Diagnostic and surgical hysteroscopy of the uterus: what is it and how is it performed? Detection of intrauterine pathologies by diagnostic hysteroscopy Examination of the uterus hysteroscopy

Hysteroscopy is a visual examination of the uterus and cervical canal using specialized optical equipment. The procedure significantly expands the diagnostic possibilities in assessing the condition of the uterus and treating pathological processes.

The procedure not only allows you to accurately diagnose intrauterine pathology, but also makes it possible to perform simple operations without incisions and injury to surrounding tissues.

What is hysteroscopy and its types?

To date, this effective method of endoscopic diagnosis is used to detect intrauterine pathologies in most gynecological hospitals.

There are several types of hysteroscopy, depending on the goals and objectives of the doctor:

• diagnostic involves examination of the inner surface of the uterus using optical instruments. The procedure allows you to determine the presence or absence of a pathological process. The integrity of the tissues during the diagnostic study is not violated;
• surgical is carried out for the purpose of atraumatic endoscopic intervention and surgical treatment of various intrauterine pathologies. In particular, with the help of surgical hysteroscopy, the removal of polyps and myomatous nodes is successfully carried out;
• control necessary to monitor the progress of treatment. The examination allows you to identify its effectiveness, fix relapses in time, monitor the condition of the uterus after surgical or conservative therapy.

Modern medical equipment allows you to get the most complete picture of the state of the uterus and cervical canal. Different types of hysteroscopes, depending on the degree of magnification, help to assess the condition of the epithelium and internal structures of the uterine endometrium, as well as to carry out microscopic diagnostics by examining the uterine epithelium at the cellular level.

Microhysteroscopy allows for high-precision endoscopic operations, due to the multiple magnification of the image.

To conduct such an examination, a prerequisite is the stretching of the uterine cavity through liquid or gaseous media. Depending on the stretching method used, there are liquid and gas hysteroscopy. To do this, doctors use carbon dioxide, saline, dextran, dextrose solution, sorbitol, sterile water. All used environments provide the best visualization during the examination, being absolutely safe for the patient.

Why is hysteroscopy prescribed?

Among the indications for hysteroscopy, the following pathologies are distinguished, requiring confirmation of the diagnosis, control and treatment:

• endometrial polyps;
• myoma nodes;
• intrauterine synechia;
• various physiological defects of the uterus;
• suspicion of the presence of a foreign body or perforation of the walls of the uterus;
• suspicion of a malignant tumor;
• intrauterine fistula;
• adhesions in the uterine cavity.

Examination is often prescribed for infertility. Hysteroscopy before IVF (in vitro fertilization) allows you to assess the condition of the uterus and make sure that it is physiologically ready for the procedure. Relative indications for hysteroscopic examination may be bleeding from the genitals, irregular menstruation, primary miscarriage, and control after hormone therapy.

Contraindications for hysteroscopy

There are a number of pathologies in which endoscopic diagnostics is unacceptable:

• cervical stenosis;
• acute inflammatory process;

Preparation for surgery and necessary tests

Before the procedure, the patient must undergo a mandatory gynecological examination. The initial examination helps the doctor assess the condition of the vagina and the vestibule of the cervix, as well as exclude the presence of an infectious lesion of the genital organs. During the examination, the doctor takes tests for hysteroscopy (a bacteriological smear from the vagina, as well as a smear for oncocytology). The results of the analyzes are required to exclude the presence of absolute contraindications to the procedure.

Rules for preparing for hysteroscopy of the uterus:

• do not use vaginal suppositories, suppositories, sprays and other medications, as well as intimate hygiene products for a week before the procedure;
• refrain from sexual intercourse for two days before the study.

What day is a hysteroscopy done?

Depending on the indications, the study is carried out in different phases of the cycle. If the procedure was prescribed for the diagnosis of adenoma or uterine fibroids, the study must be carried out in the first phase of the menstrual cycle (a few days after the end of menstrual bleeding). In the second phase of the cycle, hysteroscopy is performed to diagnose infertility and endometriosis.

For control and diagnostic hysteroscopy, hospitalization is not required, however, in the case of a surgical operation, the procedure is most often performed in a hospital.

How is hysteroscopy performed?

The procedure is performed under anesthesia and does not take longer than 15-30 minutes. The vagina is expanded with speculums to gain access to the cervix.

Using special devices, the doctor evaluates the length of the uterus and expands the cervical canal, after which he inserts a hysteroscope connected to the fluid supply system into the uterine cavity.

Moving the hysteroscope clockwise, the doctor examines the mouth of the fallopian tubes, assesses the condition of the endometrium, the shape and relief of the uterine cavity.

Video: "What is hysteroscopy of the uterus? Preparation, conduct and rehabilitation. Hysteroscopy and IVF"

In most cases, the procedure is easily tolerated by patients. Diagnostic hysteroscopy does not require additional observation and further rehabilitation, and is also very rarely accompanied by pain and bleeding.

If a surgical hysteroscopy has been performed, the patient needs medical supervision for some time after the completion of the procedure. To prevent the development of bacterial infections, antibiotics of various pharmacological groups are prescribed. Additionally, the nature of bleeding after hysteroscopy of the uterus is assessed. Most often, spotting is moderate, and after a while they disappear completely. Scanty vaginal discharge after the procedure is not a cause for concern.

To relieve pain, doctors recommend taking over-the-counter painkillers (Ibuprofen, Analgin, Baralgin) in the first days after surgery. Painkillers should be taken only if there is a pronounced pain syndrome. With mild pain in the lower abdomen, additional treatment is not required. Minor pains after hysteroscopy go away on their own within a couple of days.

If a woman has been prescribed a curettage procedure, doctors recommend preventing pregnancy for several months. The most optimal period for pregnancy after hysteroscopy with curettage is at least a year after the procedure.

• sex after hysteroscopy is unacceptable for a couple of days after the study;
• refuse to use tampons, suppositories and vaginal suppositories;
• you should refrain from visiting baths, saunas, swimming pools. It is not recommended to take a bath;
• 3 days after the procedure, the patient can return to her usual routine.

Possible complications and consequences of hysteroscopy

Hysteroscopy is a safe diagnostic procedure, after which there are practically no complications. In rare cases, after the study, an infectious lesion of the uterine cavity is observed. In rare cases, there is severe uterine bleeding.

Abundant periods after hysteroscopy are not a pathological consequence of the procedure, however, in the event of abundant purulent and bloody discharge in the middle of the cycle, accompanied by fever and severe pain, you should consult a doctor.

Hysteroscopic picture and possible pathologies

Picture of a hysteroscopic examination of a healthy woman:

• in the first phase of the cycle, the endometrium has a uniform pale pink color and a small thickness. In the later phases of the cycle, the vascular pattern of the endometrium becomes less noticeable, folds form on the surface of the endometrium. The color intensity of the endometrium increases in the last phase of the cycle;
• The uterus is normally oval in shape. The mouths of the fallopian tubes are clearly visible at the beginning of the cycle, until the endometrium is thickened. With various intrauterine pathologies, the hysteroscopic picture changes.

With endometrial atrophy, the uterine mucosa has an uneven color, and foci of hemorrhages can be observed on it. The endometrium is thin, blood vessels show through it.

With submucosal myoma, the study reveals a rounded neoplasm protruding into the uterine cavity. The myomatous node has well-defined contours and a uniform pale pink hue.

Hyperplasia is characterized by uneven thickening of the endometrium, which acquires an uncharacteristic bright pink color.

