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INTRODUCTION NTRODUCTION NTRODUCTION NTRODUCTIONNTRODUCTION
ysteroscopy is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. Hysteroscopic polypectomy and myomectomy are just a few of the commonly performed procedures. Hysteroscopy has nearly replaced standard D&C for the management of abnormal uterine bleeding (AUB), as it allows for direct visualization and diagnosis of intrauterine abnormalities, and it often offers an opportunity for simultaneous treatment (Pop-Trajkovic-Dinic et al., ).
Surgical management with hysteroscopic myomectomy has been reported to yield pregnancy rates of . - . (mean of ) in infertile women. Intracavitary lesions are implicated as causes of infertility, and their removal may increase fertility. However, literature supporting the significance of this association is scant. Overall, pregnancy rates of - in previously infertile women have been reported after hysteroscopic polypectomy (Spiewankiewicz et al., ).
Asherman syndrome was identified in as uterine synechiae. These intrauterine adhesions (IUA) are often associated with amenorrhea or infertility. Hysteroscopy is the gold standard used to diagnose and treat these adhesions. Benefits include visually directed lysis. Filmy adhesions are often lysed by distention alone, whereas the dense adhesions
often require cutting or excision with blunt, sharp, electrocautery, or laser techniques (Goldrath, ).
Operative hysteroscopy is a safe procedure resulting in complication in . - of cases. The most frequently observed complications include hemorrhage ( . ), uterine perforation ( . ), and cervical laceration ( - ).another rare complication is excessive fluid absorption with or without resultant hyponatremia (Shveiky et al., ).
Complications may occur in diagnostic or operative hysteroscopy. The complication rate in diagnostic hysteroscopy is low and was estimated by Lindemann ( ) to be . . Complications from operative hysteroscopy are more common and potentially more serious (Lindemann, ).
The use of ultrasonography at the time of intra-uterine procedures provides visualization of the intrauterine contents as well as the myometrium and may decrease procedure associated risks, particularly uterine perforation. For hysteroscopic procedures such as uterine septum, myoma, or synechiae resection, operative ultrasonographic guidance provides an alternative to laparoscopy and, as a result, shortens overall operating time, decreases cost, and eliminates the risk of laparoscopy. In addition, performing intrauterine procedures under ultrasonographic guidance may increase the likelihood of completing the procedure in a single operation (Christianson et al., ).
Studies of ultrasound assistance for hysteroscopy reported that ultrasound appears to be a safe and reliable method of assistance (Kresowik et al., ).
As with uterine septa, resection of submucosal fibroids benefits from ultrasound guidance at time of hysteroscopy. Resection of submucosal fibroids clearly within the uterine cavity is likely wanted in patients with dysfunctional uterine bleeding, infertility, or pregnancy loss who desire to optimize future fertility. A hysteroscopic approach is reasonable if the majority of the fibroid is within the cavity or if hysteroscopic myomectomy is deemed preferable to abdominal myomectomy (Session and Kawwass, ).
Currently, there is no adequate information regarding the impact of using US guidance for operative hysteroscopy so further studies are required for the assessment of role of ultrasound guidance during operative hysteroscopy