Perioperative management - Hysteroscopy, fractional curettage

Conducting an adequate medical history including previous gynecological procedures, menstrual cycle, medication, allergies, and existing conditions, as well as performing a gynecological examination. The examination is intended to identify other pathologies of the uterus or adnexa, potentially avoiding surgery. Assessment of the external genitalia, vagina, cervix, and uterus. Palpation to determine the size, position, and mobility of the uterus. Additionally, determining the actual distress or needs of the patient. Subsequently, informing about alternative treatment options.

Laboratory examination (depending on the needs of the clinic)

For women of childbearing age, a preoperative pregnancy test is mandatory.

Further examinations (MRI, CT) are only useful with corresponding indications.

Abnormal uterine bleeding (premenopausal or postmenopausal):

• Irregular, heavy, or prolonged bleeding that does not respond to medical treatments.
• Bleeding occurring after menopause that requires evaluation.

Endometrial pathologies:

• Endometrial hyperplasia: Thickening of the endometrium requiring targeted biopsy or therapeutic removal.
• Endometrial polyps: Presence of polyps that thicken the endometrium and need to be removed.
• Adenomyosis: Superficial forms where the uterine wall shows changes visible and treatable with hysteroscopy.

Uterine fibroids:

• Submucosal and intramural fibroids causing bleeding or other symptoms that can be removed hysteroscopically.

Intrauterine adhesions (Asherman's syndrome):

• Treatment of adhesions within the uterine cavity leading to fertility issues or menstrual disturbances.

Abnormal imaging findings:

• Evaluation of abnormal or unclear findings on ultrasound or MRI that may indicate pathology.

Chronic excessive vaginal discharge (leukorrhea):

• Diagnosis and treatment of chronic vaginal discharge unresponsive to other therapies.

Anatomical anomalies of the uterus (e.g., Müllerian anomalies):

• Evaluation and possible treatment of congenital malformations such as uterine septum.

Retained products of conception:

• Removal of placental remnants or other pregnancy tissues after miscarriage or delivery.

Cervical lesions:

• Examination and possible removal of pathological changes in the cervical canal.

Complications related to intrauterine contraceptives:

• Removal of embedded or displaced intrauterine devices (IUDs) or other foreign bodies.

Preoperative planning and postoperative follow-up:

• Use of hysteroscopy for planning further surgical interventions or assessing the success of a previous operation.

• Wound healing disorder,
• Infection
• Intrauterine adhesions (synechiae), scar tissue changes, and potential impacts on future pregnancies.
• Injuries to other organs, intestines, bladder, urethra
• General surgical risks (bleeding, rebleeding, thrombosis, embolism, HIT)
• Information about the risk of postoperative bleeding and the possibility of a follow-up curettage.
• Uterine perforation, possibly requiring laparoscopy to suture the defect
• Injuries to the cervix
• Positioning injuries
• Burns, when using electricity
• Information about alternative treatment methods

• no preoperative bowel evacuation
• no shaving
• if necessary, antibiotic prophylaxis during induction of anesthesia (cephalosporins of group 2 and metronidazole), depending on the extent of the surgery

Explanation of postoperative care, including possible medication, behaviors (e.g., abstaining from tampons and sexual intercourse for a certain period), and the necessity of a follow-up appointment.

Information about symptoms that should be monitored after the procedure, such as heavy bleeding, pain, fever, or unusual discharge, and the need to contact a doctor in such cases.

A final examination should be conducted before discharge. 

• Physical examination with palpation of the abdomen, 
• if necessary, a speculum setting with rectal/vaginal examination should also be performed.
• Information on postoperative behavioral measures (resumption of moderate to heavy activities in 1-2 weeks)