2500 Outpatient diagnostic hysteroscopies

doi:10.1016/0029-7844(96)00108-1

Obstetrics & Gynecology

Volume 88, Issue 1, July 1996, Pages 87-92

https://doi.org/10.1016/0029-7844(96)00108-1 Get rights and content

Objective

To evaluate the feasibility and acceptability of outpatient diagnostic hysteroscopy.

Methods

The outcome of 2500 consecutive outpatient hysteroscopies was analyzed. Cervical dilation was performed when necessary and local anesthesia was not administered routinely. Endometrial biopsy and minor hysteroscopic procedures were carried out when indicated. Findings and outcome were compared according to patient characteristics.

Results

The most common indication for hysteroscopy was abnormal uterine bleeding (87%). Hysteroscopy was performed successfully in 96.4%, and a complete view of the uterine cavity was obtained in 88.9%. Local anesthesia was used in 29.8% and was associated with the need for cervical dilation; both local anesthetic use and cervical dilation were significantly more often required in nulligravid, nulliparous, and postmenopausal women. Intrauterine pathology was diagnosed in 48%, the highest incidence being found in those 50–60 years old (53.7%). The presence of fibroids was the most common abnormality (24.3%) but was seen in only 6.8% of women older than 60 years. Conversely, the incidence of endometrial polyps increased with age, up to 20.5% in women over 60 years. Endometrial biopsy was performed in 68% and produced adequate tissue for histologic examination in 83.7%. Endometrial hyperplasia or carcinoma was detected in 1%. One hundred sixteen women (4.6%) under-went a minor hysteroscopic procedure.

Conclusion

Outpatient diagnostic hysteroscopy is both feasible and acceptable in the overwhelming majority of cases, with a high detection rate for intrauterine pathology. This procedure may become as routine in the 21st century as D&C has been in the 20th.

