Hysteroscopy In Patients Research Articles

Outcomes of Mechanical Resection of Endometrial Polyps and Submucosal Fibroids Through TruClear™ Hysteroscopy.

To assess the efficacy of mechanical resection through TruClear™ hysteroscopy in patients with endometrial polyps and submucosal fibroids. Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Shifa International Hospital, Islamabad, Pakistan, from June 2018 to 2022. Patients diagnosed with endometrial polyps and submucosal fibroids confirmed by abdominal or transvaginal ultrasonography were included. Patients having a history of congestive cardiac failure, chronic kidney disease, and bleeding diathesis were excluded from the study. Data about the complete removal of pathology (endometrial polyps and submucosal fibroids), mean operating time, and postoperative complications such as bleeding and perforation were extracted. The follow-up was set up to 6 months after the procedure. The average age of the 45 patients was 35.62 ± 7.46 years. Heavy menstrual bleeding was the most prevalent symptom, seen in 73.3% of cases, followed by irregular vaginal bleeding (IVB) in 11.1% of cases. The most frequent disease identified by sonography was a polyp in 21 (47%) instances, followed by submucosal fibroids in 12 (27%) cases, mixed pathology in 10 (22%), and malignancy in 2 (4%) cases. The overall average operative time was 36.46 ± 24.94 minutes. A hundred percent removal of lesions was observed in this study. Persistent symptoms were observed in 13% of patients after the surgery so they were treated with other interventions. The most common intervention was an intrauterine hormonal device. Intraoperative bleeding was observed in only one patient and was managed by intraoperative intrauterine balloon insertion. The recurrence rate was 8.9% (4/45). TruClear™ hysteroscopy showed a major advantage in the successful and complete removal of the pathology, low operation time, and complications. Fibroids, Hysteroscopy, Polyps, Endometrial resection, Menstrual bleeding.

#199 : Does Hysteroscopic Evaluation of Uterine Characteristic Improve Outcome of Thin Endometrium in Patients with a History of Repeated Implantation Failures?

Background: Repeated implantation failure (RIF) is a problem for many patients suffering from infertility and their physicians. Despite numerous developments in the field of assisted reproduction, the implantation rate remains low. Among the various reasons of implantation failure, endometrial regularity has an important role. Recently, hysteroscopy is an accurate method for evaluating the endometrial integrity, with the ability to treat uterine pathology for repeated implantation failure patients. Objective: The aim of this study to evaluate the incidence of uterine pathology among infertile women with a history of two implantation failures after IVF and estimate the effect of diagnostic hysteroscopy and hysteroscopic procedures in uterine cavity on achieving a pregnancy in these patients in Mongolia. Materials and Methods: The retrospective study population included infertile women who attended the outpatient department of the Creation and Love Women’s infertility clinic, between August 2020 and July 2022 in Mongolia. The study inclusion criteria were women who had more than two RIF of IVF/ET cycle. Pregnancy and nonpregnancy rate after hysteroscopic procedures were analyzed included in patients reports archived in clinical data. Results: Hysteroscopy were performed on 35 women who had at least two RIFs. The participants’ mean age was 40.3±5.3 and mean duration of infertility year was evaluated 5.53±3.7. Mean AMH level was 1.4±1.6 ng/ml. All patients were diagnosed abnormal uterine cavity by hysteroscopy. Out of 35 patients participated in this study who underwent hysteroscopic evaluation, 20 patients (57.1%) showed synechiae (mild, moderate and severe synechiae). Second most frequent hysteroscopic finding was the endometrial polyp, accounting for 15 (42.9%) patients. Pregnancy rate after hysteroscopic procedures was 8 patients (23%) in this study group. The duration of infertility year was significantly different in pregnant and nonpregnant women underwent hysteroscopic correction (p<0.05). Conclusion: The intrauterine pathology diagnosed by hysteroscopy in patients with previous IVF failure were found all patients in this study. The synechiolysis was common abnormality in Mongolia may cause by artificial abortion. The correction of abnormalities such as and polyp synechiolysis might improve the outcome of successful pregnancy rate.

