Identification of intrauterine pathologies by the method of diagnostic hysteroscopy. Hysteroscopy and its consequences Hysteroscopy course of the operation

Date: 21.10.2019

There are many methods for instrumental examination of the uterus. One of the high-tech methods of diagnostics and microsurgical intervention is hysteroscopy.

Description and features

Hysteroscopy of the uterus is a highly informative way to visualize the uterine cavity using a hysteroscope. The latter is a device of several elements: an optical tube, an LED connector, an eyecup. There are several types of hysteroscopes: operating rooms (endowed with a special barrel for attachments, used for simple surgical intervention) and outpatient (for examination and diagnosis of pathologies).

In gynecology, hysteroscopy is carried out for several purposes:

Diagnostics. Hysteroscopy is performed to identify various pathologies and a detailed study of the uterine cavity. Diagnostic hysteroscopy of the uterus allows you to detect various neoplasms, determine the size, localization and structural features of pathological areas, assess the state of the organ in endometrial diseases, etc.
Surgery. In addition to visualization, surgical hysteroscopy involves the use of special instruments. Hysteroscopy of the uterus allows you to remove the polyp, curettage. Hysteroscopy is also performed for uterine myoma (benign formation from muscle tissue) and other tumors.
Control of treatment. Hysteroscopy of the uterine cavity allows you to evaluate the effectiveness of the treatment, control the course of the pathological process, and also identify complications in a timely manner.

Depending on the indications, diagnostic hysteroscopy and curettage can be performed simultaneously and separately.

Office hysteroscopy

V medical practice the process of examining the uterus is sometimes called "office hysteroscopy." It differs little from the classical (surgical) one. The main difference is that the latter is carried out in a hospital setting, using anesthesia. Office hysteroscopy is performed without anesthesia, on an outpatient basis.

Indications

Indications for diagnostic hysteroscopy:

Suspicions of uterine pathology (for example, hysteroscopy is performed with suspicions of uterine polyps, fibroids, oncology, perforation of the uterine wall, etc.).
Infertility.
Spontaneous miscarriages.
Uterine bleeding.
Clarification of availability foreign objects in the uterine cavity (for example, a spiral).
Monitoring therapy after surgery, medication, etc.

Indications for hysteroscopy with separate diagnostic curettage:

Removal of endometrial polyps. Hysteroscopy is a highly effective treatment for this pathology. Endometrial polyps are easily injured, which can lead to infection, hysteroscopy in this case allows you to completely get rid of the formations and control the recurrence of pathology.
Shown hysteroscopy for endometriosis. Very often for more effective diagnosis and the treatment of this pathology, hysteroscopy is combined with laparoscopy.
Submucosal myoma.
Intrauterine adhesions, septa.
Cauterization of blood vessels.
Incomplete miscarriage, frozen pregnancy.
Expansion of the narrowed canal.
Removal of tumors.
Sterilization, etc.

Hysteroscopy and rdv also involves taking material from the uterine cavity (hysteroscopy with endometrial biopsy). Such a procedure is carried out if there is a suspicion of malignant process... The obtained tissue sample is sent for histological examination.

In some cases, laparoscopy and hysteroscopy are performed. The combined technique is used in the presence of cysts, tumors, endometriosis of the ovary, uterus, ovarian apoplexy, etc.

Contraindications

Despite the fact that the procedure is considered safe, there are still contraindications to its implementation:

The period of bearing a child.
Profuse uterine bleeding.
Low blood clotting.
Acute infectious and inflammatory processes in the pelvic organs.
The grave condition of the patient.
Age up to 15 years old, virginity.

Preparation

Preparation for hysteroscopy is necessary in order to maximally protect the woman's body from all kinds of complications during and after the procedure.

List of tests before the procedure:

Vaginal swab.
General analysis of blood, urine.
HIV test.
Blood test for sugar, bilirubin, blood clotting, Rh factor.
Fluorography.
Electrocardiogram.
Ultrasound of the pelvic organs.

The last meal before the procedure should be at least 12 hours in advance. It is recommended to exclude the day before dairy products... Fluid intake should also be limited 10 hours before the procedure. This will prevent possible vomiting during and after anesthesia.

The patient's bowel and bladder should be emptied. A woman should follow the rules of personal hygiene and get rid of hair in the genital area before the procedure. In addition, the patient must notify the doctor about the medications they are taking.

When they spend

On what day of the cycle to do hysteroscopy?

On what day of the menstrual cycle is hysteroscopy done for women reproductive age? - Usually prescribed for 7-9 days from the beginning of the menstrual cycle. During this period, the endometrium is thin, practically not covered with blood vessels, which increases the diagnostic accuracy.
On what day is the procedure performed for women during menopause? - At any time, in the absence of intense bleeding. This option is also possible in emergency cases for urgent indications, the main thing is that hysteroscopy is not carried out during menstruation.

Procedure progress

How is hysteroscopy performed? Before starting the procedure, a woman is treated with the surface of the thighs, genitals alcohol solution... A hysteroscope is inserted into the uterine cavity for a panoramic view of the organ. At this point, the doctor injects a small amount of air or liquid into the uterus to expand the walls of the organ and improve imaging accuracy.

During the examination, the obtained data are displayed on the screen, so that the doctor can assess the features of the uterus, identify deviations from the norm and make the correct diagnosis. The duration of the procedure depends on the purpose of its implementation. Diagnostic manipulation takes 20-30 minutes on average. If hysteroscopy with diagnostic curettage is performed (for example, hysteroscopy of uterine fibroids), then after a thorough examination, the doctor removes the pathological formation. The duration of the procedure usually does not exceed 1 hour.

The procedure may seem unpleasant for a woman. If it is carried out for medicinal purposes (for example, removal of polyps and other formations in the uterus), then various pain relievers are used: local or general anesthesia.

Sick leave

How many days of sick leave? sick leave not issued because the procedure is considered a minimally invasive surgical intervention, after which it is not required long recovery... The patient is usually allowed to go home on the day of the operation. But some paid clinics, after hysteroscopy of the uterus, carried out for therapeutic purposes (with surgery) and the use of anesthesia, can offer a sick leave for 3-5 days.