Endometrial cancer is characterized by the development of large folds and polypoid formations prone to contact bleeding.

Endometrial polyps are represented by multiple neoplasms with a pronounced vascular pattern, protruding into the uterine cavity and having an irregular shape.

Intrauterine synechia during examination are determined in the form of fragments of fibrous tissue that does not have a vascular pattern. Synechiae reduce the volume of the uterus and limit visual access to its corners.

If the patient has a suspicion of a malignant tumor, an additional histological examination of the tissues is necessary to clarify the diagnosis.

Hysteroscopy of the uterus: indicative prices

How much does a hysteroscopy cost? The cost of the procedure depends on the type of clinic and the region in which the operation is performed. Also, the cost of the procedure is affected by its complexity.

Prices for diagnostic and control hysteroscopy on average vary between 4-9 thousand rubles. Surgical hysteroscopy will cost the patient more: prices for endoscopic surgery reach 13-20 thousand rubles.

Hysteroscopic examination is a safe, low-traumatic and virtually no side-effects procedure that significantly expands the arsenal of diagnostic techniques in modern gynecology.

The procedure does not impair the woman's reproductive function and does not affect the woman's ability to further conceive children. Today, hysteroscopy is one of the most important methods that guard women's health.

Hysteroscopy is a method of examining the cavity uterus using a hysteroscope special optical device). This procedure can be performed both for diagnostic purposes and for the treatment of diseases of the uterus. Diagnostic hysteroscopy is performed to detect uterine pathologies and control previous surgical treatment. The purpose of therapeutic hysteroscopy is the removal of neoplasms and foreign bodies of the uterine cavity, the treatment of hyperplastic processes ( excessive formation of structural elements of tissues). Hysteroscopy is considered a minimally invasive method, that is, when it is performed, minimal tissue damage occurs, which reduces the risk of complications. At the moment, for the detection and treatment of certain pathologies of the uterus, this method is unique.

Anatomy of the uterus

From an anatomical point of view, the following sections of the uterus are distinguished:

• Body. In the uterus, the anterior and posterior surfaces are distinguished. The part of the body located just above the attachment to the uterus of the fallopian tubes is called the fundus of the uterus.
• Neck. This part is a continuation of the body of the uterus. The upper part of the cervix, adjacent directly 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 vaginal cavity through the uterine opening. The mucous membrane that covers the cervical canal contains numerous glands. In some pathological conditions, the excretory ducts of these glands can be blocked, leading to the formation of cysts filled with cervical secretions ( Naboth's cysts).
• isthmus represents the place where the body of the uterus passes into the cervix. Its length is about 1 cm.

The following layers are distinguished in the wall of the uterus:

• 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 perimetrium extends to the bladder, forming the vesicouterine cavity, and the rectum, forming the recto-uterine cavity ( Douglas space).
• Myometrium- this is the muscular membrane of the uterus, which consists of three layers - superficial ( outer), average ( vascular) and internal ( subvascular). Muscle fibers are intertwined with each other in various directions - longitudinal, oblique and circular ( circular). In the body of the uterus, muscle fibers are located mainly longitudinally, and in the region of the neck and isthmus - circularly.
• endometrium is the mucous membrane of the uterus, which consists of the basal and functional layers. The basal layer is adjacent directly to the myometrium. The functional layer is located more superficially and is thicker. In the functional layer, cyclic changes occur associated with the menstrual cycle. These changes are proliferation ( overgrowth) endometrium, rejection of the functional layer and its regeneration ( recovery) after menstruation. Tubular glands are located in the endometrium.

Indications for hysteroscopy of the uterus

Indications for hysteroscopy of the uterus are:

• control study after surgical interventions on the uterus, after hormonal therapy;
• bleeding during the postmenopausal period period of life after the last menstruation);
• suspicion of an abnormal development of the uterus;
• suspicion of endometrial pathology;
• suspicion of the presence of damage to the myometrium;
• menstrual irregularities;
• spontaneous abortion;
• suspicion of the presence of foreign bodies in the uterine cavity;
• perforation is suspected wall perforation) uterus;
• postpartum complications;
• diagnostic curettage of the endometrium ( recommended under hysteroscopy control).

Hysteroscopy is absolutely contraindicated during pregnancy, as the procedure may lead to its interruption ( miscarriage). Also, hysteroscopy is contraindicated in certain pathological conditions.

Contraindications for hysteroscopy are:

• Systemic infectious diseases. This contraindication is absolute, since the risk of spreading the infectious process is very high. Hysteroscopy can be performed only after the elimination of the pathological process.
• Inflammatory diseases of the genital organs. The study is not performed in acute inflammatory diseases or exacerbation of chronic diseases. In this regard, they are preliminarily treated and the activity of the inflammatory process is reduced.
• Cervical cancer is an absolute contraindication. The reason is the high risk of spread of the tumor process to the surrounding tissues. This is due to the fact that hysteroscopy uses liquid media to expand the uterine cavity, which, on the one hand, contributes to better visualization of the walls of the uterus, and on the other hand, the spread of tumor cells in the uterine cavity or through the fallopian tubes into the abdominal cavity.
• Uterine bleeding. With uterine bleeding, the diagnostic value of the procedure may be low due to the low information content in case of heavy bleeding. In this case, it is recommended to conduct hysteroscopy in such a way that it is possible to receive and outflow of fluid through different channels, as well as to ensure constant 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 insufficient visibility of the walls of the uterus. In this regard, this method is usually carried out on the 5th - 7th day of the menstrual cycle.
• The serious condition of the patient. The severe condition of the patient with somatic diseases is a contraindication until compensation is achieved ( recovery) of the patient's condition.
• Stenosis ( constriction) cervix. This condition is associated with a high risk of tissue damage to the cervical canal.
• Violation of blood clotting. This condition is accompanied by a high risk of developing extensive blood loss during surgery and postoperative bleeding.

Hysteroscopy technique

The main instrument with which hysteroscopy is performed is the hysteroscope, which is an optical system.

The hysteroscope consists of the following parts:

• telescope;
• metal case;
• valve for gas or liquid;
• valve for removing gas or liquid;
• channel for the introduction of instruments.

To perform various manipulations, the hysteroscope is equipped with auxiliary tools. As auxiliary tools, endoscopic catheters, forceps, scissors, probes, laser and electrical conductors are used.

On what day of the menstrual cycle is a hysteroscopy of the uterus performed?

Anesthesia for hysteroscopy of the uterus

If general anesthesia is not possible, paracervical anesthesia is performed. To do this, the tissues around the cervix are infiltrated with anesthetics ( drugs that cause anesthesia). This method is considered less efficient.

The next stage of intervention is the expansion of the uterine cavity. Although it is possible to perform the procedure without expanding the uterine cavity, this technique is currently used much less frequently. Usually, hysteroscopy without expanding the uterine cavity is performed on an outpatient basis. The expansion of the uterine cavity can be carried out in two ways - with the help of gas or liquid.

Hysteroscopy technique

Depending on the method of expanding the uterine cavity, hysteroscopy can be of two types:

• gas hysteroscopy;
• liquid hysteroscopy.

According to the size of the cervix, a cap is selected, which is put on and fixed on it. To wash the walls of the uterine cavity, a small amount of saline is injected ( 50 ml), which is then sucked out. A light source, a tube for gas supply, is attached to the hysteroscope. Further, after the expansion of the uterine cavity, its detailed examination is carried out.

