Hysteroscopy

It should be performed in pre ovulatory phase when chances of bleeding are less.Diagnostic hysteroscopy can be performed under local anaesthesia but therapeutic hysteroscopy requires general anaesthesia.
Procedure-
1>women is placed in lithotomy position& bimanual exam is done to confirm position & size of the uterus.
2>cervix is dilated upto 4 to 5 cm
3>hysteroscope is connected to the distending media.
4>as medium distends the cervical canal telescope is progressively advanced into uterine cavity.
5>care is taken not to perforate uterine wall.
Indications-
A>dignstic-
1)to study endocervical mucosal lining in ca cervix,endocervical polyps
2)congenital malformatins of the uterus such as bicornuate or septate uterus
3)endometrial tuberculosis
4)ashermans syndrome
5)misplaced IUCD
6)endometrial lesions & abnormal uterine bleeding-endomdtrial & placental polyp,endometrial hyperplasia,submucous fibroid polyp,endometrial hyperplasia
7)cornual tubal blockage
B>therapeutic =
1)to prevent uterine perforation while excising uterine septum
2)ashermans syndrome
3)to retrive embeded IUCD
4)during polypectomy
5)submucous fiaroid
6)dysfunctional uterine bleeding
7)tubal sterilization
8)tubal blockage

Contraindications-
1)genital tract infection
2)pregnancy
3)during menstruation
4)scarred uterus& enlarged uterus more than size of 12 wks size
5)cervical stenosis.
Complications=
A)during procedure -
1)anasthetic complications aare more when co2 is used for dilatation
2)uterine perforation
3)organ injury to bowel & intestine
4)thermal injury to bowel when cautery & laser are used
5)bleeding
6)sepsis usually with myomectomy
7)embolism with co2
8)alergic rx with dextran & glycine
9)fluid overload
B>late complications-
1)hadmatometra
2)unwanted pregnancy following TCRE
3)ca endometrium
4)infections
5)dysmenorrhoea
6)amemorrhoea
7)treatmemt failure
8)rupture uterus during pregnancy.