#196 : Office Hysteroscopy Results in Patients with Recurrent Implantation Failure at Tam Anh General Hospital

Background and Aims: To describe the clinical characteristics and evaluate the results of office hysteroscopy in patients with recurrent implantation failure at Tam Anh General Hospital. Methods: A descriptive study on 151 patients at Tam Anh General Hospital who had failed embryo transfer twice or more consecutively was carried out from January 2021 to March 2023. Results: 151 patients were included in the study, 41,1% of which had unexplained infertility. The mean age and duration of infertility were 34,5 ± 5,2 years and 5,7 ± 3,4 years, respectively. 55,0% of patients exhibited uterine cavity abnormalities during office hysteroscopy, with the most common is endometritis accounting for 29.8%. The median time to perform the procedure was 3 (2) minutes, the mean VAS pain score was 3,2 ± 1,1 points. No complications related to office hysteroscopy were noted. Conclusions: A office hysteroscopy was able to detect intrauterine pathologies which were missed by other investigative modalities. In individuals who have experienced repeated implantation failure, office hysteroscopy is a safe and practical approach that should be recognized as a crucial tool for intrauterine evaluation.

Clinical efficacy and risk factors for suction curettage and hysteroscopy in patients with type I and II cesarean scar pregnancy.

To investigate the clinical efficacy and evaluate risk factors for suction curettage (SC) and hysteroscopy in the treatment of type I and II cesarean scar pregnancy (CSP). This was a retrospective study including 100 women diagnosed with type I/II CSP. Patients were treated with either ultrasound-guided SC (SC group) or hysteroscopy resection (surgery group). The success rates, mean operation time, hospitalization duration, hospitalization cost, risk factors, adverse events, and complications were analyzed. The success rate of the SC and surgery groups were 85% and 100%, respectively, and the difference was statistically significant (P = 0.032). There was one case of type I CSP and eight cases of type II CSP that failed SC treatment. No failed cases were found in the surgery group. Analysis of the causes of treatment failure revealed that diameter of the gestational sac was a risk factor for SC failure (odds ratio, 19.66 [95% confidence interval {CI}, 1.70-227.72], P = 0.017). Comparing the clinical outcomes between the SC and surgery groups, although the mean operation time of the SC group was significantly shorter than the surgery group (15 [CI, 15-20] vs. 30 [CI, 27-40], P = 0.001), the cost and duration of hospitalization were significantly lower in the surgery group than that in the SC group. No significant differences were observed for adverse events and complications between the two groups (P > 0.05). Hysteroscopy is an effective and economical method for treating type I/II CSP. Moreover, SC is not recommended for patients with type I/II CSP with a gestation age ≥8 weeks.

Role of Hysteroscopy in Patients with Previous In Vitro Fertilization Failure: An Institutional Experience in Rural Population.

(1) To evaluate the use of hysteroscopy in the assessment of uterine pathologies, not evident on ultrasonography or hystero-salpingography in women with previous one or more IVF failures and (2) to determine whether correction of such pathologies during hysteroscopy improves clinical pregnancy rates in these women. This is a prospective randomized study. The study population included were women with primary and secondary infertility registered at our center, fit into the inclusion and exclusion criteria of this study. The total 180 patients were included. Hysteroscopies were performed in 90 patients with at least one IVF cycle failure and another 90 patients taken as control with similar demographic parameters. The average duration of infertility between both the groups was not significant. Hysteroscopy was able to detect intrauterine pathologies in around 40% of the cases, which were treated in the same treatment phase. Early ultrasound findings with gestational sac and cardiac activity were found to be significant between two groups. We noticed clinical improvement in IVF success rate after hysteroscopy. Hysteroscopy may be offered to the patients with previous one or more IVF failures, as clinically some of the previously undiagnosed pathologies could be detected and treated to achieve the positive outcomes.

High-flow nasal oxygen reduces the incidence of hypoxia in sedated hysteroscopy for assisted reproduction.

