What is a Hysteroscopy

In hysteroscopy, the uterus it kept in check in order to make sure there is no damage to the uterus due to any abnormal bleeding. This method is practised with the help of a hysteroscope, which is basically a thin tube inserted into the vagina through either diagnostic or operative hysteroscopy.

What is diagnostic hysteroscopy?

Diagnostic hysteroscopy lets you diagnose the problems of the uterus and confirm results for other tests. It is often used with other procedures, such as with laparoscopy, dilation and curettage (D&C), or cervical biopsy. In this process, a thin tube called an endoscope that has a camera in it is inserted into your abdomen. This lets the doctor view all the insides of your body, namely the uterus, ovaries and fallopian tubes.

Why should diagnostic hysteroscopy be performed?

This process is used only if:

  1. You experience bleeding after menopause.
  2. Experienced a miscarriage.
  3. Unable to conceive or get pregnant
  4. Your IUD is not where it should be.

How is diagnostic hysteroscopy performed?

In order for this process to start, you will be given sedatives so that you can relax and be prepared for anaesthesia. This is the entire process:

  1. A hysteroscope enters your uterus through the vagina and cervix.
  2. Carbon dioxide gas inflates the body organs so that the doctors are able to see the uterus and fallopian tubes properly.
  3. Small instruments like the hysteroscope are used to clearly see the uterus and other parts.
  4. This entire process can take any amount of time from five minutes to more than an hour.

Dilation and curettage

In this process, the tissues are removed from the uterus and dilation of the cervix happens. It also removes the inner lining of the uterus. This process takes place when someone has a miscarriage or an abortion. It is a process that involves sharp curettage due to dilation and removal of uterine contents

When do you need a Dilation and Curettage

A Dilation and Curettage is recommended only if you are experiencing one of the following:

  1. Abnormal uterine bleeding.
  2. Bleeding after menopause.
  3. Abnormal endometrial cells

How to treat the condition

Diagnostic Hysteroscopy is performed with Dilation and Curettage. A thin tube with a camera is inserted into the vagina and pushed through the cervix and the uterus. It is then monitored on the screen to check if anything is abnormal. The wall of the uterus lining is visible and the doctor checks for any polyps, fibroid tumours, or anything else, and then they take the required tissue samples.

Benefits of hysteroscopy and D&C combined

There are many benefits to this procedure, some of them being:

  1. Your hospital stay is shorter.
  2. You recover faster.
  3. You do not need any pain medications after surgery.
  4. No need for open abdominal surgery.

What is a cervical biopsy?

In this process, tissues are removed from the cervix. It is usually performed after there is some abnormality found during pelvic exams or Pap smear. Some of these problems lead to a high risk of cervical cancer. With this biopsy, you can find precancerous cells and cervical cancer. It is also used to diagnose or treat genital warts or polyps.

Types of cervical biopsies

There are three ways to remove tissue from the cervix:

  1. Punch biopsy: Small pieces of tissue are taken from the cervix. This is done with the use of an instrument called biopsy forceps. A dye is put into your cervix in order to look for any kind of abnormalities.
  2. Cone biopsy: With a laser, tissues that are shaped like a cone are used to get rid of the cervix. General anaesthesia is given to the patient in order to put them to sleep.
  3. Endocervical curettage: Cells are removed from between the uterus and vagina, which is called the endocervical canal. A curette is used that has a tip shaped like a hook.

The process used depends on your medical history and condition, and why you are getting your biopsy done.

How to prepare for a cervical biopsy

The week after you get your period, you should schedule for a biopsy. This simplifies the process and makes it easier for the doctor to get clean samples. Do not take any medicines without asking your doctor.  There are some medications that increase the risk of bleeding, such as aspirin, ibuprofen, naproxen and warfarin.

Before you go for your biopsy, avoid tampons, vaginal creams and sexual intercourse for at least 24 hours. In cone biopsy, you are not allowed to eat at least eight hours before the procedure.

On the day of your biopsy, you will require pain relievers. There might also be some bleeding after the procedure, which is why you should carry some pads. Bring someone along so that they can take you back home. You will still be under the influence of general anaesthesia that makes you drowsy after the procedure. Avoid doing things until it wears off.

What to expect during a cervical biopsy

In the start, you will be asked to lie down on an examination table. A medical instrument is pushed into the vagina to open the canal. The cervix is cleaned with a solution and then identification of any abnormal tissues is done by the Schiller’s test. A curette will be used to remove the tissues. It may sting a bit but after the biopsy is completed, the cervix is filled with some absorbent material that helps reduce the bleeding procedure.

Safety of the procedure

Hysteroscopy with Dilation and Curettage and Cervical Biopsy is a relatively safe procedure. There are some complications that might take place, with rare risks.

  1. Any issue with anaesthesia
  2. Infections
  3. Heavy bleeding in the vaginal area
  4. Injury to the cervix, uterus, bowel or bladder
  5. Scars in Intrauterine scarring
  6. Other reaction to the substances used

After anaesthesia is used, you are kept under observation for a couple of hours before you are permitted to go home. You may also experience cramping or vaginal bleeding, shoulder pain, nausea or sickness. This can happen due to the carbon dioxide that was used. Certain activities are to be avoided such as heavy lifting, sexual intercourse, and the use of tampons.

However, if you face any of these problems then immediately contact your doctor.

  1. High Fever
  2. Severe abdominal pain
  3. Heavy vaginal bleeding or discharge
  4. A lot of pain

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  3. Dr Nandini Gupta has completed her MBBS from AIIMS, MRCGP from the UK, DRCOG from the UK, DFFP from UK and LMSSA from the UK. She has experience of 28 years. SHe is a General Physician.
  4. Dr Jaya Agarwal has completed her MBBS, DGO, DNB and DGE. She is a Gynecologist and an Obstetrician for 17 years.
  5. Dr Prof. Sadhana Kala has completed her MBBS and MS and practises Obstetrics and Gynaecology since the past 45 years, She is an experienced Gynecologist, Infertility Specialist and an Obstetrician.
  6. Dr Anupam Sibal has completed his MD, FIAP, FIMSA, FRCP from London, FRCPCH and FAAP. He is a Pediatric Gastroenterologist and Hepatologist and has 22 years of experience.
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Conclusion

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