Hysteroscopy: are out-patient services the way forward? V Nair, D Fleming, N Al-Shabibi

1. Hysteroscopy: are out-patient services the way forward? V Nair, D Fleming, N Al-Shabibi Kingston Hospital, Kingston Hospital NHS Trust, United Kingdom Objectives Methods Results Conclusions Retrospective analysis of proformas used for all women who underwent outpatient hysteroscopy during the six month period from April to September 2011. Data stored in Microsoft Excel spread-sheet. 84 patients underwent outpatient hysteroscopy, of which 80 had a successful procedure giving us a success rate of 95.2%. The indications for referral were: menorrhagia (28%), post-menopausal bleeding (22%), intermenstrual bleeding (12%), prolonged periods (10%) and irregular periods (10%). Missing intra-uterine contraceptive devices (IUCD), post-coital bleeding and subfertility constituted the remaining. Majority of the women had saline distention for hysteroscopy, 2 women required cervical dilatation and 3 were administered local anaesthetics. 33% of women had diagnostic hysteroscopy only, 58% had endometrial biopsy along with hysteroscopy and 27% had additional operative procedures eg: polypectomy, division of adhesions, IUCD retrieval, coil change or Mirena insertion. None of the patients had any significant complications (bleeding, perforation, false passage or admission following procedure etc), however 8 of the patients complained of pain which settled before leaving the clinic. 38% of patients were discharged to their family doctors’ care following the procedure, 38% were sent back to the referring consultant and 24% were offered further procedure/s under general anaesthesia. To evaluate our newly commenced outpatient hysteroscopy service in terms of the indications for referral, success rates and complications of procedures carried out, and on-going management. Outpatient hysteroscopy is a very successful service that hospitals can provide with good patient outcomes. It can be diagnostic as well as therapeutic with majority of women needing no further interventions. Having outpatient hysteroscopy facility in a hospital decreases the need for patients to undergo general anaesthesia and thus avoids associated complications. It also helps hospitals manage their day surgery waiting lists better.