases of the urinary organs or the reproductive system. The procedure is not carried out in the presence of bleeding from the genital tract.
A contraindication is a condition in which there is a narrowing of the cervical canal of the neck. Such an intervention is not possible in the presence of cervical cancer.
An absolute contraindication to hysteroscopy is the presence of severe kidney disease, pulmonary or heart failure, a post-infarction condition, as well as poor blood clotting.
The medical procedure is not carried out in the presence of a woman intolerant of drugs used for anesthesia.
How is hysteroscopy performed
It is important to note that hysteroscopy of the uterus is a short procedure (diagnosis takes 10-30 minutes, it takes no more than 60 minutes to perform the operation). Before it is performed, anesthesia is performed.
When performing diagnostics at the request of the patient, local anesthesia can be used by injecting lidocaine into the cervix. During operations, general intravenous anesthesia or anesthesia is used by injecting painkillers into the spinal canal.
After treatment with an antiseptic, the cervical canal is dilated and a hysteroscope is inserted into it. At the same time, the cervix, uterine cavity and tubes are examined successively. If tumors are detected, endometrial particles are selected for further histological examination.
Before the operation, saline or gas is injected into the uterus through one of the channels of the hysteroscope in order to facilitate access to its individual sections. Removal of polyps, fibroids, biopsy.
All removed material is sent for histological examination to clarify the benign or malignant nature of tumors. At the end of the manipulation, the saline solution is pumped out.
After the diagnostic procedure, the woman remains under medical supervision for 2 hours, then goes home. After the surgery, she needs to spend 2 days in the hospital.
With strict observance of the rules of preparation for the procedure and its qualitative implementation, complications do not arise. However, the possible consequences can be:
- mechanical damage to the uterus with instruments
- bleeding associated with damage to the large vessels of the endometrium,
- getting into the uterus infection and the development of the inflammatory process (endometritis).
An increase in pain in the lower abdomen, an increase in temperature, an increase in the intensity of bleeding, and the appearance of discharge with an unpleasant odor and impurities of pus can speak about the appearance of complications. If uterine perforation occurs, the pain in the abdomen is sharp and severe. There is internal bleeding, which is accompanied by nausea, dizziness, vomiting, a drop in blood pressure.
Possible accumulation of blood inside the uterus (formation of hematometers). This causes severe pain. Scraping is done to remove lumps and prevent inflammation of the uterus.
If there are signs of unfavorable course of the recovery period, the patient should immediately consult a doctor in order to take timely measures to eliminate the consequences.
Limitations after surgery
During the postoperative period, a woman must follow certain rules in order not to provoke a deterioration of her condition.
You should avoid thermal procedures, bathing in a hot bath (it is better to take a warm shower), applying a heating pad to the stomach to reduce pain, stay in a hot room or under the rays of the sun. Warming up can cause increased bleeding.
Do not use hygienic tampons, douching, use vaginal ointments or candles, not prescribed by a doctor. It is necessary to carry out hygienic procedures
Do not miss visits to the doctor. If you experience the slightest discomfort in the lower abdomen should be notified to the doctor.
In the first month after surgery, you must abandon sex. Pregnancy after removal of adhesions and polyps may occur in the next cycle. In the next 2-3 months it is better to use condoms.
The uterus is part of the female reproductive (sexuala) system. The uterus is located in the pelvic cavity. Anterior to it is the bladder, and behind the rectum. The uterus is pear-shaped and flattened anteroposteriorly.
From the anatomical point of view, the following uterine sections are distinguished:
- Body. In the uterus distinguish the anterior and posterior surfaces. The part of the body located just above the attachment to the uterus of the fallopian tubes is called the bottom of the uterus.
