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Diagnostic Hysteroscopy (+ targeted biopsy/polypectomy)

Diagnostic Hysteroscopy (+ targeted biopsy/polypectomy) operating theatre - gynaecology
IN REVIEWPENDING CLINICAL VERIFICATION
Indications
  • AUB evaluation
  • Polyps/submucous lesions
  • Retrieved-missed IUD
  • Adhesions assessment
Consent points
  • Perforation/trail-off failures
  • Fluid-absorption risks (distension media)
  • Day-case expectations
Equipment
  • Hysteroscope +/- operating sheath, distension media pump, graspers/scissors/bipolar
  • Video tower
Anaesthesia
  • Outpatient no-anaesthetic/minimal vs GA per case

Relative contraindications: Active pelvic infection · Pregnancy · Cervical cancer suspicion (staging implications)

Preparation

  • Pregnancy exclusion
  • Timing proliferative phase or GnRH-primed for better views
Procedure steps
  1. Vaginoscopic entry (no tenaculum) where possible
  2. Systemic survey: tubal ostia->fundus->anterior/posterior/cervix
  3. Targeted biopsies/polyp morcellation
  4. Document mapping + images
Troubleshooting:
  • Poor distension: clamp leaks/check inflow pressure limits
  • Media deficit >1000-1500 mL hypotonic: stop + electrolytes watch (OHIA risk)
Complications & management
Uterine perforation

Usually managed conservatively if blunt/small; energy injuries need laparoscopy urgently

Fluid overload hyponatraemia

Stop media; diuretics/electrolytes per protocol

Postoperative care

  • Discharge same day uncomplicated; results discussion

Admission & discharge

Care setting: Usually outpatient/day care; admit a procedural complication

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

When admission or continued hospital care is needed

  • Suspected perforation/organ injury, uncontrolled bleeding, severe persistent pain, infection or an anaesthetic problem requires hospital assessment.

When clinic, day care or home care may be suitable

  • Uncomplicated outpatient hysteroscopy may be followed by home recovery once symptoms and the clinical assessment are satisfactory.

Before going home

  • Pain/bleeding and observations support home care; recovery from any anaesthesia/sedation is adequate and transport/support instructions are met.
  • The patient understands what was done and when/how biopsy results will be communicated.

Discharge medicines and treatment changes

  • Provide a defined oral pain-relief plan if needed; further treatment depends on the actual procedure/findings.
Medicine doses — use only when indicated

Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.

When appropriate for uncomplicated recovery.

Paracetamol (acetaminophen) — oral pain reliefMédecins Sans Frontières · Current online monographchecked
Dose1 g (two 500 mg tablets) per dose
RouteOral
FrequencyEvery 6–8 hours when needed; maximum 4 doses in 24 hours
DurationAccording to clinical response: reduce/stop as pain improves. Record the prescribed supply and review date; persistent or increasing pain needs reassessment rather than an automatic repeat course.
PreparationCheck tablet strength: two 500 mg tablets = 1 g. Count paracetamol in every combination/OTC product towards the total; this is not an IV preparation.
Max dose4 g in 24 hours for the stated adult population. Lower weight, hepatic impairment or other risk factors require an individual reduced prescription; do not automatically use this maximum.
  • Indication: Short-term maternal postoperative/postpartum pain or other mild pain after assessment; adult ≥50 kg
  • MSF oral monograph: no pregnancy or breastfeeding contraindication. The dose does not replace assessment of the cause of pain.
Monitoring
  • Pain and functional recovery; investigate increasing pain, fever or other warning symptoms.
  • Check all prescribed/OTC paracetamol, weight and hepatic risk; suspected excess dosing requires urgent assessment.
Contraindications: Paracetamol allergy; avoid duplicate paracetamol-containing products. · Hepatic impairment needs caution and a clinician-adjusted regimen. This adult ≥50 kg card is not a weight-based prescription for smaller adults or children.

Tests, pending results and their reviewer

  • Name the reviewer of histology and any other outstanding results.

Home care and counselling

  • Explain expected cramps/bleeding, hygiene and the procedure-specific advice for sex/activity; give sedation/anaesthetic restrictions when applicable.

Follow-up: when and what to review

WhenAction / responsible service
At the specified results/review appointment
Communicate histology and further management; provide a contact if results do not arrive.
Sooner if recovery is not improving
Assess persistent pain/bleeding or infection concern.

Return urgently

  • Heavy bleeding, fever/offensive discharge, severe/worsening pain, collapse or breathing difficulty needs urgent review.

Open the complete discharge checklist →

Sources for this plan:
RCOG · Patient information based on 2024 GTG59 / 2023 GPP16checkedRCOG · Current public recovery informationcheckedMédecins Sans Frontières · Current online monographchecked
Follow-up: Histology review clinic · Sources: CDC (USA), RCOG, RCOG, Médecins Sans Frontières, NICE, India MoHFW / NHM, WHO, NICE
CDC (USA) · 2021 edition (current as of check)checkedRCOG · Patient information based on 2024 GTG59 / 2023 GPP16checkedRCOG · Current public recovery informationcheckedMédecins Sans Frontières · Current online monographcheckedNICE · NG194, recommendationscheckedIndia MoHFW / NHM · LaQshya district-hospital SOP, linked editioncheckedWHO · 2022 official recommendation summarycheckedNICE · CG50, recommendationschecked