Backgrounds and aimsPain is the main reason for hysteroscopy failure. In day-surgical settings, hysteroscopy procedures are commonly performed with the patient under sedation. Hypoxia is the most common adverse event during sedation and can lead to severe adverse events. This study aimed to compare the incidence of hypoxia when using high-flow nasal oxygen (HFNO) with that when using regular nasal oxygen in patients undergoing hysteroscopy with sedation.Materials and methodsIn this single-center, prospective, randomized, single-blinded study, 960 female patients undergoing elective diagnostic or operative hysteroscopy were randomly enrolled into the following two groups: the regular nasal group [O2 (3–6 L/min) covered by an HFNO] and the HFNO group [O2 (30–60 L/min)] from September 2021 to December 2021. All women were sedated with propofol (1.5 mg/kg) and remifentanil (1.5 μg/kg) in the operating room. The primary outcome was the incidence of hypoxia (75% ≤ SpO2 < 90%, < 60 s).ResultsHFNO decreased the incidence of hypoxia (75% ≤ SpO2 < 90%, < 60 s), subclinical respiratory depression (90% ≤ SpO2 < 95%) and severe hypoxia (SpO2 < 75% for any duration or 75% ≤ SpO2 < 90% for ≥ 60 s) from 24.38 to 0.83%, from 11.25 to 1.46% and from 3.75 to 0%, respectively (P < 0.001).ConclusionIn procedures conducted to treat female infertility, HFNO can reduce hypoxia during hysteroscopy in patients sedated with propofol, and it can prevent the occurrence of subclinical respiratory depression and severe hypoxia.

Hysteroscopic evaluation of chronic endometritis and its relation to unexplained infertility

Background Hysteroscopy is considered the gold standard for detecting diseases of the uterine cavity. It is simple, safe, and can be performed in an outpatient clinic. Although endometritis is not clinically clear, it may lead to infertility. Moreover, there is strong evidence that endometritis may lead to a premature spontaneous birth. Aim This study aimed to assess the diagnostic value of diagnostic hysteroscopy in patients with chronic endometritis. Patients and method The current study was performed on 50 women with unexplained infertility. All patients presented to the outpatient clinic of Tanta University Maternity Hospital in the follicular phase of menstruation. Results Hysteroscopic findings in the form of hyperemia, edema, micropolyps, and dark blue spot suggesting chronic endometritis were found in 31 cases. Histopathological examination confirms the diagnosis of chronic endometritis in 28 cases by detection of plasma cells in the endometrial biopsy. Microbiological examination showed a positive growth in 17 cases by detection of organisms in the endometrial biopsy; 1 of them showed positive chlamydial infection and 4 cases of mycoplasma in the multiplex polymerase chain reaction test. There was a significant association between hysteroscopic picture suggesting chronic endometritis and its confirmation by histopathological examination of endometrial biopsy. Conclusion Hysteroscopy is a convenient examination for detecting chronic endometritis. It could be applicable for investigating asymptomatic infertile patients. Antibacterial, antichlamydial, and antimycoplasma drugs have a good result in chronic endometritis. Endometrial dyeing with methylene blue at hysteroscopy improves the detection of chronic endometritis. More studies are recommended for endometrial evaluation by hysteroscopy.

Comparative Study between the Diagnostic accuracy of 3D Ultrasound and Hysteroscopy in patients with premenopausal uterine bleeding

Comparative Study between the Diagnostic accuracy of 3D Ultrasound and Hysteroscopy in patients with premenopausal uterine bleeding

Evacuating Uterine Contents before Operative Hysteroscopy in Patients With Active Uterine Bleeding: A Randomized Clinical Trial

Objectives: Concurrent bleeding or existing clots usually obscure the vision field and decrease the hysteroscopy success rate. Therefore, any efforts made to have a clear view during the hysteroscopy will improve the diagnostic or treatment outcomes. We examined the effect of preoperative clot evacuation on hysteroscopy related outcomes. Materials and Methods: In this parallel-group randomized clinical trial conducted in Al-Zahra hospital, Tabriz, Iran, 114 women with uterine bleeding were randomly assigned to receive either clot evacuation before standard operative hysteroscopy or after that from December 2018 to September 2019. The study outcomes were the clarity of vision, amount of bleeding, the volume of required distension media, duration of the procedure, and postoperative complications. Results: There were statistically significant differences in the frequency of the clear vision (P&lt;0.001), the severity of bleeding, mean procedure time (P&lt;0.001), mean used distension media and the mean postoperative hematocrit levels in favour of women with pre-hysteroscopy intrauterine evacuation. There was no difference in in-hospital stay and anaesthetic complications among the two groups. The procedure was successfully performed on all participants of both groups with no post-operative complications. Conclusions: Removal of clots and other uterine contents before the insertion of the hysteroscope rendered better and faster access to the uterine wall to observe existing abnormalities. This additional surgical step could significantly impact surgical and clinical outcomes.

Whether preoperative hysteroscopy increases the dissemination of endometrial cancer cells: A systematic review and meta-analysis.

