Things to note before hysteroscopy

Hysteroscopy is an important gynecological examination method. Through this examination method, we can understand our own health and rule out many diseases. However, hysteroscopy cannot be performed casually, because it will cause certain harm to your body. If you are not careful, it may lead to serious risks. You should communicate fully with your doctor before the examination. So, what are the precautions before hysteroscopy?

1. Preoperative preparation

1. Perform cardiopulmonary examination, measure blood pressure and pulse, check leucorrhea, and perform cervical scraping.

2. Choice of examination time: Except for special circumstances, it is generally appropriate to do the examination within 5 days after the end of menstruation.

2. Operation steps

1. Anesthesia and analgesia: You can choose any of the following:

(1) Indomethacin suppository: Insert 50-100 mg of indomethacin suppository deep into the anus 20 minutes before the examination.

(2) Paracervical nerve block anesthesia: 5-10 ml of 1% procaine is injected into each side of the cervix.

(3) Surface anesthesia of the cervical mucosa: Use a long cotton swab soaked in 2% lidocaine solution to insert into the cervical canal at the level of the internal cervical os and retain for 1 minute.

(4) Uterine mucosal spray anesthesia: 8 ml of 0.25% bupivacaine is sprayed onto the surface of the endometrium through a special tubular injector and checked after 5 minutes.

2. Inspection method: Take lithotomy position, routinely disinfect the vulva and vagina, clamp the anterior lip of the cervix with a cervical forceps, use a probe to find out the depth and direction of the uterine cavity, and expand it to 6.5-7 according to the outer diameter of the sheath. 5% glucose solution or normal saline is commonly used to distend the uterus. First, the air between the sheath and the optical tube is emptied, and the hysteroscope is slowly inserted. The light source is turned on and the distending fluid is injected. The distending pressure is 13-15kPa (1kPa=7.5mmHg). After the uterine cavity is filled, the field of vision is bright and the scope can be rotated for comprehensive observation in sequence. First check the uterine fundus and the anterior, posterior, left and right walls of the uterine cavity, then check the uterine horns and fallopian tube openings. Pay attention to the morphology of the uterine cavity, whether there are endometrial abnormalities or space-occupying lesions, perform targeted biopsy when necessary, and finally, carefully examine the internal cervical os and cervical canal while slowly pushing out the scope.

3. Inspection and processing

Sexual intercourse is prohibited for two weeks after the operation. Antibiotics will be given to prevent infection if necessary, and the primary disease will be treated.

IV. Prevention and Treatment

1. Injury: It is mostly related to rough operation and can cause cervical tear, uterine perforation, fallopian tube false passage, fallopian tube rupture, etc.

2. Bleeding: Hysteroscopy will not cause severe bleeding. If there is excessive bleeding, the primary disease should be treated.

3. Infection: rare, mostly with a history of chronic pelvic inflammatory disease, the indications should be strictly controlled.

4. Complications of CO2 uterine distension: Prolonged operation time and excessive uterine cavity perfusion may cause CO2 gas embolism. The operation should be stopped immediately, oxygen should be inhaled, and dexamethasone should be injected intravenously.

5. Cardiocerebral syndrome: Dilation of the cervix and expansion of the uterine cavity can lead to increased vagus nerve tension, which is similar to what occurs during vacuum extraction during artificial abortion.