Liquid hysteroscopy
To expand the uterine cavity during liquid hysteroscopy, high and low molecular weight liquid media can be used ( solutions). High-molecular media ( dextran) are practically not used, since they have an increased viscosity, slow absorption from the abdominal cavity, high cost and are accompanied by an increased risk of developing an anaphylactic reaction. The most commonly used low molecular weight solutions. As low molecular weight solutions, physiological saline, distilled water, Ringer's solution, glucose solution, glycine solution are used.

Liquid hysteroscopy also has disadvantages, the main of which are the risk of overloading the vascular bed, and relatively the risk of developing infectious complications. When comparing the advantages and disadvantages of both methods of expanding the uterine cavity, many doctors prefer liquid hysteroscopy.

During the procedure, it is of great importance to constantly measure the volume of fluid and the pressure under which it is supplied to the uterine cavity. These two indicators affect the quality of the review during the operation, the possibility of manipulation and the development of complications during and after the operation.

With liquid hysteroscopy, for a better outflow of fluid, the cervix is ​​​​dilated using Hegar 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. After making sure that the device is in the uterine cavity, they begin to examine the walls of the uterine cavity, the mouth of the fallopian tubes and the cervical canal.

If pathological changes in the endometrium are detected, a biopsy is performed ( excision of a piece of tissue for further histological examination).

How to prepare for a hysteroscopy of the uterus?

What tests should be done before hysteroscopy of the uterus?

The main studies prescribed before hysteroscopy are:

• coagulogram ( assessment of the state of the blood coagulation system);
• blood sugar ( glycemia);
• x-ray examination of the chest;
• ultrasound ( ultrasound procedure) abdominal cavity;
• transvaginal ultrasound ( when the probe is inserted into the vagina) or transabdominal ( when the probe is passed along the abdominal wall) Ultrasound of the small pelvis;
• ECG ( electrocardiogram);
• examination of smears from the vagina for the degree of purity ( with 3 and 4 degrees of purity, the intervention is carried out only after the sanitation of the vagina);
• bimanual study ( a study of the state of the uterus, which is carried out with two hands, with one hand located in the vagina, and the second on the anterior abdominal wall).

Immediately before the procedure, a number of preparatory measures are carried out. These include not 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?

A normal hysteroscopic picture may look different, depending on the time when the study was performed ( proliferative or secretory phase of the menstrual cycle, menstruation, postmenopause).

The state of the endometrium has its own characteristics in the following periods:

• proliferative phase. The endometrium is light pink in color, thin. There may be isolated areas with small hemorrhages. The mouths of the fallopian tubes are available for review. From about the ninth day of the cycle, the endometrium gradually thickens, forming folds. Normally, the uterine mucosa is thickened in the region of the fundus and posterior wall of the uterus.
• secretory phase. The endometrium becomes thickened and edematous, acquiring a yellowish color. The orifices of the fallopian tubes may not be visible. A few days before menstruation, the endometrium becomes hyperemic ( bright red), which can be confused with pathological changes in the endometrium. The vessels of the endometrium in this phase are more fragile, because of which they can easily be damaged and cause bleeding.
• Menstruation. During menstruation, hysteroscopy reveals scraps of the mucous membrane. By the second - third day of menstruation, there is an almost complete rejection of the endometrium, fragments can still be observed in places.
• Postmenopause. Postmenopausal women are 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. During the postmenopausal period, the folded structure of the mucous membrane disappears, synechia may be observed ( adhesions).

With hysteroscopy, the following pathological signs can be detected:

• trauma to the endometrium;
• blood clots;
• varicose veins of the uterus;
• rupture of endometrial vessels;
• abnormal development of the uterus;
• atrophy of the endometrium with punctate and multiple hemorrhages ( with diabetes);
• areas of hemorrhage;
• proliferation of the endometrium;
• the presence of polyps;
• areas with dystrophic changes ( malnourished tissue);
• areas of necrotic ( unviable) tissue;
• the presence of foreign bodies;
• the impossibility of identifying the mouth of the fallopian tubes;
• the presence of inflammatory changes in the mucous membrane.

What diseases can be detected by hysteroscopy?

Diseases that can be detected with hysteroscopy are:

• submucosal uterine fibroids;
• endometrial polyps;
• polyps of the cervical canal;
• endometrial cancer;
• adenomyosis;
• intrauterine synechia;
• intrauterine septum;
• bicornuate uterus;
• foreign bodies in the uterine cavity;
• perforation of the uterus.

endometrial hyperplasia

Pathological changes detected during hysteroscopy of the uterus can be varied and differ depending on the type and prevalence ( local or widespread) hyperplasia, presence of bleeding, duration of bleeding.

Endometrial hyperplasia can be normal or polypoid. With normal hyperplasia, a thickening of the endometrium is observed, 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. With polypoid hyperplasia on the mucous membrane, numerous growths in the form of polyps, multiple endometrial adhesions are revealed. Polypoid hyperplasia should be differentiated from the physiological state of the mucous membrane in the secretory phase. A biopsy is performed to confirm the diagnosis. When making a diagnosis, the data of a histological examination, the day of the menstrual cycle on which hysteroscopy was performed, and clinical manifestations are taken into account.

Submucosal uterine fibroids

Myomas are presented in the form of submucosal ( myomatous) nodes, which, as a rule, have a spherical shape, a dense consistency. The nodes gradually deform the uterine cavity. Submucosal 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 sizes that they can fill almost the entire uterine cavity.

The criteria characterizing myomatous nodes are:

• the size;
• location;
• intramural component value ( part of the node, located mainly in the wall of the uterus);
• amount ( single or multiple nodes);
• base width ( knot with a wide base or on a leg).

endometriosis

Hysteroscopy can detect endometriosis localized within the uterine cavity ( internal endometriosis). In the case of localization of the pathological process outside the uterine cavity, ultrasound and laparoscopy are prescribed. The final diagnosis of endometriosis is established on the basis of clinical manifestations, data from instrumental studies and the results of a histological analysis of the biopsy.

Endometrial polyps

Most often, polyps are single formations. The pathological condition in which multiple polyps are found is called endometrial polyposis. Clinical symptoms in the case of polyps of small sizes 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 irregularities may appear.

The hysteroscopic picture of endometrial polyps can be varied depending on the type of polyp. Polyps are differentiated by size, location, color, structure, and also according to histological examination.

Endometrial polyps can be of the following types:

• Fibrous polyps. They can reach 1.5 - 2 cm in diameter, as a rule, they have a leg. They are rounded formations of a whitish color with a smooth surface. By external signs, fibrous polyps may resemble myomatous nodes, which requires careful 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 are formations of a pale pink color with a smooth surface. They 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 region of the fundus of the uterus and the orifices of the fallopian tubes. The surface of adenomatous polyps is uneven, they are most often gray in color. The presence of adenomatous polyps is accompanied by a high risk of degeneration into a malignant formation.

In some cases, the polyps of the uterine body reach such large sizes that they penetrate the cervical canal. This condition is more common in postmenopausal women.

Polyps of the cervical canal

In more than 30% of women with 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 become malignant, so timely diagnosis and treatment play a big role.

endometrial cancer

Endometrial cancer can spread to the mucous membrane of the cervical canal, ovaries, abdominal cavity. Hematogenous spread of the malignant process is accompanied by the appearance of distant metastases ( tumor spread to other tissues).

Hysteroscopy reveals that the tissues of the uterus are very loose. Even with a slight increase in the rate of fluid supply to expand the uterine cavity, the tissues begin to break down and bleed. On the mucous membrane, "craters" are detected ( ulceration of the mucosa in the affected areas), growths of the mucous membrane of various shapes, areas of necrotic tissue. The surface of the neoplasm is uneven, characterized by an increase in the vascular pattern.