To determine whether hysteroscopy (HSC) increases the risk of intraperitoneal dissemination in endometrial cancer patients. We conducted a comprehensive review of multiple databases. Quality assessments of eligible studies were performed using the Newcastle-Ottawa and Jadad scales. Positive peritoneal cytology (PPC) as the outcome of interest was compared between endometrial cancer patients with and without HSC. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated as a measure of effects. Three case-control studies and eight retrospective cohort studies included 3364 patients, of whom 1116 underwent preoperative HSC, which resulted in a significantly higher PPC rate (OR, 1.82; 95% CI, 1.31-2.54; p=0.0004). I2 was 11%, and the heterogeneity was acceptable. The difference between the groups with stages I-II was statistically insignificant (OR, 1.50; 95% CI, 0.75-2.99; p=0.25). When liquid was used as the uterine distension medium during HSC and the intrauterine pressure was controlled under 80 mmHg, the difference between the two groups was also insignificant (OR, 1.18; 95% CI, 0.50-2.79; p=0.71). However, when the intrauterine pressure exceeded 80 mmHg, the difference between the two groups was statistically significant (OR, 2.18; 95% CI, 1.28-3.73; p=0.004). This meta-analysis indicates that preoperative HSC in patients with endometrial cancer may increase the risk of intraperitoneal dissemination of malignant cells, which may be associated with intrauterine pressure >80 mmHg but not with stages I-II. There is no reason to avoid HSC for the diagnosis of endometrial cancer, especially in early stages, but intrauterine pressure should possibly be controlled below 80 mmHg.

Pseudo Vaginoscopy: A Modified Vaginoscopy Technique for Outpatient Hysteroscopy in Cases with Difficult Access

Background: Outpatient hysteroscopy is a safe, reliable and cost-effective alternative to hysteroscopy under a general anaesthetic for the diagnosis of abnormal uterine bleeding. Objectives: The objective of this study was to introduce new technique of pseudo-vaginoscopy for better movement of hysteroscope and less procedural pain. Also to assess acceptability of patients for outpatient hysteroscopy when appropriate analgesia was given prior to the procedure. Methodology: A prospective study was conducted of 74 women attending for outpatient hysteroscopy at the West Cumberland Hospital over a period of one year. Selection criteria include very narrow and atrophic vagina and failed speculum examination in gynaecology outpatient clinics. Results: Of the women studied, 95.5% stated that they would recommend the procedure to friends in future, whilst 5.8% would not want to go through it again. The type of anaesthetic administered during the procedure seem to influence whether women would attend for outpatient hysteroscopy in future.&#x0D; Conclusion: Our pseudo-vaginoscopic approach allows more freedom for the scope movements not limited by the speculum with the advantage of prior cervical preparation. It was certainly at value for operative outpatient hysteroscopy in patients with very high BMI where access was difficult owing to depth.

Eficacia diagnóstica de la ecografía y la histeroscopia en pacientes con patología endometrial

Objective: To determine the diagnostic efficacy of ultrasound and hysteroscopy in patients with endometrial pathology who attended the gynecological service of the Hospital Universitario “Dr. Pedro Emilio Carrillo” January 2017- July 2017. Method: A correlational, quasi-experimental and prospective study was conducted, including 33 patients with endometrial pathology who had transvaginal ultrasound, hysteroscopy and sampling for histological study. Results: The average age of patients was 50±0.23 years (33 - 72 years), the average age of menarquia was 11.84 years; obstetric history had the following means: gestations: 2.27±2,15; 1.72±2.12; abortions: 0.09±0.38; C-section: 0.45±0.97. The menstrual cycle was irregular in 54.5%; 81.8% reported dysmenorrhea and 63.6% used oral contraceptives. Most of the patients reported having pelvic pain and a family history as a risk factor. The most frequent ultrasound diagnosis was endometrial thickening. The most common hysteroscopic diagnosis was submucosous myoma (36.4%). Transvaginal ultrasound for the diagnosis of submucosal fibroids has 100% specificity and sensitivity; hysteroscopy has 96% specificity for endometrial polyp, premalignant lesions have 100% specificity and 50% sensitivity, malignancies had 50% sensitivity and 100% specificity. There was a very low sensitivity of hysteroscopy for diagnosis of hyperplasms and polyps. Conclusion: Ultrasound has excellent efficacy for diagnosing submucosous fibroids. Hysteroscopy is very specific but has a very low sensitivity for the diagnosis of hyperplasms, polyps, and premalignant lesions. Keywords: Endometrial polyp, Submucosal myoma, Endometrial pathology, Hysteroscopy, Ultrasound.

