What are the indications of hysteroscopy?
- AUB
- Ultrasound showing polyps, endometrial thickening
- Submucous and partially intramural fibroids
- Suspected intrauterine adhesions
- Mullerian tract anomalies, i.e., uterine septae
- Retained intrauterine devices or other foreign bodies
- Investigation of retained products of conception
- Endocervical lesions
- Cervical stenosis
What are the absolute and relative contraindications for hysteroscopy?
Absolute contraindications:
• Viable intrauterine pregnancy
• Untreated pelvic infection in an unstable patient
Relative contraindications:
• Treated pelvic infection.
• Previously multiple, failed attempts at hysteroscopy in a woman with ultrasound evidence of carcinoma
• Excessive, uncontrolled uterine bleeding in an unstable patient
• Already diagnosed endometrial or cervical cancer
• Current indication for emergency hysterectomy
Give examples of hypo-osmolar distension medias that can be used for hysteroscopy.
What are the advantages and disadvantages of using hypo-osmolar distension medias to perform hysteroscopy?
Hypo-osmolar liquids: 1.5% glycine and 3% sorbitol.
Advantages:
- Non-conductive so can use monopolar
Disadvantages:
- Excess absorption and hyponatremia (transurethral resection TUR syndrome)
Give examples of isotonic distension medias that can be used for hysteroscopy.
What are the advantages and disadvantages of using isotonic distension medias to perform hysteroscopy?
Isotonic liquids: 0.9% (normal) saline, Hartmann’s solution.
Advantages:
- Cheap
- Readily available
- Cannot cause TUR syndrome
Disadvantages:
- Inability to use monopolar electrosurgery.
You are performing operative hysteroscopy.
What systems or actions can you use to prevent fluid overload in your patient?
- Using an active input/output monitoring system.
- Limiting operating time to <60 mins.
- Stopping operating when fluid deficit reaches >1000 mLs if patient is old or medically co-morbid.