If signs of endometrial cancer are detected on hysteroscopy, especially a common form, its removal is considered inappropriate. Initially, a biopsy is performed followed by a histological examination. The results of the study are one of the determining factors in the choice of treatment tactics. Timely detection of endometrial cancer plays a key role.

Adenomyosis

Adenomyosis is a disease that should be given great attention, as it is a precancerous condition. Malignancy ( transformation of a benign tumor into a malignant one) is observed in about 10% of cases.

Hysteroscopy for adenomyosis reveals pathological changes in the form of dots or slits ( "eyes") black or purple in color, from which blood may stand out.

The hysteroscopic picture differs at different stages of adenomyosis:

• 1 stage. Characteristically, there is no change in the relief and density of the walls of the uterus, bleeding areas of a dark blue or purple color are found.
• 2 stage. There is uneven relief of the walls of the uterus, low extensibility of the uterine cavity.
• 3 stage. Characterized by bulging of the mucous membrane of the uterus in some areas, thickening of the walls of the uterus. For this stage, the creak of the walls of the uterus is characteristic due to their excessive compaction.

Identification of this disease during hysteroscopy is sometimes difficult. In this regard, such additional research methods as ultrasound, MRI are prescribed ( Magnetic resonance imaging), histological examination.

endometritis

Hysteroscopic signs of endometritis are:

• hyperemia ( redness) the walls of the uterus;
• symptom of "strawberry field" ( whitish ducts of the glands against the background of a bright red mucous membrane);
• bleeding at the slightest touch;
• sagging of the walls of the uterus;
• uneven thickening of the uterine mucosa;
• pinpoint hemorrhages.

Intrauterine synechia

The presence of synechia in the uterine cavity is a factor that interferes with the normal functioning of the endometrium and can lead to various complications - menstrual irregularities, miscarriages, premature birth, infertility.

A hysteroscopic examination reveals whitish strands extending between the walls of the uterus. Synechia located in the area of ​​the cervical canal can lead to its infection. As a rule, when synechia is found in the cervical canal during hysteroscopy, surgical treatment is immediately performed, that is, dissection of these formations.

In the development of Asherman's syndrome, 3 stages are distinguished:

• 1 stage. Involvement in the pathological process of less than ¼ of the uterine cavity, the absence of damage to the fundus of the uterus and the mouth of the fallopian tubes.
• 2 stage. Involvement in the pathological process up to ¾ of the uterine cavity, partial overlap of the mouth of the fallopian tubes and the bottom of the uterus.
• 3 stage. Involvement in the pathological process of more than ¾ of the uterus.

Intrauterine septum

The presence of an intrauterine septum is accompanied by a high risk of pregnancy complications - infertility, abortion, 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 greatly complicates the birth process.

A hysteroscopic examination reveals 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 straightened.

To complete the clinical picture, in parallel with hysteroscopy, additional research methods can be prescribed - laparoscopy, MRI. This is due to the need to differentiate the intrauterine septum from another anomaly in the development of the uterus - a bicornuate uterus.

bicornuate uterus

Uterine cleavage may be complete or incomplete. As a rule, with a bicornuate uterus, one cervix and one vagina are formed. Hysteroscopy of the bicornuate uterus reveals the division of the uterus into two cavities above the cervical region, the bulge and arched shape of the median wall of the uterus. The orifices of the fallopian tubes are visualized.

In addition to a hysteroscopic examination, laparoscopy is performed, which allows you to clarify the diagnosis by examining the uterus from the abdominal cavity. On laparoscopy, the bicornuate uterus has a saddle shape with two "horns".

Foreign bodies in the uterine cavity

Ligatures in the uterine cavity are threads made of silk or lavsan, with the help of which sutures were applied during various operations on the uterus. Bone fragments are usually the result of long term abortions. IUDs and their fragments may remain in the uterine cavity if they are unsuccessfully removed. The remains of the ovum in the uterus are a sign of an incomplete abortion. Remains of placental tissue can be observed after childbirth as a complication.

Hysteroscopy allows you to identify foreign bodies, their location, the degree of damage to surrounding tissues, the introduction of foreign bodies into the endometrium or myometrium.

Foreign bodies in the uterine cavity

Laparoscopy can be used to remove foreign bodies simultaneously with hysteroscopy. This means that the removal is carried out using a hysteroscope, but under laparoscopic control.

Perforation of the uterus

Perforation as can be detected during hysteroscopy, and can be its complication. If a perforation occurs during hysteroscopy, the ongoing procedure is immediately stopped and measures are taken to eliminate the perforation. Perforation of the uterine wall can be carried out with instruments during surgical procedures. Perforation of the uterus during laser or electrosurgical operations is considered the most dangerous, which is accompanied by an increased risk of damage not only to the uterus, but also to other nearby organs ( intestines).

The main signs indicating perforation are a sharp failure of the hysteroscope, an increase in the amount of fluid supplied and a decrease in the amount of outflowing fluid.

What to do after hysteroscopy?

The presence of discharge from the genital tract for several weeks should not disturb the patient, as this is normal after hysteroscopy. In this condition, drugs are not prescribed.

The doctor may prescribe a course of anti-inflammatory and antibacterial therapy for preventive purposes. Drugs can be prescribed for oral administration, in the form of injections or vaginal suppositories. In the presence of inflammatory diseases of the uterine cavity, drugs are prescribed before the procedure. It is considered inappropriate to prescribe antibiotic therapy to all patients ( without the need).

In some cases, hormone therapy may be prescribed. The goal of postoperative hormonal therapy is to accelerate re-epithelialization ( restoration of the epithelial lining), especially in the case of multiple adhesions.

Intimate life after hysteroscopy of the uterus must begin, following the recommendations of doctors. Usually, experts recommend starting sexual activity at least 3 to 4 weeks later. Early onset of sexual activity after hysteroscopy can lead to the development of complications.

A repeated hysteroscopic examination is scheduled 2 weeks after the intervention. The doctor evaluates the effectiveness of the manipulation, the condition of the uterus, the presence of complications. During this time, biopsy results also appear.

Therapeutic hysteroscopy

Hysteroscopic operations are divided into two types:

• Simple operations. They do not require special preliminary preparation for the operation. Simple surgeries can be performed on an outpatient basis. Such operations include the removal of polyps and myomatous nodes of small sizes, the dissection of a thin uterine septum, the removal of foreign bodies located in the uterine cavity and not embedded in its walls ( removal of fragments of an intrauterine contraceptive, remnants of the ovum or placenta).
• Complex operations. Complex operations are carried out only in stationary conditions. Such operations include the removal of foreign bodies that have grown into the wall of the uterus, the removal of large polyps, and the dissection of the thick uterine septum. Complex hysteroscopic operations in some cases are carried out after preliminary preparation with hormonal preparations. Often, these operations are performed simultaneously with laparoscopy.

Therapeutic hysteroscopy may be a planned operation, or the doctor may decide to treat immediately after the discovery of pathological changes in the uterus during diagnostic hysteroscopy.

