The value of hysteroscopy for diagnosing pathology of the uterine cavity in the postpartum period

Abstract

Although hysteroscopy is considered a gold standard of diagnosis and treatment of different pathologies of uterine cavity and the postpartum period is not considered to be a contraindication to hysteroscopy, the study of the state of the uterus after delivery with the use of hysteroscopy is not common. We propose that hysteroscopy is a valuable diagnostic method in the postpartum period, potentially reducing the risk of postpartum complications. The article presents a brief literature review regarding the role of hysteroscopy in the diagnosis of uterine pathology in the postpartum period. The following effects of hysteroscopy on the postpartum uterus are observed: mechanical effect of fluid flow on the wall of the uterus increases contractility, provides washing out of the uterine cavity (blood clots, decidual tissue) and reduction of the number of bacteria (bactericidal effect of antiseptics). Indications for hysteroscopy in the postpartum period are presented. Hysteroscopic picture in the normal course of the postpartum period is described, as well as in such pathological conditions as uterine subinvolution, endometritis (after vaginal delivery and delivery by cesarean section) and placentation abnormalities. The technique of hysteroscopy in the postpartum period is described, which has some significant differences from traditional hysteroscopy. Photos of the uterine cavity one month after cesarean section are presented. Pathologies of the uterine cavity in the postpartum period are a subject that require further investigations not only by traditional non-invasive visualization techniques, but also by modern minimally invasive endoscopic technologies. Hysteroscopic visualization of the uterine cavity allows confirming the diagnosis and, if needed, accurately performing of the necessary intervention with minimal risk of intra- and postoperative complications.