Endometrial biopsy (Endometrial sampling or curettage)

Endometrial biopsy is a procedure that involves the removal of tissues from the endometrium, which is the inner lining of the uterus.

Reason for the procedure

It is done to diagnose endometrial cancer or hyperplasia (with or without atypia). Endometrial hyperplasia is a potentially precancerous condition. This procedure is indicated in a woman with abnormal uterine bleeding. This includes bleeding between menstrual periods, excessive bleeding during a menstrual period, or bleeding after menopause. It is also done to exclude endometrial cancer in post-menopausal  women with abnormal endometrial finding on ultrasound scan of the uterus.

Procedure

There are 2 ways to obtain the endometrium tissues:

1. Endometrial sampling (Outpatient clinic)
This is usually performed in the doctor’s clinic with little or no anaesthesia necessary. The woman will lie on her back, in a similar position as for Pap Smear (Thin Prep) examination. A speculum is inserted into the vagina to bring the cervix into view and to hold the walls of the vagina open. In some cases, it is necessary to use a tenaculum (a hook-like instrument that holds and helps stabilize the cervix). A small, thin, pliable straw-like tubing (called pipelle aspirator) is used to aspirate out a small amount of tissue by inserting it through the cervix into the uterus. This is called endometrial sampling.

2. Endometrial curettage (done in operating theatre)
This procedure is usually done in conjunction with a diagnostic hysteroscopy. Previously, it is often called a dilatation and curettage (D & C). 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. In the operating theatre, the vagina is cleansed with an antiseptic solution before inserting the hysteroscope. The hysteroscope can show the presence of submucous fibroids or polyps in the uterine cavity. Following hysteroscopic examination, a small curette is used to scrape against the inner lining of the uterus to gather the endometrial tissues for histological examination. Sometimes, the opening of the cervix may be very small and needs to be dilated with special dilators before inserting the curette.

Expected outcome

The outpatient procedure (endometrial sampling) is usually straightforward, and you can return to work immediately if you want to. Sometimes, slight uterine cramping may be present and responds well to simple pain-killer medications. If the procedure is done in an operating theatre with general anaesthesia (endometrial curettage), you will need to rest at home for at least one day. In the first week following the procedure, you should expect slight per vaginal bleeding. The laboratory examination will generally determine if there are any abnormal cells found in the uterine lining. A normal (or negative) result will show no cancerous or precancerous cells. However, there is a small chance of a false-negative result. If the histology is abnormal, your health care provider will discuss further testing or treatment options.

Risks

Endometrial sampling is unlikely to be associated with any risks. If the procedure is performed under anaesthesia (endometrial curettage), with or without the diagnostic hysteroscopic examination, the possible complications are:

  • Excessive bleeding.
  • Endometritis (a rare infection of the uterus).
  • Inadvertent injury to the uterus (uterine perforation) or the cervix.

Post-procedure care (for endometrial curettage)

  • Bathe or shower as usual.
  • The biopsy may cause a small amount of bleeding (spotting). Wear sanitary pads and avoid tampons temporarily which may lead to infection. Your menstrual flow may be heavier than usual.
  • Wear a pad or panty-liner for few days.
  • Do not douche unless it is prescribed for you.
  • There is no specific dietary restriction.

Medications

  • Hormones may be prescribed to manage your abnormal menstrual bleeding.
  • You may have uterine cramping pain following the procedures, usually lasting for few hours and up to a few days. You may use non-prescription drugs, such as paracetamol or any nonsteroidal anti-inflammatory drugs (NSAIDs) for the pain.

Activity

  • Office procedure (endometrial sampling) – you can return to work on the same day or take a day rest if you feel uncomfortable.
  • Endometrial curettage – resume daily activities, work or driving as soon as possible. This is usually possible after 1 to 2 days later and when you feel well.
  • You can resume sexual relations when spotting ceases.

You should see your doctor immediately if you have:

  • Vaginal discharge increases or begins to have an unpleasant odour.
  • You experience cramping or pain that simple medication does not relieve quickly.
  • Abnormal heavy vaginal bleeding or fever develops.

 

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Pre-Pregnancy Care for Woman with Type 2 Diabetes Mellitus

Article contributed by Ms Yong Lai Mee

The prevalence of Type 2 Diabetes Mellitus (T2DM) among women in childbearing age is increasing. Pre-existing T2DM in pregnancy increased the risk of maternal and neonatal complications such as macrosomia big baby), miscarriage, stillbirth, eclampsia (high blood pressure and its complications), and preterm labour. The American College of Obstetricians and Gynaecologists and the American Diabetes Association emphasized the importance of achieving optimum diabetes control for promoting the well-being of maternal and reduced prenatal fetus and baby adverse outcomes. Below are some tips to achieve optimum pre pregnancy diabetes care.

