Complications of hysteroscopy

Posted by e-Medical PPT Thursday, March 15, 2012
Complications may occur in diagnostic or operative hysteroscopy.
The complication rate in diagnostic hysteroscopy is low and was estimated by Lindemann (1989) to be 0.012% .
Complications from operative hysteroscopy are more common and potentially more serious.

Complications of surgery may arise during the operation or be delayed.
Intra-operative complications include: uterine perforation and haemorrhage.
Delayed complications include: infection, discharge and adhesion formation.

Uterine Perforation
The uterus may be perforated by:
A dilator,
The hysteroscope or
A surgical instrument.

The management will depend on the:
Size, method and site of the perforation,
Whether there is risk of injury to another organ and
Whether or not concomitant observation with a laparoscope was being performed.

Simple perforation may be made with a cervical dilator or with the hysteroscope.
Perforation should be suspected if the dilator passes to a depth greater than the length of the uterine cavity.
Perforation with the hysteroscope should be avoided by always introducing the telescope under direct visual control.
Simple perforation rarely causes any further damage and may be treated conservatively by observation and appropriate broad spectrum antibiotics.
Laparoscopy may be considered  to exclude bleeding.

Complex perforation
It is unusual for perforation with scissors to cause injury to other organs although this may occur when dividing adhesions in cases of extensive Asherman's syndrome.
Hysteroscopy in these cases should always be accompanied by laparoscopy to recognize impending or occult perforation.

Haemorrhage
Intrauterine bleeding occurring during the procedure should be immediately obvious and         can usually be controlled by spot electrocoagulation.
If coagulation fails to control the bleeding, the procedure may have to be abandoned and tamponade performed by inserting a Foley catheter and distending the balloon.
The catheter should be left in situ for a few hours after which the bleeding nearly always stops.

LATE ONSET COMPLICATIONS
Infections
Acute pelvic inflammatory disease is rare following hysteroscopic surgery.
This may be prevented by prophylactic antibiotics.
The diagnosis is made by the presentation of the classic symptoms and signs and
Treatment should be by appropriate antibiotics following culture of vaginal swabs and blood.

Adhesion Formation
Intrauterine adhesions are common especially after myomectomy when two fibroids are situated on opposing uterine walls.
In this case the myomectomy is better performed in stages to prevent adhesion formation.

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