AIBU hysteroscopy pain & bleeding

[loveyogalovelife]

I had a hysteroscopy on Monday to put a camera inside. Should have been routine, i.e.dilate my cervix, put a tiny camera on a bendy stick into my uterus...

I woke up after the op in agony begging for morphine;10mg didn't work so they gave me diclofenac as a suppository as well. Lots of blood.

The registrar said it was because they had had to force my cervix open as it was really tightly shut.

Now I've discovered that hysteroscopies should be done in the week after ovulation when it's easy to get in

AIBU to think the hospital should have told me that and asked where I was in my cycle?

I'm reading stories of women with scarring in cervix and womb caused by medical negligence that causes infertility.

Can still feel pain and sore even now

[Blueroses99]

That sounds horrible, I'm sorry you had to go through that. I had a hysteroscopy mid IVF cycle as a suspected polyp developed during down regging. So where I was in my natural cycle was not relevant and I wasn't asked. I was in a lot of pain afterwards too and felt v groggy and found myself overdoing it really easily as my energy levels were very low, but I put it down to recovery from GA rather than the procedure itself.

Completely separately, it turns out I have an incompetent cervix which caused me to lose my precious baby at 21wks. I will be monitored during any future pregnancy and a stitch put on to keep the baby in. The hysteroscopy was entirely unrelated and did not cause the cervix issue but if you are concerned, you could ask for the cervix length to be monitored.

Before you get too worried about medical negligence, I would wait for the pain to settle and have a follow up with your consultant.

[MozzchopsThirty]

I had a hysteroscopy under GA with some bleeding after but no pain
Surely where you are in your cycle wouldn't make a difference?

[loveyogalovelife]

Thanks bluerose. I'm so sorry to hear about your MC. 21 weeks must have been awful, I can't imagine how you must have felt.

By coincidence I also have an incompetent cervix, as I had most of it removed when I was 19 due to a positive smear / pre-cancerous cells. So I'll also need a stitch. I've done a bit of research and would be keen to find an experienced consultant to do the stitch, and for them to use thin thread: www.genesisresearchtrust.com/news/cervical-stitch-procedure-linked-to-increased-risk-of-premature-birth-and-neonatal-loss

[loveyogalovelife]

In the first half of your cycle the cervix is open, so the sperm can get into the womb to fertilise the egg. After ovulation it's closed. I've read FAQs about hysteroscopy online and it says the op should ideally take place the week after ovulation. After ovulation the cervix is firm and shut. The registrar told me it was firmly closed and they had had to force it open, which was the reason for the blood and pain.

[Blueroses99]

Thank you liveyoga. There were no warning signs that I might have an incompetent cervix, as I've never had any surgery etc. Bit puzzled that you're known to have an incompetent cervix but they had to prise it open

The expert seems to be Dr Gibb at The Birth Company in Harley Street. I haven't seen him myself as my NHS consultant would monitor my care including the stitch, but I know others that have seen him 👍

[loveyogalovelife]

Bluerose, an incompetent cervix still closes after ovulation and in pregnancy, otherwise you would be able to get pregnant at all...

But it's not as strong as a normal cervix and so as a pregnancy develops, the cervix may not be able to hold the additional weight and it can give way leading to MC.

A stitch typically needs to go in at around 12 weeks to avoid miscarriage.

In severe cases, bedrest may be prescribed from as early as 4 months, but hopefully the stitch does the job for most.

Do you also know you'll need a Caesarean section? This book might be a useful read: Ros Kane - Cervical Stitch (Shirodkar Suture): What it's Like

[Blueroses99]

I would have a mcdonald stitch, rather than a shirodkar, put in between 12-14 weeks and removed at 37 weeks, so I might not need a c section but it would ok either way. I am fully prepared for bed rest from second trimester (as are my employers as they requested I saw their Occupational Health doctor after my recent loss and he recommended it).