Postoperative period

Effects

Possible consequences after hysteroscopy:

After the procedure, for medicinal purposes, minor bleeding in the vagina is possible, because blood vessels are injured. They usually last no more than 5 days.
Also, after the operation, pain in the lower abdomen of mild and moderate intensity may appear (may radiate to the lumbar region). They usually last no more than the first 10 days.
After anesthesia, the patient may also be disturbed: general muscle weakness, depression, depressed mood. These are the consequences of anesthesia, to which chills, fever, headache can also join.
Perforation of the uterus is possible - a puncture of the organ wall with a surgical instrument.

To reduce the manifestations of discomfort after hysteroscopy of the uterus, it is recommended to observe simple recommendations postoperative period.

Any surgery associated with the risk of infection. Therefore, if the doctor prescribes antibacterial, anti-inflammatory, antimicrobial drugs, then you should adhere to the recommendations and observe the frequency, dosage and duration of admission. This helps to reduce the likelihood of an inflammatory process to a minimum.

If you are very worried painful sensations, then it is appropriate to accept medicinal product groups of NSAIDs, for example, Ibuprofen, Tenoxicam, Nimesulide, Diclofenac, etc. The drugs have a combined effect on the body: they reduce inflammation, lower the temperature, and relieve pain.

If the patient is worried for more than 5 days with an increased body temperature, acute pain that cannot be relieved by pain medications, discharge with an admixture of pus, or unpleasant odor, profuse bleeding and other alarming symptoms, you should immediately go to the hospital.

What can not be done after hysteroscopy of the uterus?

Use tampons. It is better to give preference to sanitary napkins.
Having sex. To exclude infection, you should limit your sex life for the first 2 weeks after surgery.
Take hot water treatments.
Use vaginal suppositories.
Perform vigorous physical activity.

Pregnancy

When is pregnancy possible after hysteroscopy? Depending on the purpose of the conduct and the established diagnosis, there may be several options regarding the timing of pregnancy:

If the procedure was carried out for diagnostic purposes, then a healthy woman can become pregnant immediately after it.
If the procedure was carried out for medicinal purposes, then the onset of pregnancy is regulated by the peculiarities of the pathological process, the volume of surgical intervention, as well as the recommended recovery time (usually 3-6 months).

The time when you can plan a pregnancy without fear for your health and the health of the child is in each case individually and can only be established by a doctor, having previously estimated all the risks for the woman and the child.

Sometimes one examination in the gynecological chair is not enough, and the doctor directs the woman to additional examinations... One of these is hysteroscopy of the uterus. This method is informative and effective. Can be used for both diagnosis and treatment various diseases.

Collapse

What is hysteroscopy of the uterus?

This procedure in gynecology implies the introduction of a mini-camera into the organ, which is located on a special probe. The hysteroscope (this is the name of the device) also has LEDs, with the help of which all mucous membranes are visible.

There are surgical and diagnostic hysteroscopy. If the doctor's goal is to examine the endometrium of the uterus to confirm or clarify the diagnosis, this is a diagnostic procedure. If neoplasms need to be removed without incisions and punctures, then surgical hysteroscopy is done.

When is the operation performed?

If you need to find out clearly the diagnosis of the patient, an examination of the uterus is carried out, namely:

if it is impossible to get pregnant;
if intermenstrual bleeding is present;
after systematic spontaneous abortion;
with organ defects;
if there is a suspicion of endometriosis, polyps, oncology.

Also held in surgical purposes, for:

elimination of the remnants of the placenta after delivery;
removal of neoplasms in the form of polyps, fibroids or adhesions;
elimination of intrauterine rings, spirals, etc.

Types of hysteroscopy

As mentioned above, the procedure is of two types. Surgical and diagnostic. Let's take a closer look.

Surgical

During this procedure, both optical and surgical equipment are used. Organ pathologies are treated in a radical way, while injuries are minimal. Here you need anesthesia for hysteroscopy of the uterus.

Diagnostic

When carrying out such a manipulation, the integrity of the mucous membranes is not violated. The doctor examines in detail the entire uterine cavity. After this diagnosis, you can confidently say whether a woman has a benign or malignant formation.

Contraindications to surgery

Cannot be used if present:

an infectious disease;
pregnancy;
inflammation in the pelvic organs;
stenosis of the uterine neck;
bleeding.

Preparing for the procedure

How to prepare for a hysteroscopy of the uterus? Before the operation, the doctor should examine the patient in the gynecological chair using mirrors. This is necessary in order to study the condition of the vaginal walls and partly the cervix. In parallel with this, a bacteriological smear is taken, which will exclude various infections. If there are inflamed areas or the presence of infection, then hysteroscopy is not performed.

The woman herself needs:

forget about sex for one, two days;
give up intimate gels and aromatic bath foams for a week;
do not douching 5-7 days before manipulation;
wait 5 days using vaginal pills, candles, creams, etc .;
an enema should be done the day before the procedure;
immediately before carrying out, empty the urethra;
in the morning it is forbidden to eat anything (if the procedure will be anesthetized).

also in mandatory a woman undergoes tests before hysteroscopy of the uterus:

general (blood, urine);
HIV research;
Wasserman reaction.

In addition to laboratory research preparation for hysteroscopy of the uterus includes examination by a therapist. After she does a fluorography, ultrasound diagnostics genitals and ECG. All the data obtained will help the gynecologist decide on the auxiliary drug that is used during hysteroscopy. All preparatory measures before surgery are mandatory. On their basis, the postoperative treatment and the drug used for anesthesia will be selected.

Anesthesia with hysteroscopy

Before the operation, the doctor must decide on the choice of anesthesia. His choice will directly depend on the planned intervention and on the results of the preliminary examination.

Types of anesthesia

Used for hysteroscopy of the uterine cavity anesthesia:

Local. An injection with an anesthetic drug is injected into uterine cervix... It is useful for diagnostics.
General. Intravenous administration. During medication sleep the doctor performs all the manipulations.
Regional. This term refers to epidural anesthesia. The medicine must be injected into the area of the spine. V currently given view the most popular.

Sometimes pain relief is not used. The reason for this is allergic reactions and other contraindications.

Let's consider each separately.

Local anesthesia

With the help of this type, only diagnostic hysteroscopy of the uterus is done. Under local anesthesia the procedure is performed on an outpatient basis. Before placing the hysteroscope in the uterine cavity, the specialist injects the uterine cervix with anesthetic drugs. After that, you need to stand for 10-15 minutes and carry out hysteroscopy. The most optimal drug for local anesthesia is lidocaine.

Keep in mind! After such anesthesia, severe pain will not be felt, but some discomfort will remain.