- Neck. This part is a continuation of the body of the uterus. The upper part of the cervix adjacent to the body of the uterus is called supravaginal. The lower part of the cervix is called the vaginal and is located in the lumen of the vagina. This part of the cervix can be examined with a vaginal speculum. In the thickness of the cervix is the cervical canal (cervical canal), which opens into the cavity of the vagina uterine hole. The mucous membrane that covers the cervical canal contains numerous glands. In some pathological conditions, the excretory ducts of these glands can be blocked, which leads to the formation of cysts filled with cervical secretions (nabot cysts).
- Isthmus represents the transition of the uterus to the cervix. Its length is about 1 cm.
In the wall of the uterus distinguish the following layers:
- Perimetry - This is the outer layer of the uterine wall, which is a serous membrane (performs a protective function). The serous membrane is formed by the visceral peritoneum and covers the anterior and posterior surfaces of the uterus. The perimetry spreads to the bladder, forming a vesico-uterine cavity, and the rectum, thus forming a rectal-uterine cavity (Douglas space).
- Myometrium - is the uterine muscular layer, which consists of three layers - superficial (outer), average (vascular) and internal (subvascular). Muscle fibers intertwine in different directions - longitudinal, oblique and circular (circular). In the body of the uterus muscle fibers are located mainly longitudinally, and in the neck and isthmus - circular.
- Endometrium represents the uterine lining, which consists of the basal and functional layers. The basal layer is directly adjacent to the myometrium. The functional layer is more superficial and thicker. In the functional layer, cyclic changes associated with the menstrual cycle occur. These changes are proliferation (sprawl) endometrium, rejection of the functional layer and its regeneration (recovery) after menstruation. In the endometrium are tubular glands.
Indications for hysteroscopy of the uterus
Hysteroscopy of the uterus is carried out in order to diagnose diseases of the uterus and their treatment. Pathological conditions that are indications for hysteroscopy can only be determined by a doctor.Timely hysteroscopy allows time to carry out treatment and often avoid serious consequences. The doctor who prescribes hysteroscopy of the uterus, as a rule, is a gynecologist, who, after talking with the patient and examining her, assumes the presence of any disease of the uterus.
Indications for hysteroscopy of the uterus are:
- control study after surgery on the uterus, after hormone therapy,
- postmenopausal bleeding (period of life after the last menstruation),
- suspected uterine abnormality,
- suspected endometrial pathology,
- suspected myometrial lesion,
- menstrual disorders,
- spontaneous abortion,
- suspicion of foreign bodies in the uterus,
- suspicion of perforation (perforation of the wall) uterus,
- postpartum complications
- endometrial diagnostic curettage (recommended under the control of hysteroscopy).
Hysteroscopy is absolutely contraindicated during pregnancy, as the procedure can lead to its interruption (miscarriage). Also, hysteroscopy is contraindicated in certain pathological conditions.
Contraindications for hysteroscopy are:
- Systemic infectious diseases. This contraindication is absolute, as the risk of the spread of the infection process is very high. Hysteroscopy can be carried out only after the elimination of the pathological process.
- Inflammatory diseases of the genital organs. The study is not conducted in acute inflammatory diseases or exacerbations of chronic diseases. In this regard, their treatment and reduction of the activity of the inflammatory process is carried out previously.
- Cervical cancer is an absolute contraindication. The reason is the high risk of spreading the tumor process to the surrounding tissues. This is due to the fact that during hysteroscopy, liquid media are used to expand the uterus, which, on the one hand, contributes to a better visualization of the uterus walls, and on the other hand, to the spread of tumor cells in the uterus or through the fallopian tubes into the abdominal cavity.
- Uterine bleeding. In case of uterine bleeding, the diagnostic value of the procedure may be low due to low informational content with heavy bleeding. In this case, it is recommended to carry out hysteroscopy in such a way that there is a possibility of fluid inflow and outflow through different channels, as well as to ensure continuous washing of the uterus and removal of blood clots.
- Menstruation. This is a relative contraindication, since during menstruation the information content of hysteroscopy is very low due to the insufficient view of the walls of the uterus. In this regard, this method is usually carried out on the 5th - 7th day of the menstrual cycle.
