Office hysteroscopy: a review

With the invention of new techniques and modalities “see and treat” has become the norm of management now a days. Diagnostic hysteroscopy combined with histological examination of an endometrial biopsy is considered the ‘gold standard’ in the diagnosis of intrauterine abnormalities. The importance of office hysteroscopy lies in the fact that there is no need of any anesthesia and after the procedure the patient can return into his routine activity only with the minimal aid of NSAIDs. Two different types of hysteroscopes are used worldwide: flexible or rigid, which are made in different sizes. Optic miniaturization has been one of the greatest technological advancements in the field of hysteroscopy, both for rod-lens and fiberoptic scopes. The main concerns in office hysteroscopy are the need for necessary expertise, pain management and management of the complications in the office setting and the high cost of the equipment needed for the procedure. But office hysteroscopy has already demonstrated good correlation of findings compared with inpatient hysteroscopy, providing distinct advantages such as reduced anesthesia risks, enhanced time and cost-effectiveness, and faster recovery with less time away from work and home.

Uterocutaneous Fistula after a C-Section in a Patient with Second Trimester Fetal Demise and Chorioamnionitis

Uterocutaneous fistulae are very rare entities with only about 120 cases reported in the literature. They are mostly described after a C-section or other pelvic surgery. We hereby describe a uterocutaneous fistula in a 41-year-old patient 5 months after a C-section because of a chorioamnionitis and a 22-week fetal demise. One month after the C-section, she underwent a diagnostic hysteroscopy to exclude postoperative intrauterine adhesions. Afterwards, she complained of pelvic pain, persistent metrorrhagia, and significant weight loss during 2 months. She consulted the emergency unit several times, and lastly endometritis was diagnosed. She was treated with antibiotic therapy for 7 days, without significant clinical improvement. She presented at our institution 48 hours after a carbuncle had appeared in her right iliac fossa. A uterocutaneous fistula was diagnosed on the CT scan. The patient received IV antibiotic therapy and underwent a total hysterectomy with bilateral salpingectomy by laparotomy, as she did not want a conservative surgery. The clinical postoperative evolution was favorable. Symptoms of UCF can be very unspecific. To avoid medical wandering and improve the patient’s care, UCF should be in the differential diagnostic of abdominal pain after a pelvic surgery. Moreover, in patients with previous C-section and infectious perioperative status, the risk of PID or pelvic abscess must be careful evaluated before intrauterine diagnostic or therapeutic procedures.

A clinical audit of hysteroscopy in a tertiary care teaching. What challenges did we face?

Background: The aim of the study was to evaluate indications, operative findings and complications in patients undergoing hysteroscopy.Methods: The data of all patients who underwent hysteroscopy in the department of obstetrics and gynecology in a tertiary care teaching hospital were included retrospectively from November 2017 to October 2018.Results: There were 59 patients who had hysteroscopy for various indications. Twelve patients and forty-seven patients were subjected to diagnostic and operative hysteroscopy respectively. Indications for diagnostic hysteroscopy were for postmenopausal bleed (3), carcinoma of the breast on tamoxifen with bleeding PV (3), recurrent implantation failure (6). Operative hysteroscopy was performed for endometrial polyp (30), myomectomy (9), septal resection (7), copper T removal (1). Complications of hysteroscopy were: media efflux and poor visualization in 10 (17%), minor hemorrhage (9) 15.1%, perforation 2 (3.3%). Minor hemorrhage was managed with tranexamic acid. The perforation in two patients happened during the dilatation of the cervix with metal dilators.Conclusions: One of the major challenges encountered was the efflux of the distension media due to excessive cervical dilatation, which did not provide satisfactory hysteroscopic view. Another complication was perforation during cervical dilatation using Hegars dilator. Use of misoprostol and the use of small sheath hysteroscopes have minimized the need for cervical dilatation.

Study of various intrauterine pathologies by hysteroscopy leading to various gynaecological problems

Background: This study was to diagnose different types of intrauterine pathologies, their locations and relations with clinical presentations (like abnormal uterine bleeding (AUB), recurrent abortions, unexplained infertility and secondary dysmenorrhoea) by hysteroscopy. To know the prevalence and identification of the demographic relations of different intrauterine pathologies and clinical symptoms were observed. This study also aimed in selecting OPD or indoor operative procedure.Methods: Data collection of 144 cases was done with suspicion of intrauterine pathology on the basis of history and clinical examination. They were screened by per abdomen, per speculum, pelvic examination. USG and HSG in cases of infertility were used. Further intrauterine pathologies were explored by hysteroscopyResults: On hysteroscopy no abnormality was detected in 80/144 (55.6%) cases which was the maximum finding observed. AUB 96 (66.7%) was the most common presenting complaint followed by infertility 39 (27.1%). In 96 cases there was no organic pathology. Thickened endometrium was the commonest 17/144 (11.8%) pathology observed by hysteroscopy followed by endometrial polyp 14/144 (9.7%).Conclusions: With increasing demands for one-stop clinics where diagnosis and treatment are offered in same sitting. Diagnostic hysteroscopy by virtue of its diagnostic and therapeutic capabilities can become the procedure of first choice in evaluation of gynaecological problems.

Chronic endometritis. Towards the improvement of diagnostic methods

This paper reviews an important issue that significantly affects female fertility, chronic endometritis. This condition is characterized by clinical presentations of various severity and abnormalities of endometrial morphology. The rate of chronic endometritis varies greatly, mainly due to predominantly asymptomatic course and imperfect diagnostics. Pathogenic mechanisms of endometrial inflammation and different views on its effects on female reproductive potential are addressed. Further search for endometrial receptivity markers is needed as these markers will allow for assessing the severity of endometrial damage to develop the algorithm of preconception care. The authors focus on diagnostic techniques for chronic endometritis and their value. Immunohistochemistry of endometrium is a promising tool to be applied to diagnose endometrial inflammation and monitor treatment efficacy. A complex diagnostic approach to chronic endometritis that includes pelvic ultrasound, Doppler ultrasound, assessment of endometrial microbiota, diagnostic hysteroscopy and endometrial histopathology, and evaluation of endometrial receptivity is useful. KEYWORDS: chronic endometritis, termination of pregnancy, infertility, autoimmune processes, chronic inflammation, endometrial structure, immunohistochemistry. FOR CITATION: Shamilova A.M., Il’ina I.Yu., Borovkova E.I., Dobrokhotova Yu.E. Chronic endometritis. Towards the improvement of diagnostic methods. Russian Journal of Woman and Child Health. 2021;4(3):243–249 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-243-249.