Residual Disease after Operative Hysteroscopy in Patients with Endometrioid Endometrial Cancer Associated with Polyps.

To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. In 78 cases (75%), the polyp had EC, and in 40 (38.5%), it was restricted to the polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without disease outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.

Oncological safety of hysteroscopy in the diagnosis of stage I endometrial cancer: protocol for a systematic review and meta-analysis

BackgroundThe oncological safety of diagnostic hysteroscopy in patients with stage Ⅰ endometrial cancer remains uncertain and conflicting. The aim of the proposed systematic review and meta-analysis is to summarise the...

The Invisible External Cervical Os. Tips and Tricks to Overcome this Challenge during In-Office Hysteroscopy

Hysteroscopy is considered the gold standard technique for the diagnosis and management of intrauterine pathology allowing to "see and treat" patients in 1 session if desired [1-3]. Pain and the inability to enter the uterine cavity are the most common limitations of hysteroscopy, especially when performed in an office setting [4-7]. Cervical stenosis is a common hysteroscopic finding frequently encountered in postmenopausal women, especially in patients with a history of cervical procedures such as cone biopsy [8]. It represents a challenge even for the most expert hysteroscopist. Overcoming the stenosis of the external cervical os is technically more demanding than facing the obliteration of the internal os. The aim of this video article is to illustrate the use of simple techniques that allow the hysteroscopist to safely identify the location of the external cervical os and to overcome the difficulties in entering the uterine cavity during in-office hysteroscopy in patients with severe cervical stenosis including those with complete obliteration of the external cervical os. These techniques are easy to adopt and can be used in different clinical situations in which the hysteroscopic evaluation of the uterine cavity is needed in women with severe cervical stenosis. A series of videos of challenging cases with severe cervical stenosis with complete obliteration of the external cervical os are presented that demonstrate maneuvers to properly identify and enter the cervical canal, unfolding key aspects of the procedure. Tips and tricks to facilitate the adoption of these useful maneuvers into clinical practice are highlighted. In-office diagnostic hysteroscopy was performed using a 5-mm rigid continuous flow operative hysteroscope. Patients were placed in a dorsal lithotomy position. The vaginoscopy "no touch" technique was used [9]. No anesthesia or sedation was administered to any of the patients. Normal saline was used as distention media. Taking advantage of the magnification provided by the hysteroscope, the location of the external cervical os was determined. In cases in which the external cervical os was not clearly recognized, the cervix was gently probed with the use of the uterine palpator, grasper, or scissors (Fig. 1). Recognition of the landmarks of the cervical canal provides reassurance of the adequate identification of the external cervical os and facilitates the use of the correct plane of dissection that leads into the uterine cavity (Fig. 2). Additional maneuvers that are useful to navigate the endocervical canal to overcome stenosis of the internal cervical os are also illustrated. The combination of a delicate technique and operator experience aids in overcoming the challenge of cervical stenosis in an office setting. Adopting the presented tips and tricks to enter the uterine cavity in the presence of severe cervical stenosis will reduce the rate of failed hysteroscopic procedures, decreasing the need to take patients to the operating room and the use of general anesthesia.

Clinical study of hysteroscopy combined with laparoscopy in the diagnosis and treatment of unexplained infertility

Objective: To explore the importance of the diagnosis and treatment value of laparoscopy and hysteroscopy in patients with unexplained infertility. Methods: A total of 519 cases diagnosed as unexplained infertility, received laparoscopy and hysteroscopy in Peking Union Medical College Hospital from May 2012 to December 2015. The causes of infertility were evaluated, and the subjects were followed up to observe the nature pregnancy rate. Results: Among 519 unexplained infertility patients, pelvic abnormalities had been explored in 466 (89.8%, 466/519) cases. Pelvic endometriosis combined with adhesions, pelvic adhesion alone, uterine leiomyoma and uterine cavity polyp were 72.4% (376/519), 12.3% (64/519), 3.7% (19/519) and 1.3% (7/519) respectively. The total natural pregnancy rate within the 3 years of follow up was 53.9% (208/386), and the natural pregnancy rate was 29.8% (31/104) in patients aged 35 years and over. Conclusions: The patients with clinical diagnosis of unexplained infertility should be examined by hysteroscopy and laparoscopy. Under the examination, the causes of infertility could be found more intuitively, and targeted treatment could be carried out to improve the pregnancy rate. The natural pregnancy rate of the elderly patients decrease obviously after operation, and the time of natural trying pregnancy should not be too long.

