Orlando MS, Bradlley LD. Implementation of office hysteroscopy for the evaluation and treatment of intrauterine pathology. Obstet Gynecol 2022;140.
The authors provided this information as a supplement to their article.
©2022 American College of Obstetricians and Gynecologists. Page 1 of 3
Appendix 1. Leiomyoma uterus labeled with International Federation of Gynaecology and Obstetrics leiomyoma subclassification system and pictured with no distending fluid (A), appropriate hysteroscopic fluid distension pressure to maximize visualization of submucous myomas (B), and over-distension leading to distortion of pathology (C). Reprinted with permission, Cleveland Clinic Foundation ©2022. All rights reserved.
Orlando MS, Bradlley LD. Implementation of office hysteroscopy for the evaluation and treatment of intrauterine pathology. Obstet Gynecol 2022;140.
The authors provided this information as a supplement to their article.
©2022 American College of Obstetricians and Gynecologists. Page 2 of 3
Appendix 2. Endometrial polyp visualized with no distending fluid (A), appropriate
hysteroscopic fluid distension pressure to maximize visualization (B), and over-distension leading to lesion flattening and false negative view (C). Reprinted with permission, Cleveland Clinic Foundation ©2022. All rights reserved.
Orlando MS, Bradlley LD. Implementation of office hysteroscopy for the evaluation and treatment of intrauterine pathology. Obstet Gynecol 2022;140.
The authors provided this information as a supplement to their article.
©2022 American College of Obstetricians and Gynecologists. Page 3 of 3
Appendix 3. Components of an Effective Office Hysteroscopy Practice
Component Details
Preoperative
• Patient selection
• Counseling and informed consent
•
• Timing and endometrial preparation
• Cervical preparation
• Rule out infection
• Pregnancy test
• Discuss patient’s anticipated pathology, procedure objectives, and individual history, perform shared decision-making
• Set expectations for anticipated duration and procedure steps, provide educational materials, and obtain written consent
• Schedule during early proliferative phase or consider progestin-based treatment to thin endometrial lining
• Consider cervical ripening for patients at greatest risk of cervical stenosis or procedural discomfort
• Ensure no signs or symptoms of active reproductive tract infection
• Obtain negative urine pregnancy test, except in cases performed for pregnancy-related indications
Intraoperative
• Comfort measures
• Pain management
• Miniaturized equipment
• Limit cervical instrumentation
• Fluid management
• Video monitoring
• Training and documentation
• Utilize trauma-informed care and baseline comfort measures as desired by the patient
• Individual pain management strategies, which may include no medication, nonsteroidal anti-inflammatory drugs, local anesthetics, or conscious sedation
• Flexible or rigid hysteroscopes <5mm in diameter are associated with high diagnostic sensitivity and least patient discomfort
• Consider a vaginoscopic approach or speculum-assist without placement of a cervical tenaculum
• Use normal saline for distending media at the lowest pressure to obtain appropriate visualization
• Aim to engage patients in the procedure with video projection
• Utilize a consistent team and standardized templates for documentation to decrease patient wait times and improve efficiency
Postoperative
• Follow-up • Return to activities the following day, recommend pelvic rest 48-72 hours to limit risk for bleeding or infection