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Endometrial hyperplasia in pre-menopausal women: A systematic review of incidence, prevalence, and risk factors
2022, European Journal of Obstetrics and Gynecology and Reproductive Biology
Hormonal therapies have been associated with a range of effects on the endometrium, including endometrial hyperplasia (EH). With many medicinal products being developed for pre-menopausal women, epidemiological data regarding the population background risk could meaningfully supplement comparative risk data gathered in clinical trials. However, epidemiological studies on EH often focus on post-menopausal women. We aimed to assess the available observational evidence on the incidence and prevalence of EH among pre-menopausal women and to investigate the influence of specific risk factors.
We conducted systematic literature searches on 27 August 2021, using the Embase and PubMed databases. Searches were designed to identify studies of EH epidemiology, published in English on or after 1 January 1995, in populations of predominantly pre-menopausal women. Studies were required to report diagnostic histopathology data for at least 500 women. Relevant outcomes were the prevalence and incidence of EH, and/or the impact of pre-specified risk factors including age, body mass index (BMI) and diabetes mellitus.
In total, 3785 records were screened, and 31 references, describing 29 different studies, were included in the review. The incidence of EH among pre-menopausal women increased with age and was as high as 121 and 270 cases per 100,000 woman-years in South Korean women aged 46–50 years and US women aged 45–49 years, respectively. The prevalence of EH was highly dependent on the population studied. Estimates of EH prevalence in 14 studies of pre-menopausal women with abnormal uterine bleeding (AUB) ranged from 3.4% to 265%, higher than the reported prevalence in two studies of women with infertility (0.9% and 3.0%). Studies of risk factors found increasing age, BMI and diabetes to be associated with an increased prevalence of EH.
Published data on the epidemiology of EH in pre-menopausal women are heterogeneous, with considerable variation in study methodology and populations, and in how EH subtypes are reported. The main factors affecting the reported prevalence and incidence of EH are the reason a biopsy was performed – particularly whether patients had AUB, a key symptom associated with EH – and the presence of known risk factors.
Determining the Optimal Time Interval between Vaginal Dinoprostone Administration and Diagnostic Office Hysteroscopy in Nulliparous Women: A Randomized, Double-blind Trial
2022, Journal of Minimally Invasive Gynecology
To determine the optimal timing of vaginal dinoprostone administration before office hysteroscopy (OH) in nulliparous women.
Randomized, double-blind trial.
Tertiary referral hospital.
A total of 180 nulliparous women undergoing diagnostic OH.
We randomly allocated the women to long-interval or short-interval dinoprostone groups: three mg dinoprostone was administered vaginally 12 hours before OH in the long-interval group and 3 hours before OH in the short-interval group.
The primary outcome was pain during OH measured using a 100-mm visual analog scale (0 = no pain; 100 = worst pain imaginable). The secondary outcomes were ease of hysteroscope passage, patient satisfaction score, and drug-related adverse effects. The patients in the long-interval dinoprostone group had lower pain scores during OH (p <.001). Contrarily, pain scores 30 minutes after the procedure were similar in both groups (p = .1). The patient satisfaction score was higher and clinicians found hysteroscope passage through the cervical canal easier and quicker in the long-interval dinoprostone group than in the short-interval group (p <.001, p = .003, and p <.001, respectively). Side effects were comparable in both study groups.
Vaginal dinoprostone administered 12 hours before OH was more effective than that administered 3 hours before OH in reducing pain during OH in nulliparous women, with easier hysteroscope insertion, shorter procedure duration, and higher patient satisfaction score.
Treatment of synechiae related to infertility
2021, Gynecologie Obstetrique Fertilite et Senologie
Les synéchies sont des adhérences intra-utérines perturbant la fertilité des patientes. Elles sont le plus souvent d’origine post-traumatique. La gestion des interruptions de grossesse au premier trimestre et les retentions post accouchement sont les facteurs favorisants principaux. Les synéchies sont responsables de trouble du cycle et de fausses couches précoces à répétition. L’hystéroscopie est la méthode de référence pour leur diagnostic et leur traitement. L’objectif peropératoire est la restauration d’une cavité utérine de taille normale et d’un endomètre fonctionnel pour permettre une fécondation et une implantation. L’utilisation d’un hystéroscope de petit diamètre (5 mm) et d’instruments sans énergie ou à énergie bipolaire est recommandée. L’échoguidage facilite le traitement des synéchies sévères et limite le risque de perforation peropératoire. Le risque principal du traitement est la récidive, en particulier dans les cas sévères où la multiplication des temps opératoires est parfois nécessaire. Une hystéroscopie diagnostique à 6 semaines est recommandée pour identifier et traiter ces récidives. Différentes méthodes physiques, moléculaires ou cellulaires sont étudiées comme prévention primaire et secondaire des synéchies postopératoires. L’objectif de ce travail est de faire une revue de la littérature sur le traitement des synéchies dans le cadre de l’infertilité.