Just need to get pregnant again, otherwise it's purely hypothetical! I'm currently mid IVF cycle.

[loveyogalovelife]

Best of luck with the IVF... think positive! Great that you have support from your employer and a good plan for the pregnancy. I'll definitely look at the different types of stitches as I didn't know they varied xxx

[Blueroses99]

Thank you! I'm trying to think positive. I did a little research when IC was diagnosed, and spoke to my consultant (and OH doctor) but figured I would look into properly if when it was relevant.

What's next for you after the hysteroscopy? I saw from another thread that you were pursuing a diagnosis of Ashermans, is that right?

[loveyogalovelife]

Yes... I'm a bit lost to be honest. Had a really traumatic miscarriage earlier this year and have been super strong but I realise I'm probably not doing as well as I thought...

In the hystero they found scarring and tried to scrape it off, which might also explain the pain; I finally managed to speak to the operating consultant directly on Friday and he says if it was Asherman's my whole womb would be stuck together, so he insists it isn't.

But has no further explanation

But I'm hearing in chat groups that all womb scarring is Asherman's so I don't know...

I'm trying to get copies of the photo and all the different tests but it could take a month apparently as I have to write to the hospital legal dept (to see my own notes?!).

I was going to see Mr Lower tomorrow but people are saying it's better to be able to take my notes with me.

I've had recurrent MCs and it feels like our last chance. But scared of going through further losses. We don't know what we'll do if we don't have kids...

[fempsych]

My understanding is that ashermans has different levels and full stuck together is higher level ashermans but there is also lower level ashermans which is not stuck all together.

I had a hysteroscopy on NHS due to suspected AS (after seeing dr lower initially for private assessment) however it was actually complete cervical stenosis which was fixable, no idea what they did. Presumably they used ultrasound?

[fempsych]

Forgot to say - I had no pain.

[loveyogalovelife]

No ultrasound? I've had loads of those but scarring doesn't typically show up as far as I know. It was Hysteroscopy with camera. Healthy left side of womb and scarred RH side... see pic.

it was fine in March when I had a Hysteroscopy but then I fell pregnant, and at week 8 started to bleed and have the most agonising pain on RH side (where it always is, related to scarring?) and was diagnosed with suspected ectopic and given Metatrexate. Loads more happened, it wasn't ectopic after all... has been very confusing.

[loveyogalovelife]

Pic from hysteroscopy

[IsItOnTheTrolley]

Theatre nurse here, first of all, for the surgeon to say "force" the cervix open, isn't very good, not a way to describe any part of the procedure really.

What does happen usually, and in the 4 hospitals I've worked in, is the cervix is always dilated to the size of the hysteroscope. The hysteroscopes do come in different sizes, as do patients, but I have never seen one inserted without dilation first of all.

So as your cervix was "firmly closed", it will need some dilation, again all patients are different, women who have had vaginal deliveries tend to have an easier cervix to dilate. But this then changes with age.

Some surgeons do sometimes say the wrong things, I remember my obstetrician saying he thinks it's "too late" to a midwife as they took me in for a c section, not good, as a nurse, and with my DH a doctor too, I think we realised the gravity of the situation... Luckily Dd2 arrived with a scream!

Hope you are feeling better soon. 💐

[loveyogalovelife]

Thanks so much isotonthetrolley. The junior registrar said "your cervix was very firmly shut. We had to force it open. That is why all the blood" (she was very young and another nationality). Surely it's not good that they made my cervix bleed, surely that could indicate some damage?

[IsItOnTheTrolley]

Lovey, it's really hard to comment on something that I didn't see, but yes, sometimes the cervix does bleed, as we need to take hold of it with an instrument, before dilators are introduced. The cervix also has a very good blood supply, and so can bleed a lot, from a small amount of trauma.

Not sure if this helps you at all?

Really hope you get all the answers you want, you are always able to ask the surgeons anything you're not sure of. 💐

[loveyogalovelife]

Ok thank you xxx