General anesthesia

Hysteroscopy under such anesthetic is carried out at a hospital. If you need to remove a polyp, cyst, fibroids, adhesions, or scrape out the uterine cavity, local anesthesia can be used.

The drugs enter the body intravenously or by mask, after which the patient falls asleep. Can be used drugs in the form of Propofol and Midazolam for injection into a vein and Sevoflurane and Isoflurane for inhalation. They are the safest. After a woman gets out of her medication sleep, she feels nausea, muscle soreness, weakness, and dizziness. Everything takes place within 24 hours.

Regional anesthesia

V modern world regional anesthesia (spinal or epidural) is most preferable. The medicine is injected into the area of the spine. At the same time, the woman does not fall asleep, is in her right mind, but the lower part of her body loses sensitivity. To achieve normal (complete) anesthesia, you need to perform several manipulations. The hardest part is installing an epidural tube.

Technique of the procedure and how long does it take?

Where and how is uterine hysteroscopy performed? The woman enters the office and sits in the gynecological chair. Then the turn of the anesthesiologist comes. The specialist introduces a solution prepared in advance and monitors the patient's condition.

Then everything happens as follows:

The doctor makes the treatment of the vagina, external genital organs and cervix with an antiseptic drug.
Produces expansion of the cervical canal. For this, he uses special metal expanders.
Introduces a special tube with a light source and a video camera. With the help of these devices, the cavity of the organ is examined. During the passage of the instrument through the neck, the organ is filled with air. This is necessary so that the uterine walls are straightened, and everything can be examined without hindrance.
After that, the specialist examines all parts of the uterus in stages. The image is displayed through the camera on the monitor. The picture is enlarged several times and this makes it possible to draw appropriate conclusions and make a clear diagnosis.
If necessary, a tissue sample is taken for further laboratory research.
At the end, the uterus is cleaned of the auxiliary solution and the patient is taken out of anesthesia.

The duration of the session will take half an hour, sometimes 10-15 minutes more. It all depends on the complexity of the process.

If hysteroscopy is performed for surgical purposes, then the procedure is performed under general anesthesia. After the operation, the woman will stay in the hospital for another two or three days.

First, the surgeon will examine the organ, then remove the endometrial polyp or other formation. Video surgery is very popular nowadays. Hysteroscopy allows you to remove a pathological neoplasm without violating the integrity of the skin.

If hysteroscopy with curettage is performed, then general anesthesia and staying in a hospital for 2-3 days are also desirable.

There is no pain during the diagnostic procedure, but women with a high pain threshold may have minor pain and discomfort. Surgical hysteroscopy usually uses a pain reliever. In this case, the woman does not feel anything. If there is no anesthesia (for example, when taking a biopsy), then there are quite tangible painful sensations.

On what day of the cycle is the manipulation done? Hysteroscopy is performed from the sixth to the tenth day of the menstrual cycle. In this period uterine membranes thinner and this contributes to better visibility. If the procedure needs to be carried out urgently, then this happens any day.

Recovery period after the procedure

V postoperative period a woman may feel soreness in the lower abdomen of a pulling character. It resembles menstrual pain. For severe pain, you can take any pain reliever or antispasmodic.

Discharge after hysteroscopy of the uterus is also common. It is ok if they are no more than five days old. If the bleeding continues more and increases every day, and does not decrease, you should immediately seek medical help.

Practice shows that surgical hysteroscopy affects the menstrual cycle. The first time there are failures.

The patient cannot be recovery period do douching, put tampons or suppositories in the vagina, take hot baths or go to baths and saunas, and have sex. It is necessary to carry out regular hygiene procedures.

You can get pregnant no earlier than 3-5 months later. This time period is purely individual and is adjusted by the doctor.

Potential consequences and complications

Complications after hysteroscopy of the uterus can be of a different nature. If the procedure was carried out correctly with preliminary preparation, then Negative consequences are reduced to a minimum. There is only discomfort and minor symptoms that were mentioned above. But, alas, there are exceptions.

Anesthetic complications

Complications of this nature are associated with an incorrect assessment of the anesthetic risk, impaired anesthesia technique and allergic reaction the drug used.

If anesthesia is not suitable for the patient, the following may begin:

tachycardia:
dyspnea;
cyanosis;
pulmonary edema;
vasospasm;
hives;
loss of consciousness.

With incorrect withdrawal from general anesthesia, the following is observed:

chills;
shiver;
the development of thrombophlebitis;
apnea;
muscle weakness;
paralysis;
increased heartbeat;
cyanosis;
difficulty breathing.

Sometimes, with the introduction of small doses, anesthesia does not give the desired result, after which the woman feels everything that is happening.

Surgical complication

If tissues were touched during the procedure, then the following may occur:

Bleeding that does not decrease, but increases.
The onset of endometritis (due to tissue infection). Characterized elevated temperature, pulling pain in the abdominal region below, the presence of purulent bloody discharge.
Perforation of the uterine wall. At the same time, a woman feels a sharp pain in the lower abdomen, she is nauseous, dizzy, blood pressure goes down due to severe blood loss.

In any case, you should immediately consult a doctor.

Complications of a different kind

Also, a woman can observe discharge from the genital tract, which smells unpleasant and contains pus. This also indicates the presence of a pathology with which one cannot hesitate. Timely referral to a gynecologist will prevent further negative consequences.

How much does the operation cost?

How much does hysteroscopy of the uterus cost in Moscow? It all depends on the remoteness from the center, the qualifications and experience of specialists, the popularity of honey. center. Consider three clinics.

Output

How hysteroscopy of the uterus is done and what it is is now no secret. The procedure does not take much time; when using anesthesia, it does not bring pain. There is nothing wrong with it if you find a good clinic and experienced qualified doctor... First, you need to undergo an examination, which will make it clear if there are any contraindications to hysteroscopy. If there are any changes in the discharge for the worse in the postoperative period, or if there are sharp increasing pains in the lower abdomen, you should immediately contact your gynecologist.

In clinical and diagnostic gynecology there are many minimally invasive techniques. One of the most popular is hysteroscopy. It is prescribed for the diagnosis and treatment of gynecological problems, including such difficult diagnoses in therapy as endometriosis, obstruction fallopian tubes and uterine fibroids.

According to practicing gynecologists, hysteroscopy of the uterus is the most effective study, which, if necessary, can be used to remove pathological foci in the uterine cavity. Low trauma, lack of long-term rehabilitation and high efficiency make it one of the most common methods in gynecology.