Therapeutic hysteroscopy involves the use of the following operating techniques:

• mechanical surgery. Mechanical surgery involves the mechanical removal of pathological formations using special tools ( tongs, scissors);
• Electrosurgery. The essence of electrosurgery is the passage of high-frequency current through the tissues. Electrosurgery uses two main methods - cutting and coagulation. Moreover, for each method, the forms of the electric current used are different. At the cellular level, when cutting, there is a sharp increase in cell volume, an increase in intracellular pressure, a rupture of the cell membrane and destruction of tissues. During electrocoagulation at the site of application of the electrode, tissues dry out, denaturation ( structure violation) proteins and blockage of blood vessels, which is accompanied by a hemostatic effect. If it is necessary to use cutting and electrocoagulation at the same time, a mixed mode is used. Uterine dilation fluids used in electrosurgery must not conduct electricity. In this regard, the most commonly used media are glycine, rheopolyglucin, glucose.
• laser surgery. Laser surgery can be contact and non-contact. The laser is used as a hemostatic method, for ablation ( destruction) tissues. When using laser surgery, the doctor and the patient must wear protective goggles, as part of the laser energy is scattered and reflected, which can lead to damage to the structures of the eye, which are very sensitive to the action of the laser.

Removal of a cervical canal polyp by hysteroscopy

Cervical polyps found during diagnostic hysteroscopy are usually removed immediately. The removal method can be mechanical, electrosurgical, laser or mixed. Before removal, the doctor carefully examines the walls of the cervical canal, determines the localization, type, size of the polyps. To remove the polyp of the cervical canal, it is unscrewed with the help of tools, the formation is removed, and then the cervical canal is scraped.

The most common complications that occur after removal of a cervical canal polyp are frequent recurrences ( reappearance) polyps, cervical stenosis, infertility ( cervical factor), malignancy ( development of malignant tumors), infectious complications.

In the postoperative period, anti-inflammatory and antibacterial therapy may be prescribed to prevent complications. An important role in normal regeneration after surgery is played by personal hygiene and abstinence from sexual intercourse after the intervention ( at least 1 month).

Removal of an endometrial polyp by hysteroscopy

With large endometrial polyps, removal can be performed mechanically by unscrewing, and the leg is additionally excised with special scissors or a resectoscope.

In more complex cases ( localization of the polyp in the area of ​​​​the mouth of the fallopian tubes, parietal polyps) mechanical removal is not suitable. They resort to methods of laser surgery or electrosurgery. After removal of the polyp, cauterization of the endometrium is usually carried out in the place where the polyp was located.

After removal of the endometrial polyp, a repeated hysteroscopy is usually performed to monitor the effectiveness of the operation.

Laser cauterization of the endometrium during hysteroscopy

Indications for laser cauterization of the endometrium are:

• recurrent ( recurring a) endometrial hyperplasia;
• recurrent ( recurring a) heavy uterine bleeding;
• lack of effect from conservative therapy;
• the impossibility of prescribing other methods for the treatment of hyperplastic processes ( contraindications).

Laser cauterization can be carried out in two ways:

• contact method. The contact method involves touching the laser light guide to the walls of the uterus. The disadvantage of the contact method is that it is lengthy.
• contactless method. When using the non-contact method, cauterization is carried out without touching the laser light guide to the surface of the uterus. When using this method, changes in the mucous membrane are minimal. With the non-contact method, the conductor must be directed perpendicular to the walls of the uterus, which in some cases is quite difficult to do. In this regard, a mixed method of cauterization can be applied.
• mixed method. This method involves a combination of contact and non-contact methods.

Removal of uterine fibroids by hysteroscopy

In the presence of multiple myomatous nodes ( uterine myomatosis) it is recommended to first remove the nodes on one wall of the uterus, and after a few months - on the other. This technique avoids the formation of intrauterine adhesions.

With hysteroscopic removal of uterine fibroids, the following techniques can be used:

• Mechanical myomectomy carried out with nodes with a diameter of not more than 5 - 6 cm. This method is more convenient to use to remove myoma nodes located on the bottom of the uterus. The removal procedure is not lengthy ( about 15 min).
• Electrosurgical myomectomy. This technique uses resectoscopes ( instruments for resection) and electrodes for vascular coagulation. The loop of the resectoscope is brought to the base of the tumor, the maximum portion of the formation is cut off. The cut fragments are gradually removed with a curette ( an instrument used to remove soft tissue). Finally, the tumor bed is coagulated.
• Laser myomectomy. Contact or non-contact techniques may be used.

Complications of hysteroscopy of the uterus

Complications of hysteroscopy of the uterus are divided into the following groups:

• intraoperative complications;
• postoperative complications;
• complications associated with anesthesia;
• complications associated with the expansion of the uterine cavity.

Postoperative complications
Postoperative complications can occur both immediately after hysteroscopy and some time after it ( several days).

The main postoperative complications of hysteroscopy of the uterus are:

• Infectious complications. In infectious complications, antibiotic therapy is prescribed as a treatment. As a rule, broad-spectrum antibiotics are prescribed. It is reasonable to prescribe antibiotics based on the results of an antibiogram ( determination of the sensitivity of microorganisms to antibiotics).
• Postoperative bleeding. Postoperative bleeding usually stops after administration of hemostatic drugs ( hemostatic therapy).
• The formation of intrauterine synechia. Intrauterine synechia can form with an extensive surgical field. These formations occur most often as a complication of laser cauterization of the endometrium. The formation of uterine synechia, in turn, is fraught with the development of infertility.
• Accumulation of blood in the uterine cavity (hematometer).

Complications associated with the expansion of the uterine cavity
Such complications may be associated with improper regulation of the supply of fluid or gas to expand the uterine cavity.

Complications associated with the expansion of the uterine cavity are:

• embolism;
• overload of the vascular bed;
• hypertension;
• hypoglycemia ( when using sorbitol as a liquid medium);

Prevention of complications of hysteroscopy of the uterus includes compliance with the following measures:

• being careful during the operation;
• prophylactic antibiotic therapy;
• compliance with the rate of supply of gas or liquid to expand the uterus;
• the fastest possible execution of the operation;
• following the correct technique for performing the operation;
• carrying out manipulations under the control of laparoscopy in complex operations.

There are many methods of instrumental examination of the uterus. One of the high-tech methods of diagnostics and microsurgical intervention is hysteroscopy.

Description and features

Hysteroscopy of the uterus is a highly informative way to visualize the uterine cavity using a hysteroscope. The latter is a device of several elements: optical tube, LED connector, eyecup. There are several types of hysteroscopes: operating (endowed with a special barrel for nozzles, used for simple surgery) and outpatient (for examination and diagnosis of pathologies).

In gynecology, hysteroscopy is carried out for several purposes:

1. Diagnostics. Hysteroscopy is performed to identify various pathologies and a detailed examination of the uterine cavity. Diagnostic hysteroscopy of the uterus allows you to detect various neoplasms, determine the size, location and structural features of pathological areas, assess the state of the organ in endometrial diseases, etc.
2. Operational intervention. In addition to visualization, surgical hysteroscopy involves the use of special instruments. Hysteroscopy of the uterus allows you to remove the polyp, curettage. Hysteroscopy is also performed for uterine myoma (a benign formation from muscle tissue) and other tumors.
3. Treatment control. Hysteroscopy of the uterine cavity allows you to evaluate the effectiveness of the treatment, monitor the course of the pathological process, and timely identify complications.

Depending on the indications, diagnostic hysteroscopy and curettage can be performed simultaneously or separately.

Office hysteroscopy

In medical practice, the process of examining the uterus is sometimes called "office hysteroscopy". It is not much different from the classical (surgical). The main difference is that the latter is carried out in a hospital, using anesthesia. Office hysteroscopy is performed without anesthesia, on an outpatient basis.

