Hysteroscopy & Abnormal Uterine Bleeding - SASOG · Abnormal uterine bleeding 27(28%) 158 ......

Hysteroscopy & Abnormal Uterine Bleeding

T Matsaseng

SASOG 2014

DIAGNOSTIC ROLE

No No No!!!

•Prospective cohort study

•89 premenopausal women

Results

Soguktas S et al. EJOG 2012; 161: 66-70

Results

Soguktas S et al. EJOG 2012; 161: 66-70

Conclusion

• Hysteroscopy – superior to SIS

• Treat immediately

• Done under GA

Soguktas S et al. EJOG 2012; 161: 66-70

ADVANTAGES

• No need for anaesthesia, cervical dilatation, hospitalization

• Accurate visual assessment: canal & cavity

• Tolerable/Interactive

• Treat

Table 1. Demographics of referral patterns to hysteroscopy clinic

Referral patterns

≤ 40yr (n=96) > 40yr (n=161)

Abnormal uterine bleeding 27(28%) 158(98%)

Infertility 40(41,6%) 1(0,6%)

Recurrent spontaneous

miscarriage

26(27%) 0(0%)

Clinical suspicion of uterine

polyps or other uterine

pathology

3(3%) 2(1,2%)

Matsaseng T. Unpublished data 2010.

Light source & Camera system

• Xenon light: 175 W

• Mini-scopes: 300 W

• Recording & printing

Operative instruments

Operative instruments - electro

OPERATIVE ROLE

SURGICAL ROLE

• Polypectomy

• Myoma resection

• Metroplasty

• TCRE

Instrumentation

Complication

Haemorrhage

• Procedure

• Depend – site & energy

• 2.5% (loop & roller)

• 3.5% (loop alone)

• Electrocautery/Tamponade

• Ligation/Hysterectomy

Bradley L. Curr Opin Obstet Gynecol 2002;14:409-415.

Perforation

• 0.8% risk

• Dilatation

• Size, site & method

• Estimate (sound)

• Visualize & Combined

• Conservative/ Laparoscopy

Bradley L. Curr Opin Obstet Gynecol 2002;14:409-415.

Fluid overload

• Saline/Mannitol

• Abandon (time & 2L deficit)

• Monitoring fluid balance

• Diuretics

• Pressures <100mmgH

Bradley L. Curr Opin Obstet Gynecol 2002;14:409-415.

Lowest pressures for distention Saline safer than electrolyte free media Consider GnRHa CO2 for diagnostic procedures Input/Output Time limits (<2hrs) Automated electronic devices

AAGL Practice committee. JMIG 2013; 20(2): 137-148

AAGL Practice committee. JMIG 2013; 20(2): 137-148

Infection

• Uncommon

• Prophylactic antibiotics

• Appropriate regimen

• V. Discharge – self limiting

Bradley L. Curr Opin Obstet Gynecol 2002;14:409-415.

Adhesion formation

• Myomectomy/Resection

• Two step procedure

• IUCD

• HRT

• Second look

Roy KK et al. Arch Gynecol Obstet 2010;281:355-361.

Thank you.........