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HYSTEROSCOPY OVERVIEW

HYSTEROSCOPY OVERVIEW. Diagnosis Treatment. Contraindications to Hysteroscopy. Pelvic infection Cervical malignancy Pregnancy. Diagnostic Hysteroscopy Abnormal Uterine Bleeding. Menorrhaghia (heavy cyclic bleeding) evaluate for fibroids, polyps

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HYSTEROSCOPY OVERVIEW

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  1. HYSTEROSCOPYOVERVIEW Diagnosis Treatment

  2. Contraindications to Hysteroscopy Pelvic infection Cervical malignancy Pregnancy

  3. Diagnostic HysteroscopyAbnormal Uterine Bleeding Menorrhaghia (heavy cyclic bleeding) evaluate for fibroids, polyps Premenopausal irregular bleeding – usually anovulatory (first try hormonal correction) Post menopausal bleeding - after negative endometrial biopsy

  4. Diagnostic HysteroscopyInfertility Usually in office, local anesthesia Habitual Abortion – evaluate for Submucous myoma Septate uterus Prior to In Vitro Fertilization

  5. Distending Media • Saline • CO2 • Hyskon (use ½ strength) • Mannitol/Sorbitol/Glycine

  6. Saline Advantages Cheap Simple to use

  7. PHOTO OF SALINE INFUSION PUMP

  8. Saline Disadvantages Poor visibility if bleeding Can’t use with electrocautery

  9. CO2 Advantages Excellent image quality Extremely safe Minimal discomfort No mess – ideal for office

  10. CO2 Disadvantages Bubbles - Diagnostic only Cost - Special insufflator = high pressure (up to 100mm Hg), low flow (ml/min, not liters/min)

  11. Hyskon (Dextran) Advantages Excellent optical qualities Does not mix with blood No special equipment - 50 ml syringe Non conductive - electrocautery OK

  12. HyskonDisadvantages Very messy Requires immediate, thorough washing & rinsing (difficult in office) Rare anaphylactic reaction

  13. Sorbitol-Mannitol-GlycineAdvantages Non conductive – electrocautery OK Can use with active bleeding

  14. Sorbitol-Mannitol-GlycineDisadvantages Fluid overload – dedicated person monitor I&O every 5-10 min. Reassess at 500ml stop at 1000ml* Hyponatremia –(Na < 120 mmol/l) most common cause of death from hysteroscopy Allergic reactions – fructose (rare)

  15. Therapeutic Hysteroscopy Infertility Abnormal Uterine Bleeding

  16. Therapeutic HysteroscopyInfertility Resection of Septation (scissors, cautery, laser) Resection of Synichiae (Ascherman's syndrome) give post op estrogen and place IUD 4 weeks

  17. Therapeutic HysteroscopyInfertility Cannulation for proximal tubal occlusion – usually done with simultaneous laparoscopy Give intravenous glucagon (1–2 mg IV) to help prevent tubal spasm Laparoscope with tubal dye first, after glucagon. –problem seen at HSG may be solved

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