Hysteroscopy is a gynecological procedure for examining the uterine cavity using special device equipped with a light source and a video camera that magnifies the image by several dozen times. The procedure of hysteroscopy is resorted to if necessary, a detailed examination of the mucous membranes of the genital tract, the endocervical canal, as well as the endometrium of the uterus.

At its core, hysteroscopy of the uterus is a type of laparoscopy, but access to the inner wall of the uterus is carried out without incisions by expanding the cervical canal and introducing the equipment necessary for examination into it, as well as by carrying out diagnostic and therapeutic manipulations. If necessary, the standard examination of the uterus can be supplemented with medical procedures. The doctor may decide to have a hysteroscopy operation during the examination procedure. This flexibility and variability, as well as the absence of the need for specific preparation for the therapeutic effect, is especially appreciated in this method.

The manipulations that this gynecological examination implies can detect many pathologies of the uterus, including atypical growth or thinning of the endometrium, neoplasms, abnormalities in the structure of the uterus or appendages. In addition, pathologies can be eliminated immediately after detection, and the uterine tissues obtained during the operation remain suitable for further research.

Types of hysteroscopic procedures

There are several types of hysteroscopy in gynecology, which differ in the purpose of the procedure, in the technique and use. various substances for the expansion of the uterine cavity and modifications of the imaging device.

Classification according to the purpose of the procedure distinguishes the following types of hysteroscopy:

Diagnostic or office hysteroscopy. It is used if the doctor needs to examine the uterus from the inside in order to assess the state of the endometrium, the presence or absence of neoplasms, structural anomalies, consequences surgical treatment carried out earlier. The operation is performed in the doctor's office in the antenatal clinic. With this type of intervention, anesthesia is usually not used. During the procedure, the doctor can scrape or pinch off the endometrium or neoplasms, but resectoscopy (excision of a part of the endometrium or neoplasm with a surgical instrument) is not performed.
Therapeutic hysteroscopy. It is used in the case when the disease of the endometrium of the uterus has already been diagnosed, or there are obvious symptoms of pathologies of the genital organs, which can be eliminated by minimally invasive methods. In gynecology, such a procedure is known as hysteroresectoscopy, that is, an examination associated with the surgical removal or correction of pathological foci. A medical procedure is carried out in a hospital, as it requires the use of anesthesia.

In addition, control hysteroscopy, which is used to monitor the course of therapy, is classified as a separate type. It may be preceded by surgery or a diagnostic examination without or with curettage.

Good to know! Depending on the severity of the existing pathologies, hysteroscopy can be of the first category of complexity, second or third. The most difficult doctors call hysteroscopy when removing the uterus or large neoplasms that are bleeding.

The classification of hysteroscopy contains information about procedures using various modifications of equipment. So, for the diagnosis, as well as for the treatment of pathologies located in the uterine cavity, a non-flexible hysteroscope is used, while flexible equipment is used to examine and eliminate neoplasms in the mouths of the tubes and horns of the uterus.

In addition, experts distinguish subspecies of hysteroscopy, depending on the methods used to expand the uterine cavity. For this, a liquid medium can be used, during which, as the name implies, a liquid (sterile water, saline) is used. Also, the expansion of the organ can be carried out with the help of gas. Gas hysteroscopy is usually done using carbon dioxide, but dextran can also be used.

When to do it and how to prepare

The best results of diagnosis and treatment using a hysteroscope are obtained with a thin endometrium. Only under such conditions it is possible to visualize neoplasms in detail and avoid heavy bleeding during their removal. Therefore, the timing of the procedure is always focused on the characteristics of the patient's menstrual cycle, if she is not yet in postmenopause. In this case, the doctor takes into account the goals of hysteroscopy:

to detect tumors and polyps, hysteroscopy is desirable at the beginning of the cycle immediately after the end of bleeding, that is, on the 5-6th day of the cycle;
to diagnose infertility, the examination is carried out in the second half of the cycle;
any period is suitable for the diagnosis of endometriosis, except for the days when bleeding is observed.

In addition to cyclical changes, some external factors can affect the result of hysteroscopy. Therefore, after the doctor gives a referral for the procedure, the patient receives recommendations for preparation, which includes:

preventive therapy with antimicrobial agents, most often local in the form of suppositories or ointments for 5-7 days;
douching with antiseptics for a week before the start of the procedure;
laboratory examination for latent infections (bacteriological and PAP smear examination, blood and urine tests);
Ultrasound of the uterus with appendages;
fluorography;
cardiogram.

Note! The results of the above studies are valid for two weeks, so the woman will have to calculate the timing of their passage so that the hysteroscopy of the uterus takes place on time.

On the day of the hysteroscopy, it is recommended to reduce fluid intake so that the walls of the filled bladder do not interfere with the examination of the uterus and the implementation of therapeutic actions. Food should also be discarded at least 12 hours before the start of the procedure. This point is especially important when carrying out medical hysteroscopy.

How is hysteroscopy done

Before the hysteroscopy of the uterus begins, the woman's blood pressure and body temperature are measured. If everything is normal, the doctor is used local anesthetic(at diagnostic hysteroscopy) or general anesthesia (when planning medical and surgical procedures). In order for the doctor to start doing a hysteroscopy of the uterus, the patient must lie on a gynecological chair.

The procedure itself follows the standard algorithm:

The doctor inserts a gynecological speculum into the vagina and treats the mucous membranes with antiseptics. If necessary, anesthetic is also injected into the cervix to disable pain receptors.
The opening of the cervical canal is expanded with a special tool and a hysteroscope tube is inserted into the uterine cavity.
Carry out full inspection the uterine cavity and fallopian tubes. The state of the uterine mucosa is noted.
Depending on what methods of hysteroscopy the doctor uses, further actions consist in the selection of particles for further histology or radical removal of pathological foci. To remove the mass, the doctor expands the uterine cavity with liquid or gas and uses hysteroscopically applicable instruments such as coagulators or surgical devices.
After removal, the doctor coagulates the wounds and makes sure that there is no bleeding. If everything is in order, the procedure ends here.
The instruments are removed, the liquid or gas medium is removed from the organ cavity, and the cervix is closed and re-treated with antiseptics.

At the end of the procedure, the patient remains under the supervision of a doctor for some time.

