9: HYSTEROSCOPIC PROCEDURES

Question 1

Specificity (true negative) of EMB

Answer 1

96-99%

Question 2

Sensitivity (true positive) of EMB

Answer 2

83%

Question 3

Should HSC be first line for bx?

Answer 3

NO because of cost!

Question 3

Which is better for EMB - PPV or NPV?

Answer 3

PPV

Question 4

Contraindications to EMB

Answer 4

Cavity size
Mullerian anomalies
Pregnancy
Uterine infection
Endometrial hyperplasia or malignancy

Question 5

Risk of endometritis with EMB

Answer 5

~1%

Question 6

Risks of pregnancy with prior ablation

Answer 6

Malpresentation, prematurity, accreta, perinatal mortality

Question 7

What is post-ablation tubal ligation syndrome?

Answer 7

Cyclic pelvic pain 2/2 viable endometrial tissue trapped by the cornua (obstruction from functional endometrium)

Question 8

Names of submucosal fibroid classification system

Answer 8

European Society of Gynecologic Endoscopy (ESGE) System
Lasmar/STEP-W Classification System

Question 9

If type 2 fibroid reaches uterine serosa, what should management be?

Answer 9

Do NOT do HSC

Question 10

Preoperative ___ can be given to shrink fibroids

Answer 10

GnRH agonist

Question 11

Sensitivity, specificity, and accuracy of blind polypectomy vs HSC

Answer 11

BLIND / HSC
Sensitivity: 11/89
Specificity: 93/93
Accuracy: 59/91

Question 12

Disadvantages of blind polypectomy

Answer 12

High percent of leaving part of the polyp tissue, higher risk of uterine perforation if reinspecting cavity and polyp is still present and you have to resect more

Question 13

Risks of polypectomy (all very rare)

Answer 13

Bleeding
Infection
Uterine perforation
Adhesion formation
Fluid overload
Air embolism
Death