Blood Glucose Control

  • Keep pre pregnancy HbA1C < 6.5% to avoid complications during pregnancy.
  • Fetal mortality rate increased 4 folds in those with HbA1C >6.6%.
  • Poorly controlled pre pregnancy diabetes increases congenital heart diseases by 3 folds, neural tube defects increase by 4 folds and spontaneous miscarriages in 30-60% of all pregnancies.
  • Plan 4-6 months before pregnancy to ensure diabetes control is within target range.

Read morePre-Pregnancy Care for Woman with Type 2 Diabetes Mellitus

Uterine Prolapse (pelvic organ prolapse)

This refers to the descend of the uterus into the lower half of the vagina and beyond. In its most severe form, the whole uterus may be outside the vagina. Besides the uterus, other pelvic organ may descend as well such as bladder (cystocoele), rectum (rectocoele) and the small intestines (enterocoele).

Symptoms and signs

  • A lump is seen or felt at the opening of the vagina. It may be seen protruding outside of the vagina.
  • Vague discomfort or pressure in the pelvic region.
  • Backache that worsens with lifting.
  • Urination problems such as frequent and painful urination, difficulty in urination. occasional stress incontinence (urine leakage when laughing, sneezing or coughing), inability to control urination (uncontrollable urine leakage).
  • Difficulty in defecation.
  • Pain during or difficulty with sexual intercourse.
  • Abnormal per vaginal bleeding, usually arising from the exposed vagina wall and cervix.

Read moreUterine Prolapse (pelvic organ prolapse)

Vasectomy – Male contraception

The aim of a vasectomy is to prevent sperm from reaching the semen by disconnecting the sperm duct. The resulting ejaculate is therefore sperm-free, eliminating the risk of pregnancy. Sort of like a cheap shark fin soup without the shark fins (sperms).

Vasectomy is the contraception of choice for 6%–8% of married couples worldwide. Vasectomy is a minor procedure that provides effective and permanent contraception. In fact, it is far more effective than many other methods of contraception, including female sterilization.

Prior to a vasectomy, it is important and both husband and wife be present together to be counseled by a specialist on the implications of the procedure. It is important that the completeness of family is ascertained and that both husband and wife had discussed beforehand and agreed that it is the husband who should undergo a vasectomy to attain permanent contraception.

Read moreVasectomy – Male contraception

Lower Urinary Tract Infection (Lower UTI, cystitis)

Infection of the lower urinary tract occurs when the inner lining of the bladder becomes infected and the urine is full of bacteria. In pregnancy, 5 – 10% of women have bacteria in their bladder and some will have no symptoms at all.

How common?

Up to 40 – 50% of women will have at least one attack in their lifetime and 25% will have recurrences.

Causes

  • Bacteria can reach the bladder from the genital and anal area, or through the bloodstream.
  • Injury to the urethra or the bladder.
  • Prolonged use of a urinary catheter to empty the bladder, such as during childbirth or surgery.

Risk factors

  • Sexual activity.
  • Infection in other parts of the genitourinary system.
  • Pregnancy.
  • Poor hygiene.
  • Menopause.
  • Diabetes mellitus.
  • Underlying abnormalities of the urinary tract, such as tumours, calculi (stones), and strictures.
  • Incomplete bladder emptying.
  • During or after major surgery

Read moreLower Urinary Tract Infection (Lower UTI, cystitis)

How Pregnancy Affects the Feet

For every pregnancy journey, a mother or mother-to-be naturally experiences feelings of excitement and apprehension. In this 40-week period, a woman’s body goes through so many phases of change. Visible changes of increasing waistline and digits on the weighing scale are often coupled with swelling in the ankles and the presence of stretch marks. Internal observations will show pregnancy’s effects on metabolism, respiration, bone density, and the digestive system, to name a few.

As the body accommodates a nurturing and developing fetus, stark changes in the anatomy and physiology of a woman will occur. Throughout the course of these 9 months, such changes actually have an impact on every organ system in the body.

In this article, we will cover how pregnancy affects the feet. Swelling is a common occurrence during this phase. Also known as oedema, swelling can occur in different parts of the body though it largely occurs in the ankle region. Puffiness in the face or the hands is occasionally present. Dark spider veins, also known as varicose veins, often cause aesthetic concerns in women. Pregnancy is presumed to be a major contributing factor in its increased prevalence. Aside from its undesirable sight, this can also lead to cramps, heaviness, aching or numbness in the feet and calves.

Read moreHow Pregnancy Affects the Feet

Contraception – Male condom

The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects, so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb / uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

Read moreContraception – Male condom

Colposcopy

This is a microscopic examination of the cervix, vagina, or vulva. It is used to diagnose potential abnormalities of these areas, which sometimes cannot be seen with the naked eyes. The colposcope can magnify the tissue by up to 30 times, thus making it clearer and much more accurate in terms of surface evaluation. Therefore, the biopsy of the abnormal areas performed with a colposcopic examination is more accurate than those done without the use of a colposcope.

Why do I need a colposcopy evaluation?

  • It is usually recommended if you have an abnormal Pap smear (Thin Prep) test or when pre-cancerous lesion is suspected in the vagina or labia area.

Read moreColposcopy