What shows

It is possible to use hysteroscopy of the uterine cavity if any pathology is suspected, to confirm a previously made diagnosis, as well as to treat diseases that imply pathological changes in the endometrium.

Important! A standard examination with a hysteroscope shows even minor changes in the mucous membranes, so a study of this kind is suitable even for diagnosing the early stages of gynecological diseases.

The pathologies that hysteroscopy detects include:

hyperplastic and dystrophic changes in the endometrium;
internal endometriosis;
benign and malignant neoplasms uterine cavity;
fibroids;
inflammatory processes of the inner lining of the uterus and fallopian tubes;
intrauterine septa, synechiae and anomalies in the structure of the organ.

In addition, the method shows with high accuracy the presence of foreign bodies in the organ cavity, as well as organ perforation and obstruction of the fallopian tubes.

How long does the procedure take?

In most cases, hysteroscopy takes no more than 30 minutes. The exceptions are cases when large neoplasms are removed or the perforation of the organ wall is eliminated. In this case, hysteroscopy of the uterus takes up to 60 minutes.

The duration of the procedure can be influenced by both external and internal factors. So, if during the procedure bleeding begins, which should be urgently eliminated, the examination will take longer. The skill of the specialist also affects the duration of the operation. More experienced gynecologists do it faster than their novice colleagues.

How often can you do

It is recommended to carry out hysteroscopy of the uterus at intervals of 2 menstrual cycles. If done more often, it can provoke inflammation and menstrual irregularities. Reducing the period between examinations or therapeutic manipulations possible only if an urgent need for repeated hysteroscopy. This usually occurs when perforation or other complications are suspected.

Where is hysteroscopy done?

Diagnostic hysteroscopy is performed in the antenatal clinic in the gynecologist's office, since the procedure does not require long-term observation of the patient. The treatment procedure is done in the inpatient gynecology department. After her, the woman is under the supervision of a doctor for at least 2 days.

Rehabilitation and possible complications

Nowadays, negative consequences after hysteroscopy are rare, since the method is well studied and brought almost to perfection. All complications can be divided into several groups:

Intraoperative or arising during the intervention. It can be bleeding or perforation of the uterus. They are eliminated immediately after their occurrence, but bloody issues after hysteroscopy can persist for several days.
Postoperative complications that occur within a few days after the intervention. In this regard, the most common risk of developing infectious complications and bleeding due to poor-quality wound coagulation. In addition, blood may accumulate in the patient inside the uterus or synechiae may form. Infections are eliminated with antibiotic therapy, and a second operation is performed to eliminate other consequences. The long-term consequences of the procedure are adhesions that complicate pregnancy after hysteroscopy. They are removed by hysteroscopic or laparoscopic methods.
Complications provoked by the use of anesthesia. It can be a banal allergy to drugs, which is eliminated with the help of drugs.
Complications arising from the expansion of the uterine cavity - embolism, hypertension and anaphylactic shock... To eliminate these complications requires complex therapy, including resuscitation measures.

It is impossible to completely eliminate the likelihood of complications, but it helps to reduce the risks comprehensive examination patients. It allows you to identify factors that can affect the course of the operation and its consequences, and eliminate them in time.

Performing the procedure for endometrial diseases

The most common type of surgery is endometrial hysteroscopy. They are used for the following endometrial diseases:

polyps, which are located in the upper layers of the mucous membrane;
hyperplasia of the endometrium or endocervix (endometrioid tissue lining the cervix and its canal);
polyps of the cervical canal;
endometriosis;
at chronic inflammation endometrium.

The algorithm for performing the procedure remains the same as for other pathologies of the uterus, however, special technologies are used. For example, overgrowth with endometrial hyperplasia is removed by laser ablation. In the same way, endocervical hyperplasia is eliminated. Removal of endometrial hyperplasia in menopause is carried out using high-frequency currents or a laser.

Gynecologists prefer to remove polyps by mechanical methods: they are scraped or excised with scissors, a resectoscope or forceps, and then the wound is coagulated with high-frequency currents or a laser. At chronic endometritis in hysteroscopy, mixed technologies are used, which can combine exposure to tissue with a laser, high-frequency currents, or mechanical removal of pathological foci.

If hysteroscopy is planned for endometriosis, the procedure in most cases is prescribed after preliminary hormone therapy. Pathological lesions are then easier to detect and remove completely. The most common method of excision of endometriotic pathological tissues is laser ablation or electrocoagulation.

Indications for hysteroscopy: what they are doing

V gynecological practice the most common hysteroscopy for infertility due to obstruction of the fallopian tubes, endometriosis or the presence of neoplasms in the organ cavity. Using this method, the patency of the tubes is checked, if necessary, adhesions in the uterus are removed and benign neoplasms that interfere with conception. Shown hysteroscopy with adenomyosis and acquired anomalies of the uterus.

In addition, other gynecological problems may become indications for hysteroscopy:

incompetence of the cervix;
irregular uterine bleeding;
bleeding after menopause;
bleeding after scraping;
complications after childbirth;
recurrence of miscarriages on early dates and with miscarriage of mature pregnancy;
suspicion of organ perforation or the presence of foreign objects in it;
the presence of a scar on the uterus after surgery or injury.

Usually, such phenomena indicate the presence of pathological changes in the endometrium or the presence of neoplasms. These may be polyps or uterine fibroids that require removal. Doctors also conduct a study if endometrial cancer is suspected.

Examination by hysteroscopy is mandatory before removal of the uterus, as well as after cesarean and other operations on the organ. It is necessary to track the effectiveness of therapy, identify complications and eliminate them.

Special recommendations for performing hysteroscopy relate to conditions that are not treated with this method, but only monitor the condition reproductive organs... These include diagnosed malignant tumors uterus and appendages, as well as congenital malformations of the reproductive system. To the number of exclusively diagnostic and control procedures, doctors include hysteroscopy with a bicornuate uterus, as well as with cancerous tumors organ.

Contraindications for hysteroscopy

All contraindications for hysteroscopy can be divided into conditional and unconditional. The conditional ones include the limitations with which hysteroscopy can be performed, adjusted for their existence. These include menstruation and uterine bleeding, which can make it difficult to see. You can also carry out it with an inflammatory process in chronic form when it is in remission.

Doctors call the absolute contraindications for surgery:

systemic infections in the acute stage, including genital herpes, acute respiratory viral infections and acute respiratory infections with a runny nose, cough and other symptoms;
acute inflammatory processes;
stenosis of the cervical canal;
poor blood clotting;
severe diseases of the kidneys, lungs and liver, which make it difficult to use anesthesia.