- Severe patient condition. The patient’s severe condition with somatic diseases is contraindicated until compensation is achieved (recovery) the patient's condition.
- Stenosis (constrictiona) cervix. This condition is associated with a high risk of damage to the tissues of the cervical canal.
- Blood clotting disorder. This condition is accompanied by a high risk of extensive blood loss during surgery and postoperative bleeding.
Anesthesia for uterine hysteroscopy
The first step in the operation is pain relief. The method of anesthesia is selected each time, based on the individual characteristics of the patient and the course of the disease. Intravenous or mask anesthesia is most commonly used for hysteroscopy.
If it is not possible to perform general anesthesia, paracervical anesthesia is performed. To do this, the tissue is infiltrated around the cervix with anesthetics (anesthetic drugs). This method is considered less effective.
The next stage of the intervention is the expansion of the uterus. Although it is possible to perform the procedure without dilating the uterus, this technique is currently used much less frequently. Usually, hysteroscopy without uterine cavity dilation is performed on an outpatient basis. The expansion of the uterus can be carried out in two ways - with the help of gas or liquid.
Technique of performing hysteroscopy
The procedure for performing the operation depends on its goals, the method used for dilating the uterus, the extent of surgery, the presence of contraindications, etc.
Depending on the method of expanding the uterine cavity, hysteroscopy can be of two types:
- gas hysteroscopy
- liquid hysteroscopy.
Carbon dioxide is used as a medium for expanding the uterine cavity during gas hysteroscopy. Gas is fed into the uterine cavity using a special device - a hysterophilus. The use of other gas supply devices is not allowed, as this may lead to uncontrolled gas supply and serious complications. When conducting gas hysteroscopy, it is necessary to strictly control the gas flow rate and pressure in the uterine cavity. At normal speed, the negative effects of cavity expansion cannot be. If the carbon dioxide supply rate is excessive, then cardiac abnormalities, gas embolism and death may occur.
Gas hysteroscopy is not recommended in the presence of blood in the uterus, as the formation of bubbles, which makes it difficult to visualize tissues. The use of this method for surgical purposes is also limited.
According to the size of the cervix, a cap is picked up, which is put on and fixed on it. To flush the walls of the uterus, a small amount of saline is injected (50 ml), which is then sucked. To the hysteroscope attach a light source, a tube for the flow of gas. Further, after the expansion of the uterus, conduct a detailed examination.
For the expansion of the uterine cavity with liquid hysteroscopy can be used high-molecular and low-molecular liquid media (solutions). High molecular weight environment (dextran) are practically not used, as they have a high viscosity, slow suction from the abdominal cavity, high cost and are accompanied by an increased risk of an anaphylactic reaction. Low molecular weight solutions are most commonly used. Saline, distilled water, Ringer's solution, glucose solution, glycine solution are used as low-molecular solutions.
Liquid hysteroscopy also has drawbacks, the main ones being the risk of overloading the vascular bed, and the risk of developing infectious complications is also relative. When comparing the advantages and disadvantages of both methods of dilating the uterus, many doctors prefer liquid hysteroscopy.
During the procedure, continuous measurement of fluid volume and pressure, under which it is fed into the uterus, is of great importance. These two indicators affect the quality of the review during surgery, the possibility of manipulation and the development of complications during and after surgery.
With liquid hysteroscopy, for better outflow of fluid, the cervix is dilated using Gegar’s dilators (instruments intended for mechanical expansion of the cervical canal). A telescope, a light source, a video camera, a conductor for an expanding medium are connected to the hysteroscope. The device is slowly introduced into the cervical canal, gradually moving it deeper. Making sure that the device is located in the uterus, begin to inspect the walls of the uterus, the mouth of the fallopian tubes and the cervical canal.
When pathological changes in the endometrium are detected, a biopsy is performed (excision of tissue for further histological examination).
