Hysteroscopy and its capabilities
Hysteroscopy is used to detect foreign bodies, uterine wall perforations, determine the position of an IUD, and in cases of infertility and recurrent pregnancy loss. The procedure has a number of contraindications, including general infections, acute inflammation, and grade III–IV vaginal smears.
The diagnostic procedure can be immediately or delayed converted into a surgical one. Operations are divided into two categories:
- Simple: removal of small polyps, division of thin adhesions, extraction of a freely lying IUD.
- Complex: myomectomy, endometrial resection, division of broad septa.
Possible complications include anesthetic problems, reactions to distension media (fluid overload, arrhythmia, gas embolism), air embolism, perforation, and hemorrhage.
Laparoscopy: diagnostics and surgery
Laparoscopy is the examination of the abdominal cavity with an endoscope against the background of pneumoperitoneum. It can be elective (for infertility, myoma, endometriosis, ovarian tumors) and emergency (for ectopic pregnancy, ovarian apoplexy, torsion of a tumor pedicle).
Absolute contraindications include hemorrhagic shock, decompensated heart and respiratory conditions, uncorrectable coagulopathy, and hepatorenal failure. The manipulation may be accompanied by anesthesia complications, as well as surgical risks — vascular and gastrointestinal organ injury, emphysema, or gas embolism.
Ultrasound examinations and echogenicity
Ultrasound examination of the internal genitalia is assessed by echogenicity (the ability to reflect ultrasound) and sound conduction. Anechoic (fluid), hypoechoic (suspensions, blood), and hyperechoic (bones, gas) structures are distinguished.
Transducers can be abdominal, vaginal, and rectal. During the examination, uterine dimensions are measured, the structure of the myometrium and ovaries is evaluated, and the thickness of the endometrium ( endometrial echo / M-echo) is assessed. To assess blood flow and detect neoangiogenesis, Doppler ultrasonography with color Doppler mapping is used, calculating the resistance index and other parameters.
Hycosy and its application
Hysterosalpingo-contrast sonography (HyCoSy) is based on the introduction of sterile liquid media into the uterine cavity to create an acoustic window. The method is extremely informative for assessing tubal, peritoneal, and uterine factors of infertility, as well as intrauterine pathology (polyps, adhesions, malformations).
The study requires compliance with aseptic rules, grade I–II vaginal smears, and premedication in infertile patients. When searching for intrauterine pathology, the procedure is performed regardless of the cycle, and to check tubal patency — strictly on the 5th–8th day of the menstrual cycle.
To remember the timing of HyCoSy when assessing tubal patency: "Five to eight days — and the tubes are on display."
Class and exam questions
What are the main contraindications to hysteroscopy?
These include general infectious diseases, acute inflammation of the genital tract, grade III–IV vaginal smears, severe somatic pathologies, desired pregnancy, cervical stenosis, and advanced cervical cancer.
How do simple hysteroscopic operations differ from complex ones?
Simple operations include the removal of small polyps, thin adhesions, or a free IUD. Complex ones include myomectomy, endometrial resection, division of broad intrauterine septa, and removal of deeply embedded foreign bodies.
When is hycosy performed to assess fallopian tube patency?
Examination of fallopian tube patency is performed strictly no later than the 5th–8th day of the menstrual cycle.
What else to study on this topic
- Classification and acoustic features of tissues by echogenicity
- Normal dimensions of the uterus and ovaries in reproductive age and postmenopause
- Dynamics of the M-echo in various phases of the menstrual cycle
- Doppler parameters and their clinical significance in tumors
- Technique for performing hycosy and volumes of contrast media administration
- Comparison of indications for elective and emergency laparoscopy
Master the entire topic in the "Obstetrics and Gynecology" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Instrumental research methods in gynecology" and 973 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 21 video lessons on the subject
Other topics in the "Gynecology" section
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.