Hysteroscopy (diagnostic and operative)

The hysteroscope is a small lighted telescope used for visual examination of the cervix and the uterus to help diagnose and treat abnormalities in the cervical canal or the uterine cavity. If it is used to look for the cause of the presenting problem, it is term as diagnostic hysteroscopy. If it involves some form of surgical procedures such as removal of growths (endometrial polyps or fibroids), removal of the lining or separation of adhesions, then it is called operative hysteroscopy. In many cases, both procedures are done concurrently – the so-called “see and treat” approach.

Reasons for the procedure

  • Evaluation and treatment of abnormal uterine bleeding.
  • To look for the displaced and removal of the intrauterine device (IUD).
  • Evaluation for infertility (difficulty in conceiving) or recurrent miscarriage.
  • Uterine polyps, fibroids or adhesions (which is called Ashermann’s syndrome).
  • Obstructed fallopian tubes.
  • Congenital malformations of the uterus

Preparation for the procedure

Ideally, it is best to schedule the procedure following completion of menstrual flow when the lining is at its thinnest. However, this is sometimes not possible, especially when it is done for abnormal uterine bleeding. It can be done either as an

  1. Out-patient procedure, without any anaesthesia or analgesia – this is possible because of the small caliber of the hysteroscope and no cervical dilatation is required. Therefore, this will reduce discomfort significantly. Fasting is not required. However, it is not advisable to take a full meal just prior to the procedure.
  2. Day-case procedure, usually under a light general anaesthesia. You are required to fast for at least 6 hours before the procedure (no food or drinks at all for 6 hours). For example, if the procedure is in the morning, you should skip breakfast. If it is in the afternoon, you can have an early light breakfast (e.g. tea/coffee/milo and toast) but make sure that this is taken at least 6 hours before the procedure. Please reconfirm this with your doctor.

Description of procedure

  • It is sometimes performed in combination with a laparoscopy.
  • The hysteroscope is passed through the vagina and cervix into the uterine cavity for viewing. Saline fluid is used to distend (expand) the uterine cavity to improve visualization and allow any operative manipulations to be achieved. Video monitoring is often used at the same time.
  • For operative hysteroscopy, a variety of small surgical instruments are available for use in hysteroscopic procedures including scissors, special clamps, or wire with electro-cautery attachment for coagulation and cutting. One attachment is a “rollerball” or wire loop through which electrical heat travels to remove (resection) the fibroid or endometrial lining. After the uterus is filled with fluid to enlarge it for better viewing, the doctor moves the roller¬ball back and forth across the lining or uses the wire loop to shave off the tissue. This method is called endometrial ablation. The wire loop can be used to remove the submucous type of fibroids. This is called hysteroscopic resection of fibroid.
  • The hysteroscope is then withdrawn.

Complications

For diagnostic hysteroscopy, the risk of is very low. This includes  uterine perforation or excessive bleeding. For operative hysteroscopy, the complication rate is slightly higher and includes:

  • Pelvic infection.
  • Cervical trauma due to dilatation and manipulation during surgery
  • Excessive fluid absorption into the blood circulation.

Post-procedure care

If performed as an office procedure without any anaesthesia – the recovery is immediate. You will be allowed home as soon as you have finished the consultation with your doctor. It is best if you have someone to drive you home.

If performed as day-case under general anaesthesia:

  • Following the procedure, your vital signs will be monitored for a period of time.
  • Once the anaesthetic effect has wear off and you are fully awake, you will be allowed to go home. Please arrange for someone to drive you home.
  • There may be some slight bleeding and cramping. The fluid used during the hysteroscope will flow out for one to two days. Use sanitary napkins—not tampons—to absorb blood or drainage.
  • Antibiotics may be prescribed prior to and after the procedure to prevent infection. This is uncommon and usually not required.
  • Medicine for pain may be given during or after the procedure.
  • Rest at home during the remainder of the day. Additional restrictions may be required depending on the extent of the surgical procedure.
  • Avoid sexual intercourse for 2 weeks or as directed.
  • There is no special dietary restrictions.