What tests need to pass before hysteroscopy of the uterus?
Before carrying out a planned hysteroscopy of the uterus, certain studies must be ordered in order to assess the patient’s condition and readiness for the examination.
The main studies prescribed before hysteroscopy are:
- clinical (common) blood test,
- coagulogram (assessment of the blood coagulation system),
- blood chemistry,
- blood sugar (glycemia),
- general urine analysis,
- X-ray examination of the chest,
- Ultrasound (ultrasound procedurea) abdominal cavity
- transvaginal ultrasound (when the sensor is inserted into the vagina) or transabdominal (when the sensor is carried out on the abdominal wallA) pelvic ultrasound,
- ECG (electrocardiogram),
- examination of vaginal smears for purity (at 3 and 4 degrees of purity, the intervention is carried out only after the vagina is reorganized),
- bimanual study (examination of the state of the uterus, which is carried out with two hands, with one hand located in the vagina, and the other on the anterior abdominal wall).
Immediately before the procedure, a series of preparatory measures are carried out. These include refusal from eating the day before and a cleansing enema (preparation of the gastrointestinal tract). Hysteroscopy is performed with an empty bladder.
What are the results of hysteroscopy?
The results of a hysteroscopic examination can be presented in the form of a normal hysteroscopic picture, as well as pathological or physiological changes. For the correct interpretation of the results and diagnosis, it is necessary to know the normal hysteroscopic picture well.
Normal hysteroscopic picture may look different, depending on the time when the study was conducted (proliferative or secretory phase of the menstrual cycle, menstruation, postmenopause).
The condition of the endometrium has its own characteristics in the following periods:
- Proliferative phase. Endometrium is light pink in color, thin. Single sites with small hemorrhages can be observed. The mouth of the fallopian tubes are available review. From about the ninth day of the cycle, the endometrium gradually thickens, forming folds. Normally, the mucous membrane of the uterus is thickened in the area of the bottom and back of the uterus.
- Secretory phase. The endometrium becomes thickened and swollen, acquiring a yellowish color. The mouth of the fallopian tubes may not be accessible to the review. A few days before menstruation, the endometrium becomes hyperemic (bright red), which can be confused with endometrial pathological changes. The endometrial vessels in this phase are more fragile, due to which they can be easily damaged and cause bleeding.
- Menstruation. During menstruation, hysteroscopy reveals scraps of the mucous membrane. By the second - third day of menstruation, there is almost complete rejection of the endometrium, scraps can sometimes be observed.
- Postmenopause. The postmenopause is characterized by a pale, thin, atrophic endometrium. In this case, this is not a pathology, but is associated with age-related changes in the mucous membrane. In the postmenopausal period, the folded structure of the mucous membrane disappears, there may be synechia (spikes).
When hysteroscopy can be detected the following pathological signs:
- endometrial injury,
- blood clots
- varicose veins of the uterus,
- endometrial vascular rupture,
- abnormal development of the uterus,
- endometrial atrophy with punctate and multiple hemorrhages (with diabetes),
- areas of hemorrhage,
- endometrial growth,
- the presence of polyps
- sites with dystrophic changes (malnutrition tissue),
- areas necrotic (unviable) fabrics
- the presence of foreign bodies,
- the inability to identify the mouth of the fallopian tubes,
- the presence of inflammatory changes in the mucous membrane.
What diseases can be detected by hysteroscopy?
Hysteroscopy is often the only way by which uterus pathology can be detected and treated.
Diseases that can be detected with hysteroscopy are:
- endometrial hyperplasia,
- submucous uterine myoma,
- endometrial polyps,
- cervical polyps,
- endometrial cancer,
- intrauterine synechia,
- intrauterine septum,
- two-horned uterus,
- foreign bodies in the uterus,
- perforation of the uterus.
