DIAGNOSTIC HYSTEROSCOPY

Hysteroscopy is an important tool in the study of infertility, recurrent miscarriage, or abnormal uterine bleeding. Diagnostic hysteroscopy is used to examine the inside of the uterus, also known as the uterine cavity (Figure 3), and is helpful in diagnosing abnormal uerine conditions such as internal fibroids, scarring, polyps, and congenital malformations. A hysterosalpingogram (an x-ray of the uterus and fallopian tubes) or an endometrial biopsy may be performed before or after diagnostic hystcroscopy. Additionally, hysteroscopy can be used with other procedures, such as laparoscopy, or before procedures such as dilation and curettage (D&C).

The first step of diagnostic hysteroscopy involves slightly stretching the canal of the cervix with a series of dilatators. Once the cervix is dilated, the hysteroscope, a narrow lighted viewing instrument similar to but smaller than the laparoscope, is inserted through the cervix and into the lower end of the uterus. Carbon dioxide gas or special clear solutions are then injected into the uterus through the hysteroscope. This gas or solution expands the uterine cavity, clears blood and mucus away and enables the physician to directly view the internal structure of the uterus.

Diagnostic hysteroscopy is usually conducted on an outpatient basis with either general or local anesthesia. Diagnostic hysteroscopy is usually performed soon after menstruation because the uterine cavity is more easily evaluated and there is no risk of interupting a pregnancy.