Indications

Indications for diagnostic hysteroscopy:

1. Suspicions of uterine pathology (for example, hysteroscopy is performed with suspicion of uterine polyps, fibroids, oncology, perforation of the uterine wall, etc.).
2. Infertility.
3. Spontaneous miscarriages.
4. Uterine bleeding.
5. Clarification of the presence of foreign objects in the uterine cavity (for example, a spiral).
6. Control of therapy after surgery, medication, etc.

Indications for hysteroscopy with separate diagnostic curettage:

1. Removal of endometrial polyps. Hysteroscopy is a highly effective treatment for this pathology. Endometrial polyps are easily injured, which can lead to infection, hysteroscopy in this case allows you to completely get rid of the formations and control the recurrence of the pathology.
2. Hysteroscopy is indicated for endometriosis. Very often, for more effective diagnosis and treatment of this pathology, hysteroscopy is combined with laparoscopy.
3. Submucosal myoma.
4. Intrauterine adhesions, septa.
5. Cauterization of blood vessels.
6. Incomplete miscarriage, miscarriage.
7. Narrowed channel expansion.
8. Removal of tumors.
9. Sterilization, etc.

Hysteroscopy and carrying out rdv also involves the collection of material from the uterine cavity (hysteroscopy with endometrial biopsy). This procedure is carried out if a malignant process is suspected. The resulting tissue sample is sent for histological examination.

In some cases, laparoscopy and hysteroscopy are performed. The combined technique is used in the presence of cysts, tumors, endometriosis of the ovary, uterus, ovarian apoplexy, etc.

Contraindications

Despite the fact that the procedure is considered safe, there are still contraindications to its implementation:

1. The period of bearing a child.
2. Profuse uterine bleeding.
3. Low blood clotting.
4. Acute infectious and inflammatory processes in the pelvic organs.
5. Severe condition of the patient.
6. Age up to 15 years, virginity.

Training

Preparation for hysteroscopy is necessary in order to protect the woman's body as much as possible from all sorts of complications during the procedure and after it.

List of tests before the procedure:

1. Vaginal smear.
2. General analysis of blood, urine.
3. HIV analysis.
4. Blood test for sugar, bilirubin, blood clotting, Rh factor.
5. Fluorography.
6. Electrocardiogram.
7. Ultrasound of the pelvic organs.

The last meal before the procedure should be at least 12 hours before. The day before, it is recommended to exclude sour-milk products. Fluid intake should also be limited 10 hours before the procedure. This will prevent possible vomiting during anesthesia and after it.

The patient's intestines and bladder must be emptied. A woman should observe the rules of personal hygiene and get rid of hair in the genital area before the procedure. In addition, the patient must inform the doctor about the medications taken.

When they spend

On what day of the cycle do hysteroscopy?

1. On what day of the menstrual cycle is hysteroscopy performed for women of reproductive age? - Usually prescribed for 7-9 days from the start of the menstrual cycle. During this period, the endometrium is thin, practically not covered with vessels, which increases the accuracy of diagnosis.
2. What day is the procedure for women during menopause? – Any time, in the absence of heavy bleeding. This option is also possible in emergency cases for urgent indications, the main thing is that hysteroscopy is not performed during menstruation.

The course of the procedure

How is a hysteroscopy performed? Before starting the procedure, a woman is treated with a surface of the thighs, genitals with an alcohol solution. A hysteroscope is inserted into the uterine cavity for a panoramic view of the organ. At this point, the doctor injects a small amount of air or fluid into the uterus to spread the walls of the organ and improve the accuracy of imaging.

During the examination, the data obtained are displayed on the screen, thanks to which the doctor can assess the features of the standing of the uterus, identify deviations from the norm and make the correct diagnosis. The duration of the procedure depends on the purpose of its implementation. Diagnostic manipulation takes an average of 20-30 minutes. If hysteroscopy with diagnostic curettage is performed (for example, hysteroscopy of uterine fibroids), then after a thorough examination, the doctor removes the pathological formation. The duration of the procedure usually does not exceed 1 hour.

The procedure may seem unpleasant for a woman. If it is carried out for medicinal purposes (for example, removal of polyps and other formations in the uterus), then various painkillers are used: local or general anesthesia.

sick leave

How many sick days? As a rule, a sick leave is not issued, because. the procedure is considered a minimally invasive surgical intervention, after which a long recovery is not required. The patient is usually allowed to go home on the day of the operation. But some paid clinics after hysteroscopy of the uterus, performed for medical purposes (with surgery) and the use of anesthesia, can offer a sick leave for 3-5 days.

Postoperative period

Effects

Possible consequences after hysteroscopy:

1. After the procedure for medicinal purposes, minor bleeding in the vagina is possible, because. blood vessels are damaged. Usually they last no more than 5 days.
2. Also, after the operation, pains in the lower abdomen of weak and moderate intensity may appear (they may radiate to the lumbar region). They usually last no more than the first 10 days.
3. After anesthesia, the patient may also be disturbed by: general weakness in the muscles, depression, depressed mood. These are the consequences of anesthesia, which can also be accompanied by chills, fever, headache.
4. Perforation of the uterus is possible - a puncture of the organ wall with a surgical instrument.

To reduce the manifestations of discomfort after hysteroscopy of the uterus, it is recommended to follow simple recommendations of the postoperative period.

Any surgical intervention is associated with the risk of infection. Therefore, if the doctor prescribes antibacterial, anti-inflammatory, antimicrobial drugs, then you should follow the recommendations and observe the frequency, dosage and duration of administration. This helps to reduce the likelihood of an inflammatory process to a minimum.

If painful sensations are very disturbing, then it is appropriate to take a drug from the NSAID group, for example, Ibuprofen, Tenoxicam, Nimesulide, Diclofenac, etc. The drugs have a combined effect on the body: they reduce inflammation, lower the temperature, and relieve pain.

If the patient is worried about fever for more than 5 days, acute pain that is not relieved by painkillers, discharge mixed with pus or an unpleasant odor, heavy bleeding and other alarming symptoms, you should immediately go to the hospital.

What can not be done after hysteroscopy of the uterus?

1. Use tampons. It is better to give preference to sanitary pads.
2. Have sex. To exclude infection, you should limit your sexual life for the first 2 weeks after surgery.
3. Take hot water treatments.
4. Use vaginal suppositories.
5. Perform intense physical activity.

Pregnancy

When is pregnancy possible after hysteroscopy? Depending on the purpose of the procedure and the established diagnosis, there may be several options regarding the timing of the onset of pregnancy:

1. If the procedure was carried out for diagnostic purposes, then a healthy woman can become pregnant immediately after it.
2. If the procedure was carried out for medicinal purposes, then the onset of pregnancy is regulated by the characteristics of the pathological process, the volume of surgical intervention, as well as the recommended recovery time (usually 3-6 months).

The time when you can plan a pregnancy without fear for your health and the health of the child, in each case individually and only a doctor can determine it, having previously assessed all the risks for the woman and the child.

Hysteroscopy is a type of surgical intervention that is characterized by low invasiveness. During the manipulation, specialists have the opportunity to examine the uterine cavity thanks to the image transmitted to the monitor from the microcamera.

1. Hysteroscopy is a range of surgical actions that are carried out in the uterine cavity.
2. During surgery, diagnosis, treatment and monitoring can be performed.
3. After hysteroscopy of the uterus, in rare cases, complications arise that are eliminated subject to medical prescriptions.