Important! Examination of elderly patients is carried out with extreme caution. Particular attention is paid to stabilizing their condition in terms of major diseases.

In case of an urgent need for the procedure, the listed diseases are treated. A somewhat different picture than with colds or infections, present in patients diagnosed with cervical cancer. Their disease is an unconditional and undeniable contraindication to hysteroscopy.

Results and transcript

After the completion of the examination or operation, the doctor draws up a hysteroscopy protocol, in which he notes all key points research:

The state of the endometrium, its color and thickness, adjusted for the patient's reproductive abilities (before menopause and during menopause, it looks different).
The structure and color of the mucous membrane, its thickness and uniformity. Redness or thickening may indicate endometritis, while ulceration and looseness of the endometrium indicates oncology.
The presence of secretions or sediment on the endometrium. For example, a white-coated endometrium may indicate purulent processes or fungal infection of the organ.
The presence of neoplasms, their localization, size, method of attachment to the wall of the organ, the presence of blood vessels in them. The doctor also mentions whether bleeding is present after touching the neoplasms.
Anatomical features of the organ cavity, in particular, how clearly the mouths of the tubes are visible, whether septa, synechiae are present, and so on. If pathologies are found, their localization is entered into the results of hysteroscopy, appearance, dimensions and other characteristics.
The presence of foreign bodies in the uterus, including bone fragments, ligatures, intrauterine devices etc. The doctor indicates their size, location in the uterus, the degree of connection with the endometrium (they can be on its surface or grow into it almost completely).

Based on the data described in the protocol, a decryption is drawn up, which is later transmitted to the patient's attending physician along with the printed images.

Hysteroscopy of the uterus used for research inner surface organ. The method is effective not only as a diagnostic, but also as a way to carry out some operations. Equipment is introduced into the uterine cavity through the cervix - a hysteroscope with a camera. As a result, the image is displayed on the screen and allows you to examine the tissue for diagnosis. Intrauterine pathologies, polyps, changes without incisions, stitches and rehabilitation are revealed. Hysteroscopy can be surgical and diagnostic, as well as mixed, depending on the situation. In whole diagnostics, the procedure is performed on an outpatient basis. Surgical hysteroscopy of the uterus involves an intervention, therefore, it is performed under general anesthesia. After hysteroscopy of this type, the patient is under observation in the hospital for some time.

In what cases is hysteroscopy prescribed?

The procedure can be assigned gynecologist in some cases:

Too profuse, irregular menstrual flow.
The presence or suspicion of fibroids.
Recurrent termination of pregnancy, infertility.
Malignant and other neoplasms.

Before the procedure

The preparatory stage is a survey in gynecology... This is a smear on flora, general blood and urine tests, ultrasound examination, samples a HIV infection, ECG, fluorography. The complete list of analyzes that will be required is determined individually. Also, sometimes it is necessary to consult other specialized specialists. This is a cardiologist, endocrinologist, gastroenterologist and others.

The best time for hysteroscopy is a few days after your period. You must not eat and drink in the morning before the examination. Sex life limited to three days before the procedure. Medication should also be limited and the doctor should be warned about any medications being taken.

How is hysteroscopy

Surgery often involves removal of polyps by hysteroscopy... For this, general anesthesia is used. Several stages follow:

Treatment of the external genital organs with an antiseptic.
Expansion of the cervical canal, introduction of a hysteroscope.
Examination of the tissues of the inner surface of the uterus, the mouth of the fallopian tubes and the cervical canal.
If polyps are present, they can be removed. Also besides removal of polyps tissue samples can be taken for further cytological examination.

After hysteroscopy

As a rule, the patient can be discharged after the procedure within a few hours. After the intervention, there may be slight pains in the lower abdomen, as well as discharge with blood impurities for a couple of days. This is due to the stretching of the uterus and some damage to the mucous membrane. If the pain becomes stronger, and the discharge becomes more intense, it is necessary to see a doctor as soon as possible.

Sexual rest for three weeks or more.
Refusal from baths, saunas, swimming pool visits for at least three weeks.
Limitation physical activity lifting weights for a month.

Possible negative consequences

The procedure is classified as safe and rarely accompanied by complications. Despite this, the following consequences are encountered:

Bleeding that lasts more than three days and has an intensifying character.
Inflammatory processes in the uterus or small pelvis.
Exacerbation of chronic diseases.
Deformation of the uterus (can be observed after removal of large fibroid nodes).

When hysteroscopy cannot be performed

Hysteroscopy is surgical intervention, therefore, there are a number of contraindications to its implementation:

Pregnancy.
Oncological formations in the area of the procedure.
Acute infections.
Inflammatory diseases of the genital organs.
Bleeding, cervical stenosis.
Serious disorders of the functioning of the lungs, kidneys, liver, immune system.

Removal of polyps by hysteroscopy

In the cervix and uterine cavity, polyps are quite common. These are benign formations on the mucous membrane, which are often attached to its surface with the help of a leg. The main manifestations of polyps are:

Intermenstrual discharge.
Discomfort and pain during intercourse.
Drawing pains in the lower abdomen.

With timely removal of polyps, the problem is solved quickly and without complications. Using a hysteroscope, the doctor finds the place where the polyp is attached and cuts it off.

Where to do hysteroscopy in Moscow

Undergo a reasonable procedure the price proposes clinic CDB RAS in Moscow... Acquainted with additional information and reviews patients can be found on the website. Appointment - through the online registration form or by phone.

Over the past few years, obstetrics and gynecology have made a huge leap forward. Modern methods diagnostics allow you to determine the presence of a disease, even on early stages... And various therapeutic measures make it possible to carry out fast and high-quality therapy. And nowadays, minimally invasive methods of diagnosis and treatment are becoming more and more in demand and popular, which allow detecting and eliminating the problem without resorting to standard surgical interventions, which significantly reduces the risk of complications.

Today, many patients are prescribed a procedure called hysteroscopy. What is this technique? How is the procedure carried out? Is it associated with any complications? Are there any contraindications to its implementation? The answers to these questions will be interesting and useful to every woman.

Hysteroscopy - what is it?

Modern medicine knows many different diseases of the genital area. And in some cases, to make a final diagnosis, the doctor needs to carefully examine the inner wall of the uterus. This is exactly what hysteroscopy provides.