Synechiae are intrauterine adhesions that affect the fertility of women. They are most often of post-traumatic origin. The management of pregnancy abortions in the first trimester and post-delivery retention are the main contributing factors. Synechiae is responsible for cycle disorders and repeated pregnancy loss. Hysteroscopy is the reference method for its diagnosis and treatment. The surgical objective is the restoration of a normal sized cavity and a functional endometrium to allow fertilization and implantation. The use of small diameter (5 mm) hysteroscopes and no energy or bipolar energy instruments are recommended. Echo guidance facilitates the treatment of severe synechiae and limits the risk of intraoperative perforation. The main risk of treatment is recurrence, particularly in severe cases where multiple operating times are sometimes necessary. An office hysteroscopy at 6 weeks is recommended to identify and treat these recurrences. Different physical, molecular or cellular methods are studied as primary and secondary prevention of postoperative synechiae. The objective of this review is to provide an update on the treatment of synechiae in the context of infertility.
Hysteroscopic detection of chronic endometritis: Evaluating proposed hysteroscopic features suggestive of chronic endometritis: Suggestive hysteroscopic features of Chronic endometritis
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To evaluate the proposed criteria in a large sample and in additional subgroups in order to test the validity of the hysteroscopic features widely-accepted as suggestive of CE.
All patients (n: 2675) underwent outpatient hysteroscopy, with the vaginoscopic approach technique. Hysteroscopic features such as, stromal oedema, diffuse or focal hyperaemia, “strawberry aspect”, micropolyposis and endometrial polyps, are often indicate the presence of chronic endometritis. All hysteroscopic features, alone and in combination were applied in 7 (seven) different subgroups of the sample: total sample, women in reproductive age, women with infertility issues/IVF screening, women with history of recurrent miscarriages, menopausal women, and women with hysteroscopic indication of Abnormal Uterine Bleeding (AUB) in women of reproductive age and postmenopausal bleeding (PMB). From each case, endometrial samples were obtained and immunohistochemistry, identifying CD-138, was applied in order to diagnose CE.
A total of 2675 patients were included of which, 1444 women were found with at least one of the proposed hysteroscopic features mentioned above. Stromal oedema, focal or diffuse hyperaemia and “strawberry aspect” in combination with micropolyposis demonstrated higher rates of diagnostic accuracy in the detection of CE correlated to histologic confirmation. Micropolyposis, stromal oedema, focal or diffuse hyperaemia and “strawberry aspect” offer great diagnostic accuracy in the hysteroscopic detection of Chronic Endometritis, regardless reproductive status and/or clinical presentation. Endometrial polyps are not valid hysteroscopic features in cases of suspected CE.
Diagnostic hysteroscopy can accurately diagnose cases of CE, based on stromal oedema, focal or diffuse hyperaemia and “strawberry aspect”, in combination with micropolyposis. In subgroups of infertile women, higher diagnostic accuracy based on the hysteroscopic features mentioned, was more likely to be achieved. Whether endometrial polyps are suggestive of CE, when identified during office hysteroscopy, remains controversial.
Intrauterine adhesions: What is the pregnancy rate after hysteroscopic management?
2020, Journal of Gynecology Obstetrics and Human Reproduction
To evaluate the rate of pregnancy following hysteroscopic management of intrauterine adhesions.
Retrospective study.
From June 2009 to December 2014 in a teaching hospital.
Women treated by operative hysteroscopy for intrauterine adhesions.
Operative hysteroscopy to manage intrauterine adhesions.
Main outcome measure: rate of intrauterine pregnancy after hysteroscopic management of intrauterine adhesions.
Out of the 202 women whom benefit from hysteroscopic adhesiolysis, 112(55%) had an effective pregnancy desire. Among them, an intrauterine pregnancy was obtained for 58 women (52%) with a trend to a lower rate for type IV and Vb intrauterine adhesions management (40.5%, p = 0.09). Pregnancy rates were similar for women undergoing one or more procedures.
Hysteroscopic management of intrauterine adhesions seems useful as it leads to a pregnancy rate of 52%. However, this rate is lower in case of type IV and Vb intrauterine adhesions. Repeated procedures don’t seem to lead to less pregnancy; however, a more powerful prospective study should be performed to answer this specific question.
Effectiveness of Outpatient Versus Operating Room Hysteroscopy for the Diagnosis and Treatment of Uterine Conditions: A Systematic Review and Meta-Analysis
2019, Journal of Obstetrics and Gynaecology Canada