Hysteroscopy of the uterus - what is it

Hysteroscopy of the uterus is performed using special expensive equipment. With its help you can:

• examine the uterine cavity;
• diagnose diseases;
• to carry out medical manipulations;
• remove tumors;
• cauterize lesions;
• to collect biological material for histological studies.

Question answer

Despite the fact that hysteroscopy of the uterus has long been performed in all major hospitals, women continue to ask a large number of questions.

When is the best time to do

Hysteroscopy of the uterus is performed on certain days of the menstrual cycle:

• from 5 to 10;
• from 15 to 18;
• in emergency cases from 5 to 15.

How long does the procedure take

The duration of the procedure directly depends on the tasks assigned to the doctors and the severity of the pathology. Surgical interventions can be carried out within 10 minutes, or delayed for several hours.

How often can you do

Due to the fact that hysteroscopy of the uterus is performed under general anesthesia, it is often impossible to perform it. The frequency of the medical diagnostic procedure should be determined by the gynecologist, who will take into account all possible risks and complications for the woman's health.

Where is hysteroscopy performed?

Surgical intervention is carried out in hospitals licensed for hysteroscopic equipment.

Types of hysteroscopy

There are the following types of hysteroscopy:

• diagnostic;
• medical/surgical;
• control.

Diagnostic office

The procedure is carried out with the aim of examining the endometrium, identifying any pathological changes on the mucous membranes of the organ.

Surgical

With the help of a resectoscope, the doctor violates the integrity of the pathological tissues, performing their excision. After removal of the neoplasms, the localization sites are cauterized, which eliminates the reappearance.

Control

To evaluate the effect of hormone therapy or surgical treatment, patients are prescribed control hysteroscopy.

When is a procedure needed?

Very often, hysteroscopy is prescribed for women with infertility and those planning a pregnancy through IVF. Thanks to the procedure, doctors can assess the condition of the uterus, eliminate pathological processes that can interfere with the attachment of the embryo.

Indications

The treatment and diagnostic procedure is carried out for women in the presence of such pathologies:

• myoma nodes in the submucosal layer;
• postmenopausal bleeding;
• polyposis;
• diffuse hyperplasia;
• endometriosis;
• anomalies and defects of the fallopian tubes;
• intrauterine partitions, adhesions;
• fetal remains (after an abortion, miscarriage);
• neoplasms of a different nature;
• menstrual irregularities;
• infertility.

Attention! Hysteroscopy of the uterus is indicated for patients who have undergone hormonal or surgical treatment. In this case, an audit of the state of the organ is performed.

Contraindications

There are a number of contraindications to performing hysteroscopy of the uterus. The list has been updated:

• infections in the genitourinary system, intestines, broncho-pulmonary system;
• recently transferred or acute inflammatory processes in the endometrium, genital tract;
• narrowing of the cervical canal or neck;
• pregnancy
• intense uterine bleeding;
• pathologies of the kidneys, heart, liver, blood vessels, occurring in severe form;
• widespread cancer;
• anesthesia intolerance.

Patient preparation

In order for hysteroscopy of the uterus to be as effective as possible and without complications, patients must prepare for it. They need to pass a large number of tests, and follow a number of instructions from doctors.

Psychological attitude

It is extremely important to be in the right psychological mood before any surgical intervention. Patients should understand that without surgical procedures they will not be able to get rid of pathologies.

Hysteroscopy is minimally invasive and one of the safest procedures, after which complications rarely occur.

Basic Research

Before surgery, a woman needs to be tested and undergo hardware examinations:

1. Laboratory studies of urine, blood (general and biochemical analysis), bakposev, coagulogram, sugar, blood group, AIDS / syphilis / hepatitis.
2. Smears are taken.
3. Performed ultrasound, fluorography, cardiogram.
4. Consultation of the therapist and other highly specialized specialists is carried out.

Medical preparation

Before a hysteroscopy, a woman may be prescribed antibiotics and antifungal medications to prevent the development of infectious processes.

The patient should stop taking blood-thinning drugs a few days before the procedure. But also hormone-containing agents can be prescribed to the patient if surgical preparation of the endometrium for subsequent IVF is planned.

Sanitary and hygienic measures

Before performing surgery, the patient is sanitized the genital tract. Thanks to the treatment with disinfectant solutions, the risks of infection are reduced.

Results and interpretation

If the severity of the pathology allows surgical treatment without skin incisions, then doctors eliminate the lesions in a minimally invasive way. Thanks to hysteroscopy, you can completely remove such pathologies:

• fibroids;
• polyps;
• hyperplasia;
• adhesions, etc.

After the surgical procedures, the patient is given a medical report. All collected biological material is transferred to the laboratory for histological studies, the results of which the patient will be able to receive in a few weeks.

If cancer cells are found in them, then the woman will have to contact the oncology center for examination and treatment.

Procedure technique

The technique of performing hysteroscopy provides for a certain sequence of actions:

1. The patient is placed on a gynecological chair, her legs are fixed with straps.
2. Genital organs are sanitized with antiseptic solutions.
3. Anesthesia is administered.
4. The cervix is ​​fixed with the help of gynecological mirrors, its channel expands to perform washing and fluid removal.
5. Hysteroscopic equipment is inserted into the uterine cavity.
6. The mucous membranes are examined, the shape and condition of the organ, pipes are assessed.
7. When lesions are detected, therapeutic manipulations are performed.

Possible risks

When performing hysteroscopy, the following risks may occur:

• due to a violation of the integrity of the vessels, bleeding opens;
• trauma to the uterus with surgical instruments;
• the occurrence of hematometra;
• infection of the organ, with the subsequent development of the inflammatory process.

Attention! After hysteroscopy of the uterus, patients may experience pain in the lower part of the peritoneum. Within a few days, women will experience spotting, which may contain clots, purulent impurities.

Recovery

Despite the fact that hysteroscopy of the uterus is a minimally invasive surgical procedure, after it, patients have to recover within two weeks. Women must strictly comply with all medical prescriptions:

1. Take antibiotics.
2. Use hemostatic agents in the presence of characteristic secretions. For example, Etamzilat, Ditsiton.
3. Apply antifungal drugs, metronidazole tablets.
4. Stronger medications are prescribed to relieve severe pain and spasms.
5. If necessary, accelerate the intensity of uterine contractions, Oxytocin is activated.

Prevention

After performing hysteroscopy of the uterus, patients should take preventive measures:

• refusal of sexual contacts within two weeks;
• conception can be planned after three months;
• careful and daily personal hygiene of the genitals;
• tampons are not allowed.

Currently, clinical, laboratory, instrumental and endoscopic research methods are used for a full diagnosis in gynecological practice. All this helps specialists to determine the state of the female body, identify serious pathologies and provide timely assistance that can save the patient's life.

Any patient has encountered an examination with the help of gynecological mirrors, but endoscopic research methods can cause a number of questions in women. So, a woman may be puzzled by what hysteroscopy is, how hysteroscopy is performed and what complications it can bring with it.

Types of procedure

Hysteroscopy is divided into 2 types: diagnostic (office) and surgical (resectoscopy). Each of them has significant differences.

Office hysteroscopy

The procedure involves the following steps:

• in the process, a visual examination of the uterine cavity occurs;
• the state of the mucous membrane of the uterus is examined;
• a sample of biological material is taken for histological examination;
• minor surgical manipulations are performed (removal of polyps, dissection of adhesions and septa).

• local anesthesia is used or is completely dispensed with;
• the duration of the procedure is 10–15 minutes;
• after hysteroscopy, a woman does not need to stay in a medical facility for a long time.

