Hysteroscopy: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians.
The objective of this study was to provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning hysteroscopy. Vaginoscopy should be the standard technique for diagnostic hysteroscopy (Grade A) using a miniature (≤3.5mm sheath) (Grade A) rigid hysteroscope (Grade C), using normal saline solution distension medium (Grade C), without any anaesthesia (conscious sedation should not be routinely used), without cervical preparation (Grade B), without vaginal disinfection and without antibiotic prophylaxy (Grade B). Misoprostol (Grade A), vaginal oestrogens (Grade C), or GnRH agonist routine administration is not recommended before operative hysteroscopy. Before performing hysteroscopy, it is important to purge the air out of the system (Grade A). The uterine cavity distention pressure should be maintained below the mean arterial pressure and below 120mm Hg. The maximum fluid deficit of 2000ml is suggested when using normal saline solution and 1000ml is suggested when using hypotonic solution. When uterine perforation is recognized during operative hysteroscopy using monopolar or bipolar loop, the procedure should be stopped and a laparoscopy should be performed in order to eliminate a bowel injury. Diagnostic or operative hysteroscopy is allowed when an endometrial cancer is suspected (Grade B). Implementation of this guideline should decrease the prevalence of complications related to hysteroscopy.
Service de Gynécologie Obstétrique, Clamart, France. Electronic address: xavier.deffieux@abc.aphp.fr.
Xavier
X
Deffieux
Service de Gynécologie Obstétrique, Limoges, France.
Tristan
T
Gauthier
Service de Gynécologie Obstétrique, Marseille, France.
Nicolas
N
Menager
Service de Gynécologie Obstétrique, Le Kremlin Bicêtre, France.
Guillaume
G
Legendre
Service de Gynécologie Obstétrique, Marseille, France.
Aubert
A
Agostini
Service de Gynécologie Obstétrique, Poitiers, France.
Fabrice
F
Pierre
D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods
Distension media; Hysteroscopy; Office hysteroscopy; Operative hysteroscopy; Outpatient hysteroscopy; Vaginoscopy