Hysteroscopy and D&C - Indications and Complications

Indications

 * 1) Abnormal uterine bleeding
 * 2) Postmenopausal and unable to get adequate endometrial specimen and endometrial stripe >=5mm
 * 3) Postmenopausal and endometrial polyp or any hyperplasia on specimen
 * 4) Postmenopausal and negative endometrial sampling but persistent bleeding and failed HRT or HRTcontraindicated
 * 5) Postmenopausal and abnormal endometrial cavity contour on ultrasound or abnormal sonohysterogram
 * 6) Premenopausal > age 40 and unable to sample endometrium
 * 7) Premenopausal > age 40 and abnormal endometrial cavity contour on ultrasound or abnormal sonohysterogram
 * 8) Premenopausal age 35-40 and high risk with irregular ovulation, hypertension, obesity and unable to sample endometrium
 * 9) Premenopausal and  polyp or any hyperplasia on endometrial sampling
 * 10) Premenopausal and abnormal endometrial cavity contour on ultrasound or abnormal sonohysterogram suggesting polyp or fibroid
 * 11) Premenopausal with negative endometrial sampling and treated for abnormal bleeding hormonally for >6 months and no resolution of abnormal bleeding (normal thyroid, coagulation studies)
 * 12) Suspected Mullerian abnormalities
 * 13) Suspected intrauterine synechiae
 * 14) Prior to ablation procedures
 * 15) Prior to intrauterine tubal occlusion procedures

Complications (<4.0%)

 * 1) Cervical laceration
 * 2) Use graduated dilatators to dilate cervix to internal uterine os to size of hysteroscope or curette
 * 3) Avoid excess downward traction on cervical tenaculum
 * 4) Uterine perforation
 * 5) At exam under anesthesia, determine version and flexion position of the uterus
 * 6) Put downward traction on cervical tenaculum to straighten out cervical-uterine axis
 * 7) Avoid excessive cephalad pressure with dilator
 * 8) Inability to visualize endometrial cavity and complete the procedure
 * 9) Avoid sounding uterus or dilating cervix above the internal os
 * 10) Visualize endometrium when inserting hysteroscope into the uterine cavity so as not to disturb the endometrium
 * 11) Excessive Bleeding
 * 12) Introduce instruments into the uterus in the midline sagittal plane
 * 13) Fluid distension media problems glycine solution (hyponatremic fluid overload)
 * 14) Keep track of distension fluid used and returned; discrepancy to be less than 250ml
 * 15) Maintain intrauterine pressure at or below the patient’s mean arterial pressure
 * 16) Try to keep procedure less than 45 minutes
 * 17) Infection
 * 18) Preoperatively, culture for G.C. and Chlamydia if any discolored cervical mucous
 * 19) Avoid contaminating intrauterine instruments with vaginal blood and secretions
 * 20) Thermal energy problems
 * 21) Check weighted specula and other instruments for excessive heat
 * 22) Use instruments for ablation according to manufacturers’ instructions
 * 23) Interruption of an intrauterine pregnancy
 * 24) Test preoperatively within 48 hours of surgery for pregnancy in any reproductive age woman
 * 25) Avoid procedures in the luteal phase of menses in women without sterilization or using effective contraception
 * 26) Bladder, bowel or omental injury
 * 27) Avoid uterine perforation
 * 28) If instrument penetration is suspicious for or strongly indicates uterine perforation, discontinue procedure