eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Hysteroscopy: Workup

Author: John C Petrozza, MD, Instructor, Department of Obstetrics and Gynecology, Harvard Medical School; Consulting Staff and Chief, Division of Reproductive Medicine and IVF, Vincent Obstetrics and Gynecology, Massachusetts General Hospital
Coauthor(s): Gretchen E H Makai, MD, Instructor, Department of Obstetrics and Gynecology, Harvard Medical School; Generalist, Department of Obstetrics and Gynecology, Mount Auburn Hospital; Emily Sikking, MD, Staff Physician, Department of Obstetrics and Gynecology, New England Medical Center
Contributor Information and Disclosures

Updated: Jul 16, 2006

Workup

Laboratory Studies

  • CBC: As in most surgical procedures, the CBC provides the surgeon with information the patient's baseline status and, if blood loss is encountered, with an idea of how much blood loss is acceptable. A blood count in the reference range also ensures adequate oxygenation to all vital and healing tissues and an adequate immune response.
  • Blood typing and screening: With the risk of hemorrhage approaching 7-8% in some surgical hysteroscopic procedures, a sample in the blood bank increases the efficiency of access to replacement blood products if needed.
  • Electrolyte determinations: In patients with medical disorders that predispose them to metabolic abnormalities (eg, diuretic use), electrolytes should be tested preoperatively. Some surgeons routinely obtain baseline levels in case a significant deficit of distention medium occurs (especially with a hyposmolar solution), whereas most obtain electrolyte levels intraoperatively or postoperatively only if a clinically significant fluid deficit occurs. The ultimate decision should be based on the type of case, the surgeon's skill, the suspected fluid absorption, and the ability to accurately ascertain fluid deficits in the operating room.
  • Determination of human chorionic gonadotropin (hCG) levels: Determination of pregnancy status is mandatory in any woman of reproductive age.
  • Cervical cultures: Depending on the prevalence of chlamydia and gonorrhea in the population, this may be a worthwhile preoperative test. Also, if the patient is reporting a vaginal discharge, cultures and a wet smear for bacterial vaginosis and trichomoniasis are recommended.
  • Papanicolaou test (Pap smear): A normal finding on Pap smear, or at least an abnormal finding on Pap smear that has been appropriately evaluated, is required because trauma to the cervix may alter the appearance of any abnormalities.

Imaging Studies

  • Hysterosalpingogram or sonohysterogram: For evaluating the uterine cavity and patency of fallopian tubes, hysterosalpingography is the superior study. However, to selectively look at the uterine cavity, sonohysterography or saline-infused sonography appears to have a better negative and predictive values than those of hysterosalpingogram for determining the location and size of fibroids and endometrial polyps and for ascertaining the presence of most uterine anomalies, including septa, bicornuate uteri, didelphic uteri, and even dense adhesions.
  • CT scanning or MRI: These imaging studies are not usually needed unless the findings on sonohysterography or hysterosalpingography are inconclusive.

Diagnostic Procedures

  • Endometrial biopsy is indicated in perimenopausal or menopausal women with irregular bleeding (eg, heavy menses, irregular spotting, prolonged menses) or in women with absent menses and at least 6 months of unopposed estrogen. In these women, the risk for endometrial hyperplasia or cancer is increased.
  • In any woman undergoing endometrial ablation, benign endometrial tissue should be pathologically confirmed.

More on Hysteroscopy

Overview: Hysteroscopy
Workup: Hysteroscopy
Treatment: Hysteroscopy
Follow-up: Hysteroscopy
References
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References

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Further Reading

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Keywords

hysteroscope, rigid hysteroscope, contact hysteroscope, microcolpohysteroscope, flexible hysteroscope, electrosurgery, myomectomy, resectoscope, proximal tubal obstruction, removal of IUD, intrauterine device, müllerian anomalies, infertility evaluation, abnormal uterine bleeding, AUB, endometrial ablation

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Contributor Information and Disclosures

Author

John C Petrozza, MD, Instructor, Department of Obstetrics and Gynecology, Harvard Medical School; Consulting Staff and Chief, Division of Reproductive Medicine and IVF, Vincent Obstetrics and Gynecology, Massachusetts General Hospital
John C Petrozza, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Reproductive Medicine, and Massachusetts Medical Society
Disclosure: Interlace Medical, Inc. Consulting fee Consulting

Coauthor(s)

Gretchen E H Makai, MD, Instructor, Department of Obstetrics and Gynecology, Harvard Medical School; Generalist, Department of Obstetrics and Gynecology, Mount Auburn Hospital
Gretchen E H Makai, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Medical Association
Disclosure: Nothing to disclose.

Emily Sikking, MD, Staff Physician, Department of Obstetrics and Gynecology, New England Medical Center
Emily Sikking, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Medical Editor

Thomas Michael Price, MD, Associate Professor of Reproductive Endocrinology, Director of Reproductive Fellowship Training Program, Duke University Medical Center
Thomas Michael Price, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Phi Beta Kappa, and Society for Gynecologic Investigation
Disclosure: Clinical Advisors Group Consulting fee Consulting; MEDA Corp Consulting Consulting fee Consulting; Gerson Lehrman Group Advisor  Consulting fee Consulting; Roche/GSK Spokesperson  Consulting fee Consulting; Abbott Pharmaceuticals Grant/research funds PI; Adiana Grant/research funds PI

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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