Traditionally, hysteroscopy has been performed in the main operating room with the patient under general anaesthesia. Hysteroscopy performed in an office setting avoids the risks of general anaesthesia. The aim of this review was to evaluate the effectiveness of outpatient hysteroscopy compared with hysteroscopy performed in the operating room to diagnose and/or treat intrauterine pathology. Relevant electronic databases were searched, including Medline, EMBASE, and the Cochrane Library. RCTs and nonrandomized studies that compared the efficacy of outpatient hysteroscopy and traditional hysteroscopy performed in the operating room were included. The primary outcome of interest was diagnostic accuracy, and secondary outcomes included treatment success, adverse events, pain, patient satisfaction, and cost. The Cochrane risk of bias tool was used to assess RCTs, and the Downs and Black tool was used for nonrandomized studies. A total of 12 658 abstracts and 347 full-text articles were assessed, from which a total of 20 full-text studies met our eligibility criteria. No study compared the diagnostic accuracy of outpatient hysteroscopy with hysteroscopy performed in the operating room. There was no significant difference between hysteroscopy performed in the outpatient and operating room setting for treatment success, adverse events, and patient satisfaction. In the included RCTs, there was greater reported postoperative pain in the outpatient setting (standard mean difference 0.19, 95% CI 0.01–0.37). All seven economic studies concluded that outpatient hysteroscopy (range US$97–1258) is substantially less expensive than hysteroscopy performed in the operating room (range US$258–3144). Included RCTs had serious risks of selection, performance, and detection bias. The results of this review demonstrate that implementing hysteroscopy in an outpatient setting without general anaesthesia should be thoughtfully considered. The current available evidence demonstrates greater reported postoperative pain in the outpatient setting and no statistically significant differences in all other studied outcome measures between outpatient and intraoperative hysteroscopy procedures.
Traditionnellement, l'hystéroscopie est effectuée dans la salle d'opération principale, et la patiente est sous anesthésie générale. Une hystéroscopie effectuée en cabinet permet d'éviter les risques associés à l'anesthésie générale. Le but de la présente revue était de comparer l'efficacité de l'hystéroscopie réalisée en externe à celle de l'hystéroscopie effectuée en salle d'opération pour diagnostiquer ou traiter une pathologie intra-uterine. Les bases de données électroniques pertinentes ont été interrogées, dont Medline, Embase et la Bibliothèque Cochrane. Les ECR et les études non randomisées qui comparaient l'efficacité de l'hystéroscopie en externe et de l'hystéroscopie traditionnelle effectuée en salle d'opération ont été sélectionnées. L'issue primaire était l'exactitude du diagnostic, et les issues secondaires étaient la réussite du traitement, les événements indésirables, la douleur, la satisfaction de la patiente et le coût. L'outil d'évaluation du risque de biais de Cochrane a été utilisé pour évaluer les ECR, et l'outil de Downs et Black a été employé pour les études non randomisées. Au total, 12 658 résumés et 347 articles complets ont été évalués, parmi lesquels 20 articles entiers répondaient à nos critères d'admissibilité. Aucune de ces études ne comparait l'exactitude du diagnostic de l'hystéroscopie en externe à celle de l'hystéroscopie en salle d'opération. Aucune différence significative n'a été observée entre les deux façons de procéder en ce qui a trait à la réussite du traitement, aux événements indésirables et à la satisfaction de la patiente. Dans les ECR analysées, davantage de douleur était rapportée après l'opération chez les patientes externes (différence moyenne standardisée : 0,19; IC à 95 % : 0,01 0,37). Les sept études de coûts ont conclu que l'hystéroscopie en externe (plage : 97 1 258 $ US) était beaucoup moins coûteuse que l'hystéroscopie en salle d'opération (plage : 258 3 144 $ US). Les ECR choisis présentaient des risques importants de biais de sélection, d'exécution et de détection. Les résultats de cette étude démontrent que l'exécution d'hystéroscopies en externe sans anesthésie générale devrait être sérieusement envisagée. Excepté une douleur postopératoire plus importante chez les patientes externes, les preuves disponibles à ce jour ne montrent aucune différence statistiquement significative entre les interventions en externe et en salle opératoire pour toutes les autres issues mesurées.

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2500 Outpatient diagnostic hysteroscopies

Objective

Methods

Results

Conclusion

Fertil Steril

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Lancet

Am J Obstet Gynecol

Am J Obstet Gynecol

Fertil Steril

Fertil Steril

Lancet

The diagnostic possibilities of a modified hysteroscopic technique

Acta Obstet Gynecol Scand

Clinical perspectives

J Reprod Med

Therapeutic hysteroscopy—Indications and techniques

Panoramic hysteroscopy with directed biopsies versus dilatation and curettage for accurate diagnosis

J Reprod Med

Significance of negative hysteroscopic view in abnormal uterine bleeding

J Postgrad Med

Outcomes of referrals to gynaecology outpatient clinics for menstrual problems: An audit of general practice records

Br J Obstet Gynaecol

Hysteroscopy. Choosing distending media

Int J Fertil

Local anaesthesia and cervical dilatation for outpatient hysteroscopy

J Obstet Gynaecol

Panoramic, contact, and microcolpohysteroscopy in gynecologic practice

Hysteroscopy as an outpatient procedure

Transcervical resection of endometrium in women with menorrhagia

BMJ