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Are All hysteroscopies Justified?

Are All hysteroscopies Justified?. Amita Mahendru Chaya Ray Miss Deborah Taylor Queen Elizabeth Hospital, Kings Lynn. Are All hysteroscopies Justified?. Amita Mahendru Chaya Ray Miss Deborah Taylor Queen Elizabeth Hospital, Kings Lynn.

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Are All hysteroscopies Justified?

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  1. Are All hysteroscopies Justified? Amita Mahendru Chaya Ray Miss Deborah Taylor Queen Elizabeth Hospital, Kings Lynn.

  2. Are All hysteroscopies Justified? Amita Mahendru Chaya Ray Miss Deborah Taylor Queen Elizabeth Hospital, Kings Lynn.

  3. SHA expressed wish to reduce the number of hysteroscopy +/- D&C if it is unnecessary or not beneficial to the patient. Background:

  4. SHA expressed wish to reduce the number of hysteroscopy +/- D&C if it is unnecessary or not beneficial to the patient. Background:

  5. Aims: • Assess indications of hysteroscopy. • Standards: no national guidelines • Appropriateness assessed in light of RCOG guidance 1999 for menorrhagia and local protocol for PMB • 100% hysteroscopies to be performed for appropriate clinical reason.

  6. Standards: • Menorrhagia: Abnormal TVS as polyps or fibroids, unresponsive to medical treatment, to perform endometrial biopsy if pipelle inadequate or not possible in case of age >40 yrs or unresponsive to treatment, assess suitability for endometrial ablation.(1) • PMB: ET>4mm, endometrial polyps, pipelle inadequate or not possible.(2)

  7. Method: • Retrospective audit • 90 case notes • Inclusion criteria: undergoing hysteroscopy with/without curettage only • Time period: Jan 2006-Dec 2006.

  8. Assessment of appropriateness-By review of : • Investigations prior to the hysteroscopy-ultrasound scan and pipelle. • Hysteroscopy findings. • Histology

  9. Results • Hysteroscopy and curettage-82 • Hysteroscopy only-8 • Day surgery unit-73 • Gynecology theatres-17

  10. Indications: • Postmenopausal bleeding :62 • Menorrhagia (21) fibroid uterus, • Others (7)- pain in abdomen, infertility,vesicouterine fistula, uterine prolapse, cytology –endometrial cells, postmenopausal discharge, IMB

  11. Investigations- Ultrasound scan • TVS in all cases. • Not done in abnormal cytology, Infertility,menorrhagia,

  12. Ultrasound scan findings in cases Menorrhagia

  13. Ultrasound in PMB

  14. Pipelle sampling:

  15. Hysteroscopy findings: • Menorrhagia: abnormal 7 and14 normal • PMB: 28 normal, 31 abnormal as in endometrial polyps with 3 endometrial ca and in 3 cases hysteroscopy was not possible.

  16. Histology: • Menorrhagia: normal in 20, simple cystic hyperplasia in1. • PMB : normal in 40 cases, endometrial cancer in 3 cases, endometrial hyperplasia in 7 cases and no curettings in 19 cases.

  17. Inappropriate histology: • 10 cases, one with PMB without scan, 9 with menorrhagia where pipelle was not attempted or was not needed.

  18. Recommendations: • Follow local and national guidelines. • New NICE guidelines. • Easy availability of laminated flow charts on management • Referral of all PMB to dedicated clinic.

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