Hysteroscopy for Recurrent Miscarriage Testing or Treatment

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What is a Hysteroscopy?:

A hysteroscopy is a procedure in which the doctor inserts a small telescope (hysteroscope) through the cervix in order to examine the inside of the uterus. A hysteroscopy can be a diagnostic test or a method of seeing the uterus while performing surgery to treat uterine problems.

Why Doctors Use Hysteroscopy:

Hysteroscopy is the most reliable way of seeing the inside of the uterus.

Doctors use it to diagnose or repair problems with the uterus that might predispose a woman to recurrent miscarriages.

Doctors may also look for problems with the uterus by conducting a hysterosalpingogram (HSG). However, an HSG only provides an image. Abnormal results on an HSG might later be investigated more deeply via a hysteroscopy. Some doctors will go straight to the hysteroscopy, as minor problems can be repaired at the time of the test, thus eliminating a second procedure.

Preparing for a Hysteroscopy:

Your doctor will probably want to schedule the hysteroscopy in the first week after your menstrual period. If you have the test in a hospital, the hospital may ask you not to eat or drink anything for a period of time before the procedure –- especially if you will be having general anesthesia. Some doctors will give a mild anti-anxiety drug to take before the procedure.

What to Expect From Hysteroscopy:

Expect to have local, regional, or general anesthesia -– the exact type of anesthesia you are given depends on the situation.

Your doctor will dilate your cervix before inserting the hysteroscope and then perform the examination. If your doctor finds problems, or is performing the hysteroscopy in order to investigate suspected problems, your doctor may also perform minor surgical repairs at the time of the test.

Risks and Side Effects of Hysteroscopy:

A hysteroscopy is a fairly safe procedure, but it does carry risk of uterine perforation, hyponatremia, and infection.

In addition, anesthesia carries some small risk (varies by type and drug used). You may have cramping or spotting after having a hysteroscopy, especially if your doctor performed any repairs during the procedure.

What Your Doctor Learns from a Hysteroscopy:

A hysteroscopy could be a follow-up after an abnormal hysterosalpingogram or the primary means of checking for uterine issues that may be causing recurrent miscarriage.

In recurrent miscarriages, the primary conditions that a doctor uses a hysteroscopy to look for are:

  • Uterine septum (or other congenital malformations)
  • Fibroids
  • Polyps
  • Abnormal scarring

If any of these conditions are detected, the doctor may repair them during the test. If more extensive repairs are needed, the doctor may schedule surgery at a later date.

Sources

American College of Obstetrics and Gynecology, "ACOG Education Pamphlet AP084." Dec 1999. ACOG. Accessed 2 Dec 2007.

Harvard Medical School, "Hysteroscopy." Harvard Health Publications. Accessed 2 Dec 2007.

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