Endometrial hyperplasia is a pathological proliferation of the uterine mucosa as a result of excessive growth of endometrial cells. This condition is most often observed in women during menopause and during the reproductive period. Clinically, endometrial hyperplasia is manifested by uterine bleeding and heavy menstruation.
Pathological changes detected by hysteroscopy of the uterus can vary and vary depending on the type and prevalence (local or commona) hyperplasia, the presence of bleeding, duration of bleeding.
Endometrial hyperplasia may be normal or polypous. With normal hyperplasia, there is a thickening of the endometrium, the ducts of the glands look like transparent dots. The state of the endometrium with normal hyperplasia is similar to its state in the proliferative phase of the menstrual cycle. When polypous hyperplasia on the mucous membrane revealed numerous growths in the form of polyps, multiple endometrial adhesions. Polypous hyperplasia should be differentiated from the physiological state of the mucous membrane in the secretory phase. A biopsy is performed to confirm the diagnosis. The diagnosis takes into account the data of histological examination, the day of the menstrual cycle, in which the hysteroscopy was carried out, the clinical manifestations.
Submucous uterine myoma
Submucous (submucosaMyoma is a benign tumor that is formed from muscle tissue and is located under the lining of the uterus. Submucous fibroids are of two types - single and multiple. The most frequently diagnosed single fibroids.
Myomas are presented as submucous (myomatousa) nodes, which, as a rule, have a spherical shape, dense texture. Nodes gradually deform the uterine cavity. Submucous fibroids differ from polyps in that they remain unchanged with an increase in the rate of fluid supply to the uterine cavity. Myomatous nodes can reach such dimensions that they can fill almost the entire uterine cavity.
The criteria characterizing myomatous nodes are:
- the size,
- the amount of intramural component (part of the node, located mainly in the wall of the uterus),
- quantity (single or multiple nodes),
- base width (knot with a wide base or leg).
Endometriosis is a disease in which normal endometrial cells begin to grow outside of it. The clinical course of endometriosis depends on its location, the shape and degree of damage to the surrounding tissues. Endometriosis can be genital and extragenital. Genital endometriosis, in turn, can be internal and external.
Hysteroscopy allows you to identify endometriosis, localized within the uterus (internal endometriosis). In the case of localization of the pathological process outside the uterus, ultrasound, laparoscopy is prescribed. The final diagnosis of endometriosis is established on the basis of clinical manifestations, instrumental research data and the results of histological analysis of biopsy material.
Endometrial polyps are benign growths that represent the proliferation of tissue in the uterine lining.In the diagnosis of endometrial polyps, hysteroscopic examination is the most informative. Polyps are detected quite often, especially in postmenopausal women. The most common occurrence of polyps is associated with numerous scraping of the endometrium, especially when they are of poor quality. Also, the appearance of polyps can be associated with hormonal disorders.
Most often polyps are single formations. A pathological condition in which multiple polyps are detected is called endometrial polyposis. Clinical symptoms in the case of small polyps may not appear. In this case, they are detected by chance with a pelvic ultrasound. With large polyps, bloody discharge from the genital tract, menstrual disorders may occur.
The hysteroscopic picture of endometrial polyps can vary depending on the type of polyp. Polyps are differentiated by size, location, color, structure, and also according to histological research.
Endometrial polyps can be of the following types:
- Fibrous polyps. Can reach 1.5 - 2 cm in diameter, as a rule, have a leg. They are roundish formations whitish in color with a smooth surface. According to external signs, fibrous polyps can resemble myomatous nodes, which requires a thorough differential diagnosis using histological methods.
- Glandular fibrous polyps. Such polyps are formed from glandular and fibrous connective tissue and reach 5-6 cm in diameter.
- Glandular cystic polyps. They represent a pale pink color with a smooth surface. Can reach 5 - 6 cm in diameter.
