Medical Preparation and Treatment Prior to Hysteroscopy
The patient’s preparation and the suitable selection of them are essential so that the ambulatory hysteroscopy can be successfully made in office. The main failure causes of the technique in office are pain, cervical stenosis, and poor visualization. In patients who difficulties are predicted is necessary to optimize the preparation to avoid failure.
The use of contraceptives as a treatment prior to hysteroscopy in office for endometrial preparation is not routinely recommended. However, they may have utility used for a short period, as a treatment prior to excision of intracavitary pathology such as polyps, fibroids, or uterine septa because they can easier hysteroscopic vision and procedure.
Respect analgesia before test, there are no studies that analyze neither the optimum moment for the administration of analgesic nor what is the ideal drug since that depends on the pharmacological and pharmacokinetic characteristics of the drug used. In general, it is recommended that when a non-opioid analgesic is administered orally, it should be done one hour before the procedure. The use of opioid analgesics as the first treatment option for pain caused by hysteroscopy is not recommended because of possible side effects.
The injection of local anesthetic, preferably paracervical, significantly reduces pain during hysteroscopy (but not topical anesthesia), and that this effect is greater in the case of postmenopausal patients. However, its application is not routinely recommended for all patients, so it is important to select cases properly.
There is no consensus on whether it is necessary to use prophylactic antibiotics to prevent postoperative infection in office hysteroscopy because there are no recommendations for these minor operative procedures, probably because they cause little tissue damage in relatively small areas. At the present time, given the low risk of infection and lack of evidence about its effectiveness, routine antibiotic prophylaxis is not recommended. With respect to endocarditis prophylaxis, the American Heart Association does not recommend the administration of antibiotics with the only indication of endocarditis prophylaxis in patients who received genitourinary or gastrointestinal procedures.
When patients are receiving antithrombotic therapy, an estimate of individual patient risk for perioperative thromboembolism is subjective but should consider both the estimated baseline risk and the individual factors related to the patient and the surgery or procedure type. The decision to discontinue the treatment depends on the thrombotic risk of the patient and the inherent bleeding risk associated with the procedure.
Routine cervical preparation before office hysteroscopy should not be used routinely in the absence of any evidence of benefit in terms of reduction of pain, rates of failure, or uterine trauma. The use of misoprostol before hysteroscopy maybe to decrease pain in premenopausal women, and different administration routes are the same efficacy.
KeywordsOffice hysteroscopy Medical preparation Pretreatment Fibroid diagnosis
- 1.Tan YH, Lethaby A. Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013;11:CD010241.Google Scholar
- 3.Bifulco G, Di Spiezio Sardo A, De Rosa N, Greco E, Spinelli M, Di Carlo C, Tommaselli GA, Nappi C. The use of an oral contraceptive containing estradiol valerate and dienogest before office operative hysteroscopy: a feasibility study. Gynecol Endocrinol. 2012;28(12):949–55.CrossRefPubMedGoogle Scholar
- 7.Bellati U, Bonaventura A, Costanza L, Zulli S, Gentile C. Tramadol hydrochloride versus mepivacaine hydrochloride: comparison between two analgesic procedures in hysteroscopy. Giorn Ital Ostet Ginecol. 1998;20:469–72.Google Scholar
- 12.Practical guideline in office hysteroscopy. Italian Society of Gynecological Endoscopy (SEGI).Google Scholar
- 18.Del Valle Rubido C, Solano Calvo JA, Rodríguez Miguel A, Delgado Espeja JJ, González Hinojosa J, Zapico Goñi Á. Inhalation analgesia with nitrous oxide versus other analgesic techniques in hysteroscopic polypectomy: a pilot study. J Minim Invasive Gynecol. 2015;22(4):595–600.CrossRefPubMedGoogle Scholar
- 19.The American College of Obstetricians and Gynecologists. Antibiotic prophylaxis for gynaecologic procedures. Obstet Gynecol. 2009;13(5):1180–9.Google Scholar
- 20.Baggish MS. Complications of hysteroscopic surgery. In: Baggish MS, Valle RF, Guedj H, editors. Hysteroscopy: visual perspectives of uterine anatomy, physiology and pathology. 3rd ed. Philadelphia, PA: Wolters Kluwer; 2007. p. 469–84.Google Scholar
- 21.Thinkhamrop J, Laopaiboon M, Lumbiganon P. Prophylactic antibiotics for transcervical intrauterine procedures. Cochrane Database Syst Rev. 2013;5:CD005637.Google Scholar
- 27.Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis. Guidelines from the American Heart Association. A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;16:1736–54.CrossRefGoogle Scholar
- 28.Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th edn. American College of Chest Physicians, evidence-based clinical practice guidelines. Chest. 2012;141:e326S–50S.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Tasma ML, Louwerse M, Hehenkamp WJ, Geomini PM, Bongers MY, Veersema S, van Kesteren PJ, Tromp E, Huirne JA, Graziosi GC. Misoprostol for cervical priming prior to hysteroscopy in postmenopausal and premenopausal nulliparous women; a multicentre randomised placebo controlled trial. BJOG. 2017; doi: 10.1111/1471-0528.14567.