Norm of Hysteroscopy
Uterine cavity normal.
Usage of Hysteroscopy
Asherman's syndrome, endocervical biopsy, endometrial cavity evaluation, fibroid removal, hysterectomy, infertility, intrauterine adhesions, IUD or foreign body removal, septate uteri, and uterine arterial bleeding location.
Description of Hysteroscopy
A 4-mm hysteroscope (telescope type of instrument) is inserted vaginally into the uterus to view the disorder within the uterine cavity that is sometimes missed by hysterosalpingography or curettage.
Professional Considerations of Hysteroscopy
Consent form IS required.
Allergic reaction to Hyskon (32% solution of dextran 70 suspended in glucose) (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death); renal toxicity from contrast medium. Risks include infection, perforation, and a 1%–3% chance of developing PID. Possible life-threatening complications include disseminated intravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS).
Previous allergy to Hyskon (if use is planned). Hysteroscopy is contraindicated in pelvic inflammatory disease (PID), inflamed cervix, and purulent vaginal discharge.
- Schedule after menstrual bleeding has ceased and before ovulation.
- Have emergency equipment readily available.
- Have the client void before the procedure.
- A hysteroscope is inserted vaginally through the cervix into the uterus after the use of a speculum.
- Carbon dioxide or Hyskon is instilled to distend the uterine cavity.
- The interior walls of the uterus are closely examined for abnormalities, lesions, or bleeding, and photographs or biopsy specimens may be taken.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- Assess for side effects from the use of carbon dioxide to distend the uterine cavity: shoulder pain, diaphoresis, nausea, and postoperative bleeding.
- Assess for gas or air embolism, uterine perforation, and hemorrhage.
- Assess for side effects of Hyskon: pulmonary edema, coagulation defects, and anaphylaxis.
- Assess for hyponatremia and hypervolemia.
- Assess for transient blindness if glycine is used as irrigation solution.
Client and Family Teaching
- The procedure takes less than 30 minutes.
- It is normal to experience cramping, similar to menstrual cramps, and dizziness during the procedure. Taking prostaglandin inhibitors such as ibuprofen before or after the procedure will lessen the cramping discomfort.
- Carbon dioxide side effects (listed in option 1 under Postprocedure Care) may last for a few days. Use a mild analgesic to relieve discomfort.
- Immediately report any nausea, pain, shortness of breath, or any other symptoms of discomfort after the procedure.
- Avoid vaginal douching and sexual intercourse for 2 weeks after the procedure.
- Infection rate following surgical hysteroscopy is low at 1.42%.
Factors That Affect Results
- None found.
- Hysteroscopy did not improve the sensitivity of D&C in the detection of endometrial hyperplasia or carcinoma.
- Paracervical anesthesia fails to reduce pain during outpatient hysteroscopy and endometrial biopsy.
- Risk of vasovagal syndrome higher with use of rigid hysteroscope.
- Uterine rupture can occur up to 1 year post hysteroscopy.
- Peritonitis can occur from sorbitol used as a distending medium.
- Saline contrast hysterosonography can replace hysteroscopy in evaluation of the uterine cavity.