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Matsaseng T. Unpublished data 2010.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.........