Thanks to hysteroscopy, you can carefully examine the cervical canal and the uterine cavity from the inside.

Hysteroresectoscopy

The main actions in hysteroresectoscopy: removal of pathological formations of various nature (large polyps, myoma nodes, adhesive bands), endometrial ablation (excision of the entire thickness), elimination of abnormal bleeding from the uterus. Features of the procedure: carried out under general anesthesia (intravenous anesthesia), the duration of the procedure is from 30 minutes to 3 hours, the patient's hospitalization can last 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 a gynecological chair.

Indications and contraindications

Hysteroscopy is used against the background of such pathologies:

• with endometrial hyperplasia;
• benign growth of glandular tissue of the endometrium;
• neoplasms that occur in the myometrium;
• adhesive process in the uterus;
• oncopathology;
• malformations of the body and cervix.

Surgical hysteroscopy allows you to perform the following manipulations: excision and removal of connective tissue strands, elimination of the pathology of the bicornuate uterus, removal of benign growths of the glandular tissue of the endometrium and neoplasms of the myometrium, removal of the IUD from the uterine cavity, the remnants of an incompletely evacuated ovum, as well as the child's place, biopsy sampling .

Office hysteroscopy allows you to diagnose the impossibility of bearing a child, malformations of the reproductive organs, perforation of the uterine wall after abortion and cleansing. In addition, office hysteroscopy is performed with an unstable menstrual cycle, gynecological bleeding of various nature, as well as, if necessary, to confirm or refute any diagnosis.

There are a number of serious contraindications for hysteroscopy:

• inflammatory and infectious diseases of the reproductive organs during the period of exacerbation;
• bearing a child;
• cervical oncopathology;
• pronounced narrowing of the cervical canal;
• the general serious condition of the patient against the background of serious somatic diseases.

Hysteroscopy of the endometrium is considered to be a fairly gentle manipulation and actively replaces traumatic and dangerous interventions in the female reproductive system.

Training

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. Thanks to the sampling of biomaterial in the urethra, cervical canal and vagina, it is possible to determine the state of the flora.
• Clinical blood test, determination of the group and Rh factor, blood test for RW, hepatitis and HIV. Determine blood clotting (coagulogram).
• Macroscopic and microscopic examination of urine, which reveals renal failure.
• Ultrasound of the pelvic organs (through the anterior abdominal wall or transvaginally).
• Electrocardiogram and fluorogram.

Before the planned hysteroscopy, the patient will be required to consult with related specialists: a general practitioner, a cardiologist, an anesthesiologist. In addition, she should tell her doctor if she has any drug allergy, if she is pregnant, and if she is taking any medications on an ongoing basis.

Before conducting a hysteroscopy, a woman should adhere to the following recommendations: 2 days before the study, exclude sexual contact, a week before the scheduled procedure, do not douche and do not use store-bought gels and foams for washing.

A week before hysteroscopy, do not use medicinal vaginal suppositories (with the exception of those prescribed by a gynecologist), with persistent constipation, clean the intestines with an enema the day before the study. 2 days before the procedure, start taking sedatives, if they are prescribed by a doctor, 5 days before hysteroscopy, start taking antibiotics, if they are prescribed by a gynecologist.

On the morning of the procedure, you should stop eating and drinking. The patient must perform hygienic procedures, shave the pubic and inguinal region, and empty the bladder immediately before entering the examination room. All unnecessary items (jewelry, mobile phone) remain in the room. The patient should bring slippers, socks, a change of underwear, a bathrobe, as well as sanitary pads to the hospital, which will be needed after the procedure due to abundant vaginal discharge.

In order to better visualize the uterine cavity, it is expanded with the help of any medium.

Carrying out the procedure

Of great importance is what day the hysteroscopy is done. Planned hysteroscopy is best done from day 5 to day 7 of the cycle. At this time, the endometrium is thin and slightly bleeding. But sometimes the state of the endometrium is assessed in the luteal phase (after ovulation), approximately 3–5 days before the end of the cycle. In mature patients, as well as in emergency situations, the time of hysteroscopy can be any.

After laying the patient on the gynecological chair, her thighs, external genitalia and vagina are treated with an antiseptic agent. A two-handed vaginal examination is performed to determine the location of the uterus and its size. The lower segment of the uterus is fixed with uterine single-tooth forceps, which pull the body of the uterus, align the direction of the cervical canal and determine the length of the uterine cavity. And then the cervical canal is bougienage with a Hegar dilator.

The hysteroscope is treated with an antiseptic and gently inserted into the uterine cavity enlarged with gas or liquid. During the examination, its contents and size, shape and relief of the walls, the state of the entrance area to the fallopian tubes are studied. If any foreign bodies are found, they are removed using instruments inserted through the hysteroscope channel. Targeted biopsy is performed if necessary. The taken tissue sample is sent for histology.

According to indications, at the end of the procedure, the inner layer of the cervical canal and the uterine cavity can be removed. The anesthesiologist performs the final phase of anesthesia - brings the patient to consciousness. If there are no complications, then the patient is under the supervision of specialists for another 2 hours, and then she is transferred to the general ward. A hysteroscopic operation lasts an average of 30 minutes, and if laparoscopy is also performed, then the manipulation can last up to 3 hours.

Patients are often interested - how long after hysteroscopy can I do IVF? Experts say that these terms fluctuate and depend on the data obtained during hysteroscopy. Someone is prescribed IVF on the 10th day after hysteroscopy, and someone has to wait another six months for this moment. It all depends on the identified pathology, requiring varying degrees of surgical intervention and therapeutic measures.

With the advent of minihysteroscopes, which are very small in diameter, hysteroscopy and even minor surgical procedures have recently been increasingly performed without dilating the cervical canal.

The medium used to expand the uterine cavity can be gas or liquid

Recovery period

After a hysteroscopic examination or surgical manipulations, complications are not excluded. In the postoperative period, the uterine mucosa and the natural volume of this reproductive organ, which was disturbed by artificial increase during hysteroscopy, should be restored. Against this background, after hysteroscopy, a woman may observe the following symptoms.

Pain syndrome. The pain is usually felt predominantly above the pubis. Feelings are expressed slightly and are 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 previous size.

Vaginal discharge. Due to damage to the endometrium, in the first hours after the procedure, there may be abundant bloody-mucous discharge. After the diagnostic procedure, discharge can be observed within 5 days, and after surgical procedures - up to 2 weeks.

A woman may experience general weakness and malaise. If a feverish condition appears, then one should, without delay, seek medical help. How long the full recovery period after hysteroscopy lasts can vary greatly for each patient. As a rule, this takes up to 3 weeks on average. There are those who became pregnant naturally after hysteroscopy - this happened against the background of the removal of a polyp or atrophied endometrium.

If the patient adheres to simple recommendations, then the recovery period can be significantly reduced:

• In order not to provoke bleeding, the patient must refrain from intimacy with a man for 14 days.
• Monitor body temperature for a week, so as not to miss the complications that have arisen.
• Of the water procedures, only a hygienic shower is allowed. It is contraindicated to take baths, visit baths, saunas, swimming pools.
• Conscientiously take drugs prescribed by a doctor - antibiotics, analgesics, sedatives, vitamins.
• Follow the daily routine, eat right, play sports in a limited way.

When a patient has severe pain, bleeding opens and the body temperature rises sharply - all this is a serious reason to urgently seek help from a doctor.

Hysteroscopy itself does not affect the ability to conceive after the procedure.