This article provides basic information on examinations and procedures for the diagnosis of gynaecological conditions. It provides women with clear and necessary information on the course and preparation for the various examinations.
Table of contents:
- Hysterosalpingography (HSG) in pregnancy
- Laparoscopy in pregnancy
- Hysteroscopy during pregnancy
- Puncture of the sinus of Douglas in pregnancy
- Biopsy of the endometrium, curettage of the uterine cavity in pregnancy
- Specimen collection during pregnancy
- Histopathological examination during pregnancy
Hysterosalpingography (HSG) in pregnancy
Hysterosalpingography is performed in the diagnosis of causes of infertility. It involves taking an X-ray image to visualise the uterus and fallopian tubes after an injection of a shadowing agent directly into the uterine cavity using a special camera inserted through the cervix. It sometimes requires general anaesthesia, as, particularly if there are adhesions causing obstruction of the fallopian tubes, the patient may feel pain during the flow of the shadowing agent. The flow of the shadowing agent through the fallopian tubes is monitored on a monitor screen and several X-rays are taken. These are taken up to the 10th day of the cycle, excluding days of menstrual bleeding.
No solid food should be taken before the examination. A few tens of minutes prior to the examination, you may take some mild diastolic agents, e.g. in the form of rectal suppositories.
Laparoscopy in pregnancy
Laparoscopy is used in surgical diagnostics to allow visual assessment of the organs of the lower pelvis, including the reproductive organs, using a special apparatus introduced into the peritoneal cavity. In gynaecological diagnostics, it is used to detect the causes of infertility and the regularity of the reproductive organs as well as lesions in the organs of the lower pelvis, e.g. endometriosis. An optical instrument (laparoscope) is inserted through an approx. 5 mm incision in the umbilicus, through which a magnified image is displayed on a monitor. Before the laparoscope is inserted, it is necessary to fill the abdominal cavity with a special gas, causing the abdominal integuments to be raised and the intestines to be distended in order to obtain a better image.
For diagnostic laparoscopy, the patient must be prepared as for any surgical procedure, as it may be necessary to carry out small surgical procedures with additional instruments whose introduction into the peritoneal cavity, through successive incisions, makes this possible. In addition to basic blood analytical tests, an ECG, internal medicine and anaesthesia consultations are required to admit the patient to surgery. It requires general anaesthesia and must be carried out under operating theatre conditions.
On the day before the operation, after a light breakfast, the patient should take no solid food and drink only still mineral water. In the evening and on the morning of the day of the operation, a rectal infusion is given to cleanse the bowels. For the procedure, the patient must have her vulva and in some cases her abdomen shaved.
Hysteroscopy during pregnancy
Hysteroscopy is an examination similar to laparoscopy. The difference between the two is that hysteroscopy allows only the cervical canal and the inside of the uterus to be assessed and, unlike laparoscopy, an optical instrument, called a hysteroscope, is inserted not through the abdominal integuments, but through the vagina and the cervix. It allows sections of the endometrium to be taken. Hysteroscopyis performed to identify pathological changes in the uterus and its mucosa. It is used in infertility, abnormal bleeding and other conditions.
Hysteroscopy is particularly useful for endometrial cancer or certain forms of cervical cancer, as it allows even the smallest lesions to be located. The procedure requires general anaesthesia and the preparation should therefore be the same as for laparoscopy.
Puncture of the sinus of Douglas in pregnancy
Puncture of the sinus of Douglas involves aspiration of fluid from the uterine cavity by puncturing the posterior vaginal vault. The fluid may be either blood or pus. This examination is used to diagnose acute conditions such as rupture of ectopic pregnancy requiring rapid intervention, as well as inflammatory tumours or abscesses in the small pelvis.
If the aspirated fluid is blood, especially with clots, this indicates a ruptured ectopic pregnancy and is an absolute indication for surgery. However, if the fluid is any other secretion, it is collected and submitted for bacteriological examination. The examination can be carried out under local anaesthesia, but is usually performed under general anaesthesia.
Puncture of the sinus of Douglas does not require any special preparation, however, due to the possibility of general anaesthesia, the patient should be fasting.
Endometrial biopsy, curettage of the uterine cavity in pregnancy
Endometrial biopsy and endometrial curettage are procedures performed to remove fragments of mucous membrane from the cervical canal and the uterine cavity for histopathological examination. In the case of curettage of the uterine cavity (around day 20 of the menstrual cycle), intravenous general anaesthesia is required. Curettage allows material to be taken from the entire uterine cavity, whereas biopsy takes a random fragment of the uterine cavity.
An endometrial biopsy is used for the diagnosis of
- abnormal uterine bleeding,
- in infertility
- in suspected lesions of the endometrium.
Specimen collection during pregnancy
Specimen collection involves taking a section of the lesioned tissue and submitting it for histopathological examination. The material can be taken during short procedures as well as during surgery. Sometimes they are only taken under local anaesthesia. In gynaecology, sections are most often taken from the vaginal part of the cervix in women with an abnormal cytological smear, from the vagina or vulva.
Excision taking should not be performed during menstrual bleeding.
Histopathological examination in pregnancy
Histopathological examination involves the close examination under a microscope of tissue sections taken from pathologically affected areas. The material can be viewed in the form of colour preparations, frozen preparations or smears. It allows the exact identification of the lesion, the histological type of the tumour and the degree of malignancy. This examination is of particular importance for making a proper diagnosis and undertaking further treatment.
In order to make a correct diagnosis of the disease and undertake appropriate treatment, accurate diagnostics is essential. The ever-increasing list of diagnostic possibilities allows early detection of lesions and makes it possible to start treatment quickly enough to limit the spread of the disease.