See your doctor immediately if there is:

  • Excessive bleeding.
  • Abnormal vaginal discharge.
  • Increasing abdominal pain or abdominal distention
  • Signs of infection develop, such as headache, muscle aches, dizziness or a general ill feeling or fever.

 

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Anaesthesia and Analgesia in Obstetrics and Gynaecology

Dr. William Morton demonstrated the first public administration of ether anaesthesia in the operating theatre of the Massachusetts General Hospital on the 16th October 1846
That day is remembered as a milestone in anaesthesia and celebrated as World Anaesthesia Day.
From that date onward, many progresses have been made in the field of anaesthesia, and more so specifically for the practice of obstetrics and gynaecology.

On the 16th August 1897, a German surgeon by the name of Dr. August Bier administered the first spinal anaesthetic. Spinal anaesthesia becomes one of the most popular methods of administering a patient pain free from surgery of the lower limbs, lower abdomen and Caesarean sections and is still widely used.

Read moreAnaesthesia and Analgesia in Obstetrics and Gynaecology

Suction evacuation for miscarriage

Suction & evacuation is a technique of emptying the uterus of a pregnancy. It can be used to terminate a pregnancy or to remove a fetus that has died. It involves the removal of a fetus and accompanying tissue of the pregnancy from the uterus with instrumental evacuation through the vagina and is usually performed in the first trimester of pregnancy.

Reasons for procedure

Read moreSuction evacuation for miscarriage

Cervical Intraepithelial Neoplasia (CIN)

Cervical intraepithelial neoplasia (or CIN) refers to the presence of abnormal cells seen on the cervical cytology smear. These abnormal cells are obtained from the lining of the outer cervix and can range from mild to severe changes. A diagnosis of CIN changes is not cancer. However, the severe form of dysplasia can be considered a precancerous condition and may eventually progress to cancer in several years if not treated.

The cervical cytology smear was previously referred to as Pap smear. Currently, the newer cervical cancer screening uses a liquid based cytology and the commonest one used are: Thin Prep or Sure-Path. These are better and more accurate compared to the conventional Pap smear test.

Classification of CIN 

Read moreCervical Intraepithelial Neoplasia (CIN)

Laparoscopy in Gynaecology

Laparoscopy is a procedure that allows visual examination and surgical treatments of the pelvic and abdominal organs pathology. The procedure is performed with a laparoscope, which is a small lighted telescope.

INDICATIONS – When is it necessary

  • Evaluation and treatment of women who has difficulty in conceiving.
  • Evaluation and treatment of known or suspected endometriosis.
  • Pelvic infections
  • Removal of diseased fallopian tubes, ovaries, cysts or uterus
  • Undiagnosed pelvic pain
  • Uterine fibroids
  • Voluntary sterilization (tubal ligation or occlusion for permanent family planning)
  • For diagnosis and treatment of a variety of other pelvic or abdominal disorders

Read moreLaparoscopy in Gynaecology

Caesarean Section

WHAT IS IT?
Delivery of a baby through an incision in the mother’s lower abdominal and uterine walls and is performed when a vaginal delivery is not possible or is unsafe. This procedure is also called a C-section or Lower Segment Caesarean Section (LSCS).

 

 

 

REASONS FOR PROCEDURE

Danger to the mother or baby from one or more of many causes, including:

  • Baby’s head too large to pass through the birth canal.
  • Baby in the wrong orientation – head up (breech) or transverse.
  • Failure of cervix to dilate (failed induction of labour).
  • Abnormal placenta location obstructing the birth canal (placenta praevia).
  • Failure of normal labour progress.
  • Situation where urgent delivery is indicated such as fetal distress or severe illness in the mother (such as severe hypertension or sudden fits).
  • Infection such as HIV or acute herpes genitalis infection in the mother.

Special situations: pregnancy resulting from assisted reproductive technology (ART), maternal request

Read moreCaesarean Section