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Management of patients after hysteroscopy
Last reviewed: 19.10.2021
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Management of patients after hysteroscopic manipulations and operations
Postoperative management of patients after hysteroscopy depends on many factors: the nature of the pathology, the initial general condition of the patient and the condition of the genitals, the volume of endoscopic manipulation or surgery.
After hysteroscopy in conjunction with separate diagnostic curettage of the uterine mucosa or simple hysteroscopic operations (removal of endometrial polyps, remains of the fetal egg or placental tissue, destruction of tender intrauterine synechia, dissection of small partitions, removal of submucous nodes on a narrow base), no special recommendations are required. The patient can be discharged from the hospital on the day of surgery or the next day.
Patients after hysteroscopy on the background of the inflammatory process in the uterine cavity (pyometra, infected fetal egg fragments, postpartum endometritis, etc.) are advisable before and after hysteroscopy to perform antibacterial and anti-inflammatory therapy according to the usual method or short course: cephalosporins / in 1 g for 30 min before the operation, then in the same dose 2 times 12 hours after the operation.
Pregnant or meager spotting from the genital tract is almost always after surgical hysteroscopy for 2-4 weeks. Sometimes pieces of resected tissue left in the uterus cavity come out. In such cases, there is no need to appoint anything. Just a woman should be warned about such discharge.
After the dissection of intrauterine synechia, almost all endoscopists suggest the introduction of IUD for 2 months, since the risk of occurrence of repeated synechia is more than 50%. Asch et al. (1991) proposed the introduction of IUD containing estrogens. An alternative measure is the introduction into the uterus cavity of a Foley catheter or a special silicone balloon left in the uterine cavity for a week under the cover of broad-spectrum antibiotics. To improve the re-epithelialization of the wound surface, hormone replacement therapy is recommended for 2-3 months.
Some doctors prefer to inject IUD for 1-2 months (Lips loop) and for 3 months appoint hormone replacement therapy to restore the endometrium. In the early postoperative period, a preventive course of antibiotic therapy is carried out.
After dissection of the intrauterine device, women with repeated spontaneous abortions are given a preventive course of antibiotic therapy. The rest of this treatment can not be appointed.
The question of the need for introduction of IUD and the appointment of hormone therapy after hysteroscopic dissection of the intrauterine septum remains debatable. Most endoscopists do not recommend the introduction of IUD after hysteroscopic metroplasty, but they are prescribed estrogens. But there are also opponents of the appointment of estrogens, since microscopic studies after the operation showed complete re-epithelization of the site of the operation. In the postoperative period, it is necessary to perform a control ultrasound during the II phase of the menstrual-ovarian cycle to determine the size of the remaining part of the septum; if it exceeds 1 cm, it is advisable to repeat hysteroscopy in the first phase of the next menstrual cycle.
Some doctors do not inject CMC after dissection of the intrauterine device, but recommend a 2-month course of hormone replacement therapy. If, after the therapy, the normal uterine cavity is restored (according to ultrasound with contrasting of the uterus cavity or hysterosalpingography), the patient can become pregnant.
After resection (ablation) of the endometrium, some surgeons recommend prescribing antigonadotropins (danazol), GnRH agonists (decapeptil, zoladex) for 3-4 months to avoid regeneration of the remaining endometrial sites, but this is quite expensive treatment. More convenient and affordable for the patient is the administration of 1500 mg of medroxyprogesterone acetate (depo-provera). Such treatment is especially recommended for patients with adenomyosis.
After electrosurgical or laser miomectomy, the formation of a large wound surface and patients receiving preoperative GnRH agonists recommend the appointment of estrogens (25 mg premarin for 3 weeks) for better re-epithelization of the mucous membrane of the uterine cavity.
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