What is this procedure? Its essence is quite simple - the examination is carried out using a special hysteroscope apparatus. It is equipped with fiber optic, which allows the doctor to carefully examine the structure and, if present, the pathology of the inner wall of the uterus, examining them on a large screen.

In fact, obstetrics and gynecology are widely used this technique for both diagnostic and therapeutic purposes.

Types of hysteroscopy

Today, there are several main types of this procedure. The technique in this case depends primarily on the purpose of the hysteroscopy.

The diagnostic procedure involves examining the uterus using optical equipment. This procedure is used to detect various pathologies and neoplasms in the uterine cavity. In this case, the integrity of the tissues is not violated.
Surgical hysteroscopy involves the use of not only optical, but also surgical equipment. The procedure is used for the minimally traumatic treatment of various pathologies of the uterus. For example, there are some procedures with which hysteroscopy of the uterus is perfectly combined - removal of a polyp, elimination of some other benign neoplasms, curettage of the cavity, etc. In such cases, general anesthesia is already required.
There is also a so-called control hysteroscopy of the uterine cavity. A similar procedure is carried out if the doctor needs to carefully monitor the treatment process, evaluate the effectiveness of the effects of drugs or procedures, and also timely determine the development of complications or relapses of the disease.

It should be noted that modern equipment allows one to examine tissues under significant magnification, which makes hysteroscopy extremely valuable for both diagnosis and treatment.

When is research required?

Of course, today many women are interested in information about what constitutes a hysteroscopy of the uterus. Consequences, feedback from patients - I want to know about all this to those who are expecting such an intervention. But first you need to understand the indications for this procedure. A diagnostic examination is required:

If you suspect the presence of uterine fibroids or endometriosis.
In order to detect the remnants of the membranes of the fetus in the uterus, which can lead to the development of a mass of complications.
Hysteroscopy is indicated for women who suffer from prolonged and heavy periods, as well as uncharacteristic intermenstrual discharge and bleeding during menopause.
The procedure is carried out to detect certain malformations of the uterus.
The indication for carrying out is infertility, as well as spontaneous termination of pregnancy.
In addition, hysteroscopy is indicated for women who have recently had severe hormonal treatment... In this case, the procedure is of a control nature.

Therapeutic hysteroscopy and indications for its use

Medical or surgical hysteroscopy provides not only examination, but also treatment of various diseases of the uterus. What is the indication for this procedure?

This procedure is widely used to treat patients diagnosed with thickening of the endometrium, which is observed with hyperplasia of the mucous membrane.
There is another common problem, for which hysteroscopy of the uterus is used - removal of the polyp. At the same time, with the help of special tools, it is possible to completely remove the neoplasm and treat the uterine tissue with appropriate medications.
An indication for a surgical procedure is also a fibroid located in the tissues under the uterine mucosa.
In some cases, hysteroscopy of the uterus and curettage are combined. A similar procedure is carried out with bleeding from the uterus of unknown origin, with a frozen pregnancy and other pathologies.
With the help of hysteroscopic equipment, it is possible to quickly dissect the fused walls of the uterus or partitions in its cavity.
In some cases, intrauterine contraceptives are removed during the procedure.

Are there any contraindications to the procedure?

Despite the fact that hysteroscopy is considered one of the safest procedures, it has some contraindications:

To begin with, it is worth noting that an examination or operation is not carried out if there is inflammatory diseases external genital organs. In such cases, you first need to conduct a course of treatment.
Also, pregnancy is an absolute contraindication to the procedure, as this can lead to its termination.
Patients suffering from any acute infectious diseases, hysteroscopy is not performed. First, you need to carry out appropriate treatment and wait for the disappearance of the main symptoms.
Contraindications also include profuse uterine bleeding and cervical stenosis.
Hysteroscopy is contraindicated in women with end-stage cervical cancer.

Do you need special training?

Although this procedure it is relatively easy to carry out and safe for health, some measures will still be needed before it is carried out. Do not forget that this is a minimally invasive, but still a surgical procedure, so you should not neglect the doctor's recommendations in any case.

So what does the preparation for hysteroscopy of the uterus look like? First, the patient must be carefully examined for contraindications. To this end, general analysis blood and urine, as well as the delivery of a smear for bacteriological culture on the microflora. Tests for HIV and syphilis are also required. Sometimes a smear from the cervical canal is additionally performed.

In addition, before carrying out a hysteroscopy, a woman must inform the doctor about the medications she is taking, the presence of certain health complaints.

No special preparation is required in this case. But before hysteroscopy, it is recommended to cleanse the intestines (this can be done in the evening with a cleansing enema or laxative), as well as to empty the bladder and remove hair from the external genitals.

How is the procedure carried out?

Naturally, patients are primarily interested in the question of how a hysteroscopy of the uterus is done. In this case, it all depends on the purpose of the procedure. For example, a diagnostic examination does not require anesthesia. But the procedure looks different if the doctor has to remove neoplasms, for example, polyps in the uterus - hysteroscopy in such cases is performed under general anesthesia.

The last meal should be no later than six hours before the procedure. Drinking is not allowed four hours before the hysteroscopy.

Typically, in the ward, a woman is asked to change into a hospital gown. Here, the nurse gives the patient an injection sedative... After that, you need to move to the gynecological chair. General anesthesia provides for the presence of an anesthesiologist during the procedure - the doctor selects the appropriate anesthetic agent and its dosage, injects the drug and monitors the patient's condition throughout the procedure. Hysteroscopy begins only with the destruction of the anesthesiologist.

First, the gynecologist carefully expands the cervical canal, and then inserts a hysteroscope into the uterine cavity. This device is either a flexible hollow tube or a thin rigid wire. In any case, its end is equipped with optical instrument and a source of illumination - the image is displayed on the screen, which gives the doctor the opportunity to carefully examine and study the features of the uterine wall.

Through a special channel, either a gas mixture or a saline solution is injected into the uterine cavity - this makes it possible to expand the uterine cavity and improve visibility. First of all, the gynecologist will examine the uterine walls, the cervical canal, as well as the mouth of the fallopian tubes.

Surgical hysteroscopy, which is performed to remove polyps, curettage, etc., requires the use of special surgical equipment that is inserted into the uterine cavity through a hysteroscope.

After all the manipulations are completed, the uterus is cleaned of the remnants of saline, after which the anesthesiologist revives the patient.

