Journal Article

Why you should be performing office hysteroscopy... now

Wong, Marron, Isaacson, Keith, Miller, Valencia

2017

Overview

Introduction Office hysteroscopy (OH) remains a valuable but underutilized tool in evaluation and treatment of abnormal uterine bleeding,1 Fostering a clinic environment in which patients have access to a \"one-stop shopping\" experience has benefits for them, the gynecologist,2-5 and the medical system.6,7 In our minimally invasive gynecologic surgery (MIGS) clinic with only two providers, we perform approximately 15 OHs each week while we see our normal patient schedule. [...]the minimal pressure to obtain uterine distention is the pressure that should be used. Some studies have shown benefits of cervical preparation with vaginal misoprostol before OH.33-35 However, a meta-analysis of randomized controlled trials evaluating use of cervical preparations to reduce pain during outpatient hysteroscopy showed no reduction in pain in premenopausal or postmenopausal women who required cervical dilation of 5 mm or less.36 We do not routinely use any cervical preparation, since in our experience, most patients do not require cervical dilation with our vaginoscopic approach and pre-procedure misoprostol can be associated with bothersome side effects such as pre-procedural cramping and greater leaking of fluid.37 Be prepared OH is a safe procedure with a complication rate of less than 1%.38 However, unusual events such as severe vagal reactions, drug allergies and overdose, uterine perforation, bleeding and various cardiac events do occur. Even without using oral or local anesthesia, over 90% of patients can successfully undergo a diagnostic hysteroscopy, RESOURCES Office hysteroscopy * The American Congress of Obstetricians and Gynecologists: The use and development of checklists in obstetrics and gynecology acog.org/Resources-And-Publications/Committee-Opinions/Committee-onPatient-Safety-and-Quality-Improvement/The-Use-and-Development-ofChecklists-in-Obstetrics-and-Gynecology * Centers for Medicare and Medicaid Services: The physician fee schedule search cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx DRS. WONG AND MILLER report no potential conflicts of interest with regard to this article.

• Publisher: MultiMedia Healthcare Inc
• Subject: Biopsy / Endoscopy / Gynecology / Infertility / Medicaid / Medical diagnosis / Medicare / Obstetrics / Pathology / Patient satisfaction