- Adenomatous polyps. The sizes of adenomatous polyps vary from 0.5 to 1.5 cm. Such polyps are most often localized in the area of the bottom of the uterus and the mouths of the fallopian tubes. The surface of adenomatous polyps is uneven, they are most often gray. The presence of adenomatous polyps is associated with a high risk of transformation into a malignant tumor.
In some cases, the polyps of the body of the uterus reach such large sizes that they penetrate into the cervical canal. This condition most often occurs in postmenopausal women.
Cervical Canal Polyps
Polyps of the cervical canal or cervical polyps are formations that are benign tumors of the mucous membrane of the cervical canal. These formations as well as endometrial polyps can be fibrous, glandular-fibrous, glandular-cystic and adenomatous.
In more than 30% of women, in the presence of a cervical polyp, polyps are also found in the endometrium. The presence of such formations is accompanied by an increased risk of infertility, severe pregnancy.
The diameter of cervical polyps is usually less than that of uterine body polyps, and is about 1 cm. Their appearance is associated with chronic inflammatory diseases of the cervix and hormonal imbalance. Polyps can malignant, so timely diagnosis and treatment play a big role.
Endometrial cancer is a malignant neoplasm, which is most often found in the postmenopausal period. This disease is accompanied by abundant pathological discharge from the genital tract, uterine bleeding, pain in the lower abdomen. Symptoms appear at an early stage of development of the malignant process, which encourages women to seek medical help. This is a factor that ensures early diagnosis of the disease. Hysteroscopy allows you to identify endometrial cancer, its localization, the degree of prevalence of the tumor process.
Endometrial cancer can spread to the mucous membrane of the cervical canal, ovaries, abdominal cavity. The hematogenous spread of the malignant process is accompanied by the appearance of distant metastases (tumor spread to other tissues).
During hysteroscopy, it is revealed that the tissues of the uterus are very loose. Even with a slight increase in the rate of supply of fluid to expand the uterus, the tissues begin to break down and bleed. On the mucous membrane are revealed "craters" (ulceration of the mucous in the affected areas), the growth of the mucous membrane of various shapes, areas of necrotic tissue. The surface of the neoplasm is uneven, characterized by increased vascular pattern.
If there are signs of endometrial cancer on hysteroscopy, especially of a common form, it is considered impractical to remove it. Initially, a biopsy is performed, followed by histological examination. The results of the study are one of the determining factors in the choice of treatment tactics. A key role is played by the timeliness of detection of endometrial cancer.
Adenomyosis is a benign disease, in which there is a restructuring and proliferation of the endometrial glands. This condition is also called atypical hyperplasia. Adenomyosis can occur in diffuse or focal form.
Adenomyosis is a disease that should be given much attention, as it belongs to precancerous conditions. Malignancy (transformation of a benign tumor to a malignant) is observed in about 10% of cases.
On hysteroscopy with adenomyosis, pathological changes in the form of points or slits ("Eyes") black or purple color from which blood can be released.
The hysteroscopic picture is different at different stages of adenomyosis:
- Stage 1. The absence of changes in the relief and density of the walls of the uterus is characteristic, bleeding areas of dark blue or purple color are detected.
- Stage 2. There is uneven relief of the uterine wall, low distensibility of the uterus.
- Stage 3. Characterized by bulging of the uterine mucosa in some areas, sealing the walls of the uterus. For this stage, the creaking of the walls of the uterus is characteristic due to their excessive compaction.
Detection of this disease with hysteroscopy is sometimes difficult. In this regard, appoint such additional research methods as ultrasound, MRI (Magnetic resonance imaging), histological examination.
Endometritis is an inflammatory disease that is characterized by a lesion of the surface layer of the uterine lining. Chronic endometritis is especially well detected on hysteroscopy.
Hysteroscopic signs of endometritis are:
- hyperemia (rednessa) the walls of the uterus,
- symptom of "strawberry field" (whitish ducts of glands on the background of bright red mucous membrane),
- bleeding at the slightest touch,
- flabbiness of the uterus,
- uneven thickening of the uterine mucosa,
- point hemorrhages.