The role of diagnostic hysteroscopy in diagnosis of incomplete uterine septum/significant arcuate uterine anomaly in infertile patients in the era of transvaginal 3D ultrasound scan

BackgroundTo determine the accuracy of measurement of internal indentation length on transvaginal 3D ultrasound scan (TV 3D US) in detecting patients with an incomplete uterine septum (IUS) or a significant arcuate uterine anomaly (AUA) based on the actual length as measured on diagnostic hysteroscopy. We compared the mean internal indentation length on TV 3D US and on diagnostic hysteroscopy in patients with IUS or a significant AUA.ResultsThis is a retrospective study of 546 patients who were found to have IUS (134) or significant AUA (412) on diagnostic hysteroscopy and who had TV 3D US prior to surgery. The mean internal indentation length measured in millimeter on hysteroscopy was significantly higher than the mean internal indentation length measured on TV 3D US in patients with IUS (16.7 + 5.5 vs 5.5 + 4.2; P < 0.001), in patients with significant AUA (12.9 + 2.8 vs 3.9 + 4.6; P < 0.001), and in the overall population (13.8 + 4.0 vs 4.3 + 4.5; P < 0.001). The same findings were obtained when the comparison was limited to patients who had moderate significant internal indentation length (10–14 mm) and those with significant internal indentation length (15–25 mm).ConclusionData in this study suggests that the mean internal indentation length in patients with IUS or AUA can be underestimated on TV 3D US. A diagnostic hysteroscopy is the only gold standard to make the correct diagnosis in these patients.

Fluid deficit calculation at hysteroscopy in patients with and without tubal occlusion: could consideration of tubal passage change safety limits?

Hysteroscopy (HSC) fluid management guidelines (1) are not well-defined regarding the contribution on the fallopian tube patency to the fluid deficit (FD) during HSC and most surgeons attribute the entire FD to intravasation (2). Women with patent tubes undergoing HSC have accumulation of distention media in the pelvis which can be seen during laparoscopy (LSC) and could be in part due to transtubal passage (3). We explored whether FD could be in part due to transtubal passage. Prospective observational study. We studied 164 patients aged 20-45 years, who underwent HSC using normal saline as distension media between January 2014 and August 2017. Tubal patency was previously assessed at sonohysterogram. FD and, in LSC cases, the amount of fluid found in the pelvis, were prospectively recorded. Whitney U test was used to compare distributions with a p value <0.05 defining statistical significance (SPSS v25 for Windows; Chicago, Illinois). 164 patients were included in the study. 77 underwent HSC prior to LSC and 87 patients underwent HSC only. In the LSC group, 69 had at least one patent tube with an average FD of 438.96 ml and a calculated FD due to extravasation of 175.61 ml; 8 patients had bilateral tubal occlusion and all were found to have 0 ml of peritoneal fluid with an average FD of 141. In the HSC only group, 83 had at least one patent tube with an average FD of 307.48 ml; 4 patients had bilateral tubal occlusion with an average FD of 375.75 ml. There was no correlation between intrauterine fluid pressure and the amount of FD, or the presence of peritoneal fluid.Tabled 1VariablesHSC + LSCTubal patency (N=69)HSC + LSCTubal occlusion (N=12)HSC onlyTubal patency (N=83)HSC onlyTubal occlusion (N=4)Fluid deficit (FD) ml438.96141307.48375.75Peritoneal fluid ml175.610N/AN/AProposed FD ml281.0990.18N/AN/A Open table in a new tab Most women with patent tubes undergoing HSC have accumulation of distension media in the pelvis and transtubal passage was not correlated with the intrauterine fluid pressure. FD in patients with tubal occlusion appears to be entirely attributed to intravasation. These findings add new insight to our understanding of fluid dynamics during operative hysteroscopy that can help develop more accurate and patient-centered safety protocols.