Many women are interested in questions about how painful hysteroscopy of the uterus is. Patient reviews indicate that there is no pain in this case. Naturally, with surgical treatment this question not relevant, since the woman is under anesthesia. But diagnostic hysteroscopy is most often performed without anesthesia (sometimes the doctor can apply local anesthesia). Nevertheless, even without it, the examination is rarely painful, although discomfort may still be present.

Most often, hysteroscopy is performed on the 6-10th day of the menstrual cycle, since the uterine membrane is thinnest during this period, which improves visibility. On the other hand, for critical conditions the procedure is carried out regardless of the phase of the monthly cycle.

What happens after hysteroscopy?

Before carrying out the procedure, a woman must be sure to familiarize herself with the information about what awaits her after hysteroscopy. After surgical treatment, the patient first feels pulling pains in the lower abdomen, which are somewhat reminiscent of the sensations that occur during menstruation. If the soreness is intense, then you can take an anesthetic or antispasmodic drug that will help alleviate the condition.

Small spotting after hysteroscopy of the uterus is also considered normal. But, again, in this case it is worth listening to your body. Over the next 2-4 days, the amount of discharge should gradually decrease until it disappears completely.

Some women are interested in questions about whether this procedure affects menstrual cycle... A diagnostic examination, as a rule, does not affect menstruation in any way, but a surgical procedure can cause a slight malfunction, which should definitely be reported to the attending physician.

Complications and consequences of unsuccessful hysteroscopy

In fact, with a correct and accurate procedure, the consequences come down to a little discomfort that goes away on its own. But there are some more serious complications with which hysteroscopy can be associated. What are these consequences?

Perhaps most often in gynecological practice, uterine bleeding is diagnosed, which appears after examining the uterus with a hysteroscope. The danger is that many patients do not pay attention to bleeding, perceiving this as a normal phenomenon after the procedure. If discharge with impurities of blood is present for two days and their amount does not decrease, then you should definitely consult a doctor.

There are some other consequences of hysteroscopy of the uterus. In particular, some patients develop endometritis - inflammation of the inner layer (endometrium) of the uterus. Most often, the appearance of an inflammatory process is associated with tissue infection during the procedure. As a rule, symptoms of this disease appear after a few days. The main signs include pulling pains in the lower abdomen, an increase in body temperature, as well as uncharacteristic vaginal discharge with impurities of pus. In the presence of such violations, you should immediately consult a doctor - in the early stages, endometriosis is easily treated with medication and rarely causes any complications, which cannot be said about neglected form illness.

There is another rather common complication with which hysteroscopy is associated. What is it and how is it dangerous? Sometimes during the procedure, the uterus is damaged by the hysteroscope, which leads to perforation of its wall. It should be noted right away that such a complication is entirely the fault of the attending physician. The main signs of uterine perforation include severe sharp pains in the lower abdomen, as well as dizziness, nausea, vomiting, a sharp decrease blood pressure that is associated with blood loss. A patient in this condition urgently needs surgery.

There are some rules to follow. Hysteroscopy of the uterus is still a surgical procedure. In particular, women should not take hot baths - the best option there will be a warm shower. It is also strictly forbidden to visit saunas, baths and solariums, as this can lead to uterine bleeding and some other complications.

For a while, it is worth giving up vaginal tampons, replacing them with sanitary napkins. Douching is also prohibited. And, of course, you shouldn't have sex in the first week.

Closely monitor the state of your body. Any deterioration in health, fever, abdominal pain is a reason for a visit to the doctor. It is necessary to sound the alarm in the presence of profuse bloody and purulent discharge - in such cases gynecological examination is also required.

Where can a similar procedure be carried out?

Of course, today many patients are interested in where exactly hysteroscopy is performed. Reviews and statistical surveys confirm that the procedure can be carried out both in a hospital and on an outpatient basis.

On an outpatient basis, only diagnostic examinations are carried out today, which do not require special training or anesthesia. After hysteroscopy, the patient receives the results of the study with further recommendations and can go home.

And here are all medicinal and surgical procedures are carried out exclusively in a hospital setting. After removal of polyps, curettage or other measures, the patient should stay in the clinic for several days, since the doctor is obliged to monitor her condition.

Today, hysteroscopy is performed in almost any state polyclinic, where in the gynecological department there is necessary equipment... In addition, a similar procedure is offered by private clinics and medical offices... Be sure to ask the doctor who prescribed this procedure for more information.

What is the price?

Of course, today many patients are interested in the question of how much a hysteroscopy of the uterus costs. There is no definite answer to this question, since prices in this case depend on the purpose of the procedure and the level of complexity of the procedure, as well as the quality of the equipment used, the financial policy of the clinic and the qualifications of the doctor.

So how much will a hysteroscopy of the uterus cost? The price fluctuates quite widely. For example, the usual diagnostic procedure will cost you about 4000-6000 rubles. But surgical measures (for example, removal of a polyp, curettage) will cost more - from 15 to 30 thousand rubles, depending on the complexity of the procedure. Of course, inpatient hysteroscopy is more expensive, but this service has its merits. In particular, after the procedure, the patient remains under the supervision of a doctor and, if necessary, receives appropriate assistance.

Hysteroscopy of the uterus: patient reviews

Today, this procedure is considered extremely popular, as it helps to diagnose and treat a number of diseases of the reproductive system in time. By the way, examination must be prescribed in the treatment of infertility, as well as before in vitro fertilization.

Naturally, many patients go for a procedure called hysteroscopy of the uterus. Most reviews of this technique are positive character... Of course, a diagnostic examination without anesthesia is associated with some discomfort, but the procedure lasts no more than 20 minutes, and the results of the study are very accurate.

As for surgical hysteroscopy, all complaints of patients are most often associated with anesthesia - many women feel fatigue, weakness, nausea and other unpleasant symptoms that occur after the administration of an anesthetic. Of course, in the first days after curettage and removal of the polyp, there are pains in the lower abdomen, which, however, can be easily relieved with the help of painkillers.

The undoubted advantage of the procedure is the low tissue trauma along with high therapeutic effect... In addition, in most cases, this type of surgery does not require long-term hospitalization - the patient can return to the usual rhythm of life (albeit with some restrictions) after a few days. And, again, it is worth understanding that it depends on the experience, skills and qualifications of the attending physician how the hysteroscopy of the uterus will be performed. Reviews that are negative, as a rule, are associated with inaccurate actions of a specialist.