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Hysteroscopy

Hysteroscopy is a diagnostic test that makes use of a thin telescope-like hysterescope to view and operate upon the endometrial cavity. Carbon dioxide is filled into the cavity to aid this process. While often hysteroscopy can be done as an outpatient procedure, some women may need local anesthesia. In some cases, hysterescopy is done along with a resectoscope. But this procedure destroys the uterine lining and is not a viable alternative for women who wish to have children. A laparoscope may be used to view the uterine exteriors.


Diagnostic hysteroscopy involves observation of the endometrial cavity for any abnormalities. This procedure is often used in cases where there has been abnormal uterine bleeding or repeated miscarriage. Diagnostic hysteroscopy may also be used to confirm the results of HSG. Hysterescopy may be used to check for causes of heavy or irregular menstrual cycle or fit IUD.

Operative hysteroscopy involves use of hysteroscope to remove polyps, cut adhesions or treat fibroids and septums. This can be used as an alternative to open abdominal surgery. This involves use of operative hysteroscope that allows the physician to insert operating tools. In rare cases, hysterescopy may lead to infection and heavy bleeding or injury to the cervix or uterus.

Asherman's Syndrome

Asherman's syndrome refers to the formation of adhesions or scar tissues on the endometrium (uterine lining). Most often endometrial scarring occurs as a result of scraping of tissue from the uterine wall while performing dilation and curettage (D& C). Though D&C is mainly responsible for adhesions, uterine surgery and severe infections of the endometrium such as genital tuberculosis are some of the other factors that cause Asherman's syndrome. Normally, Asherman's syndrome shows up with decreased menstrual flow or even amenorrhea, cramping, abdominal pain and is even associated with infertility and recurrent miscarriages.


Causes of Asherman's syndrome

D&C procedure is performed for miscarriages, excess bleeding, elective abortion or to remove the retained products of conception. Some gynecological disorders call for uterine surgery. Sometimes trauma occurs to the uterine lining while performing D&C procedure or other surgery. In case of damage, the wound begins to heal and in the process, fuses with the affected portion causing adhesions. The risk of Asherman's syndrome increases with repeated D&Cs.


Symptoms of Asherman's syndrome

Infertility
Menstrual disorders such as Hypomenorrhea or amenorrhea
Repeated miscarriage
Pelvic pain as scar tissue blocks the menstrual flow.


Diagnosis and treatment of Asherman's syndrome

Hysteroscopy is the widely used method to diagnose the Asherman's syndrome as it allows the doctor to have a complete view of the uterus directly. However other methods such as sonohysterography (SHG), hysterosalpingogram (HSG) and transvaginal ultrasound examination are also used to evaluate adhesions. Blood tests are done to detect tuberculosis or schistosomiasis.

Asherman's syndrome is normally treated with surgery to remove the adhesions or scar tissue. The surgery involves hysteroscopy procedure wherein scar tissue is removed by using small instruments, micro scissors and a camera. Once the scar tissue is removed, an intra uterine balloon is placed inside the uterus to keep the uterine cavity open. This procedure aids the healing process and prevents adhesions from returning. Patient may also be prescribed oral estrogen medications for promoting growth of regular uterine lining. Patient may be called in for review hysteroscopy after two weeks of the procedure to make sure that there is no reformation of adhesions.


Hysterosalpingogram

A Hysterosalpingogram or hsg is a diagnostic x-ray of the uterus and fallopian tubes. This test allows the gynecologist to observe the inside of the uterus and fallopian tubes for any problems such as blockage of fallopian tubes, endometrial polyps, fibroids, genital tuberculosis or abnormalities in the uterine cavity. Hysterosalpingogram is also done to find problems in the uterus, such as abnormal shape and structure, an injury, adhesions or a foreign body in the uterus. HSG is often used in cases where a sterilization reversal is sought.


Hysterosalpingogram procedure

A woman must inform the radiologist if she is allergic to iodine dye, suffer pelvic or sexually transmitted disease. Women with bleeding problems such as hemophilia or those on blood thinning medicines such as aspirin must keep the doctor appraised. The gynecologist or radiologist uses a cannula to fill the uterus with iodine. The dye will flow into the fallopian tubes as the uterus is hooked with these tubes, and the pictures are taken using high steady beam fluoroscopy, as the dye passes through. In case of injury or an abnormal structure, the picture can throw up the problems. The pictures are shown on a TV monitor during the test. If another view is needs, the examination table is tilted or the patient may be asked to change positions. A blockage can prevent sperm from moving into the fallopian tube and joining an egg for fertilization to occur.


A HSG can catch if there is any problem inside her uterus that possibly prevents a fertilized egg from implanting to the uterine wall. This helps in outlining the fallopian tubes so that any abnormalities in the tubes or uterine cavity is observed. In cases of infertility due to tubal blockage, HSG is used to evaluate the location and extent of blockage. The Hysterosalpingogram procedure takes a few minutes and can be moderately uncomfortable for the woman, with possibility of cramps. Women who have tubal disease may develop pelvic infection. In rare cases, the woman develops iodine allergy. Some women notice spotting for a couple of days after the HSG.

Risks of Hysterosalpingogram

In less than 1 in 100, there may be a chance of a pelvic infection after the test. The chances are higher in those who have had pelvic infections before. Antibiotics A negligible chance of damaging or puncturing the uterus or fallopian tubes during the test does exist during the test. There could be some allergic reaction to the iodine x ray dye. If oil based dye is used, the oil can leak into the blood. This can cause blockage of blood flow to a section of the lung. But most HSG tests are water based. A woman may feel some cramping similar to menstrual cramps during the procedure and the amount of pain may depend upon the problems that the doctor finds and treats during the test. There could be some vaginal bleeding for several days after the test.

The test result is considered normal if the injected dye spills freely out from the ends of the fallopian tube and the x ray shows normal uterine shape. However, if further tests do not reveal the cause of infertility or recurrent pregnancy loss, the doctor could order for a hysteroscopy. There are chances that while a HSG could show a normal uterine shape, a hysteroscopy show abnormalities.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 15, 2019