HYSTEROSCOPY IN THE DIAGNOSIS AND TREATMENT OF UTERUS ANOMALIES IN PATIENTS WITH PREGNANCY LOSS

Introduction. The incidence of miscarriage is 15-25% of all pregnancies, increases with the age of women and has no tendency to decrease. One of the causes of miscarriage is congenital and acquired violations of the anatomical structure of the uterus. The frequency of congenital anomalies of genital organs in patients with miscarriage varies within 3-16%.Aim. To evaluate the diagnostic value and therapeutic possibilities of hysteroscopy in patients with congenital uterine anomalies and reproductive losses in history.Materials and methods. We conducted a retrospective assessment of the diagnostic value of hysteroscopy in the differential diagnosis of congenital uterine anomalies in 59 patients with reproductive losses in history and its therapeutic potential.Results. The informativeness of hysteroscopy in the diagnosis of uterine anomalies was retrospectively compared with the results obtained during hysterolaparoscopy. For 42 patients with uterine septum which was diagnosed intraoperatively was immediately performed the hysteroscopic metroplasty. The completeness of the excision of the intrauterine septum was assessed by comparing the 3D ultrasound data performed before the hysteroscopic metroplasty and in the next menstrual cycle after the operative intervention. In 4.8% of patients it was necessary to conduct a repeated surgical intervention, as during the first operation it was not possible to simultaneously achieve the complete dissection of the septum. The frequency of correctly classified anomalies of the uterus using the hysteroscopy was 84.7%. The greatest difficulties in evaluating the hysteroscopic pattern occurred in cases of differentiation of the uterus bicornis and the uterine septum. In such situations, the hysteroscopic examination should be supplemented by laparoscopy which allows to avoid making a false diagnosis. In the case of uterus unicornis, the hysteroscopic diagnosis coincided with the final one of 100%. However, even the combined use of hysteroscopy and laparoscopy causes significant difficulties in differentiating of subclasses of this anomaly which are based on the presence or absence of a functional cavity in the rudimentary horn. In such situations, 3D ultrasound is the highly informative method, according to which in our study, 42.9% of patients with unicornuate uterus had a functional cavity in the rudimentary horn which was an indication for its removing. In the case of uterus didelphys, the hysteroscopic diagnosis coincided with the data of hysterolaparoscopy in 60% of cases (p &lt;0,05).Conclusions. Hysteroscopy should be integrated into the general diagnostic scheme when examining patients suspected of Muller anomalies. The frequency of correctly classified congenital uterus anomalies using the hysteroscopy is 84.7%. Simultaneous carrying out of laparoscopy and hysteroscopy gives an opportunity in 100% of cases to put the exact diagnosis of the uterine septum and to carry out the surgical correction of this anomaly with the preservation of the integrity of the uterine wall.

Diagnostic value of hysteroscopy in patients with abnormal uterine bleeding

Objective To investigate the diagnostic value of hysteroscopy in patients with abnormal uterine bleeding. Methods The clinical data of 547 cases of abnormal uterine bleeding were analyzed retrospectively.The diagnostic curettage was conducted after hysteroscopy, the specimens were examined by histopathology, the detection result of hysteroscopy and histopathological were compared. Results The sensitivity of hysteroscopy in diagnosed abnormal uterine cavity lesions was 95.83% (161/168), the specificity was 97.63% (370/379), the false positive rate was 2.37% (9/379), the false negative rate was 4.17% (7/168), the positive predictive value was 94.71% (161/170), the negative predictive value was 98.14% (370/377), the Jorden index was 0.934.Hysteroscopy diagnosis showed that the endometrial polyps was 54 cases, the pathological diagnosis coincidence rate was 79.63% (43/54); 93 cases of simple hyperplasia, the pathological diagnosis coincidence rate was 90.32% (84/93); 16 cases of atypical hyperplasia, the pathological diagnosis coincidence rate was 87.50% (14/16); 4 cases of differentiated endometrial adenocarcinoma, the pathological diagnosis coincidence rate was 100.00% (4/4); 2 cases of uterine papillary serous carcinoma, the pathological diagnosis coincidence rate was 100.00% (2/2); 1 case of transitional cell carcinoma of endometrium, the pathological diagnosis coincidence rate was 100.00% (1/1). Conclusion Hysteroscopy can visually observe the morphology of cervical canal and uterine cavity, the diagnostic rate of endometrial polyps, simple hyperplasia, atypical hyperplasia and endometrial carcinoma are higher, so it has important clinical value in the diagnosis of abnormal uterine bleeding. Key words: Uterine hemorvhage; Hysteroscopy; Diagnosis