Intrauterine synechia are adhesions that form in the uterus and can partially or completely fill it. This condition is also called Asherman's syndrome. Hysteroscopy is the main diagnostic method for intrauterine synechia.
The presence of synechiae in the uterus is a factor that interferes with the normal functioning of the endometrium and can lead to various complications - menstrual disorders, miscarriages, premature birth, infertility.
When hysteroscopic examination revealed strands whitish, stretching between the walls of the uterus. Synechiae, located in the area of the cervical canal, can lead to its overgrowth. As a rule, when detecting synechiae in the cervical canal during hysteroscopy, surgical treatment is immediately performed, that is, dissection of these formations.
In the development of Asherman syndrome, there are 3 stages:
- Stage 1. Involvement in the pathological process of less than ки of the uterus, the absence of damage to the bottom of the uterus and the mouth of the fallopian tubes.
- Stage 2. Involvement in the pathological process up to ¾ of the uterus, a partial overlap of the mouth of the fallopian tubes and the bottom of the uterus.
- Stage 3. Involvement of more than ¾ of the uterus in the pathological process.
The intrauterine septum is an anomaly of the development of the uterus, which is characterized by the formation of a septum, which divides the uterus into two parts. This pathological condition is quite rare (2 - 3% of women).
The presence of an intrauterine septum is accompanied by a high risk of pregnancy complications - infertility, termination of pregnancy, abnormal development of the embryo, premature birth. Such complications are observed in almost 50% of women with this pathology. In the presence of an intrauterine septum, the uterus cannot contract normally during childbirth, which significantly complicates the birth process.
When hysteroscopic examination revealed a septum, which has the shape of a triangular strip. The partition can be located longitudinally or transversely, be thin or thick, full or incomplete. A complete septum reaches the cervical canal. Rarely a septum may form in the cervical canal. The walls of the intrauterine septum are straight.
For completeness of the clinical picture, in parallel with hysteroscopy, additional methods of investigation can be prescribed - laparoscopy, MRI. This is due to the need for differentiation of the intrauterine septum with another uterine anomaly - the two-horned uterus.
The two-horned uterus is an anomaly of development, which is characterized by splitting of the uterus into two parts. Normally, the uterus develops from the Mullerian ducts (channels that are formed during fetal development), which by the 15th week of intrauterine development grow together. If this does not happen, then the uterus splits into two parts. The causes of this phenomenon is the action of teratogenic factors (physical, chemical and biological factors that adversely affect the fetus during embryonic development and cause organ malformations).
Uterine cleft may be complete or incomplete. As a rule, when the two-horned uterus forms one cervix and one vagina. During hysteroscopy of the two-horned uterus, the division of the uterus into two cavities above the cervix, the bulge and the arcuate shape of the middle wall of the uterus are revealed. The mouth of the fallopian tubes are visualized.
In addition to hysteroscopic examination, laparoscopy is performed, which allows the diagnosis to be clarified by examining the uterus from the abdominal cavity. On laparoscopy, the two-horned uterus has a saddle shape with two "horns".
Foreign bodies in the uterus
As foreign bodies in the uterus, intrauterine contraceptives are most common (VMK), ligatures, remnants of bone fragments, remnants of the placenta or fetal egg. Hysteroscopy is the main method for detecting foreign bodies in the uterus.
Ligatures in the uterine cavity are threads of silk or lavsan, with the help of which sutures were stitched during various operations on the uterus. Bone fragments are usually the result of termination of pregnancy for long periods. The IUD and its fragments may remain in the uterus when they are not successfully removed. The remains of the ovum in the uterus are a sign of incomplete abortion. Remains of placental tissue can be observed after childbirth as a complication.
Hysteroscopy is allowed to identify foreign bodies, their location, the degree of damage to surrounding tissues, the introduction of foreign bodies into the endometrium or myometrium.