2024 59 OPH Flashcards
What cases should be referred to OPH?
- Abnormal uterine bleeding
- Reproductive problems
- Insertion/removal of coils
What written information should be provided prior to OPH?
- Details about procedure
- Benefits & risks
- Advice for pre-op analgesia
- Alternative options
What analgesia should be used for OPH?
- NSAIDs 1 hour before appt
- Local anaesthetic not routinely used; consider if speculum needed
- Conscious sedation not routinely used
What techniques & equipment should be used for OPH?
- Vaginoscopy
- Smallest diameter hysteroscope
- Mechanical tissue removal systems over miniature bipolar electrodes
- Saline at lowest possible pressure
What procedures can be done at OPH?
- Endometrial polypectomy
- Removal of submucous fibroids
- Endometrial ablation
- Removal of chronic retained products of conception
- Retrieval of lost coils
What are the advantages of OPH over GA hysteroscopy?
- Rapid post-op mobilisation
- Quicker recovery
- Less time off work
- Less income & costs lost
- High & equivalent satisfaction
In which circumstances might NSAIDs be unsuitable for OPH?
- Asthma
- Renal impairment
- Gastric ulceration
What analgesia can be offered if NSAIDs are unsuitable or declined? What are the significant side effects?
- TENS
- Oral opiates (drowsiness)
- Oral antispasmodics (more vasovagals)
- Inhaled nitrous oxide (dizziness)
- Penthrox: methoxyflurane
What cervical preparation should be used for OPH?
- None routinely
- Consider if cervical stenosis anticipated
- If needed, vaginal Misoprostol or dinoprostone 12 hours before
What are the pros & cons of vaginal prostaglandins in OPH?
Pros: less pain
Cons: side effects including PVB, abdo pain, GI
No reduction in complications
What size & angle of hysteroscope should be used for OPH? And rigid or flexible?
Size: ≤ 3.5 mm
Angle: discretionary; 0, 12 or 30 •
Style: discretionary
What are the advantages of saline over carbon dioxide as OPH distension medium?
- Less pain
- Better image quality
- Fewer side effects
- Shorter procedural time
- Greater patient satisfaction
- Allows operative techniques
How should saline be instilled at OPH?
- Lowest possible pressure for satisfactory view
- Consider warming to body temperature
Via what routes can local anaesthetic be administered for OPH?
- Topical to ectocervix
- Transcervical, in distension mendium or via a cannula
- Intracervical injection
- Paracervical injection
- Intrauterine fundal
What infection prevention measures should be employed with OPH?
- No routine use of antibiotics
- If infection suspected, delay, test & treat if confirmed
- If mucoid discharge during procedure indicates pyometra, immediate IV Abx
