Original Article
Impact of Uterine Scar on Pain Experienced During Outpatient Hysteroscopy: A Prospective Blinded Comparative Study

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Abstract

Study Objective

To study the impact of uterine scar on pain experienced during outpatient hysteroscopy.

Design

A prospective blinded comparative study (Canadian Task Force classification II-1).

Setting

Outpatient hysteroscopy clinic at a university hospital.

Patients

We included 140 women in the childbearing period attending an outpatient hysteroscopy clinic. Patients were divided into 2 groups. Group A included patients with previous uterine scar (n = 70) and Group B included those with unscarred uterus (n = 70). None of the patients had a previous attempt of a vaginal delivery.

Intervention

Diagnostic outpatient hysteroscopy without the use of anesthesia or analgesia.

Measurements

We assessed pain experienced during and immediately after the procedure using a 100-mm visual analog scale. We also evaluated the successful completion of the procedure.

Results

There were no statistically significant differences in the pain scores between patients with scarred uterus and those with unscarred uterus during or immediately after the procedure. The procedure was aborted in only 1 case in the scarred uterus group. This patient had a history of surgical site infection, which may denote a weak scar. There were no statistically significant differences in pain scores between patients with cesarean scar and those with myomectomy scar. No statistically significant differences in pain scores were found between patients with 1, 2, 3, or 4 cesarean deliveries.

Conclusion

Uncomplicated uterine scars do not have an impact on pain experienced during or immediately after diagnostic outpatient hysteroscopy using a 3.8-mm hysteroscope.

Section snippets

Methods

This prospective comparative observational study was performed at the outpatient hysteroscopy clinic at the Department of Obstetrics and Gynecology at Cairo University Hospital. The study was conducted from August 1, 2015 until May 1, 2016. The study was approved by the research ethics committee of Cairo University Hospital. All patients provided their written informed consent after proper explanation of the procedure.

We included women in the childbearing period (18–45 years old) attending the

Results

We recruited 140 patients who were divided equally into 2 groups: Group A, those with scarred uterus (n = 70), and Group B, those with unscarred uterus (n = 70). Baseline characteristics of patients, indications, duration, and pain scores during and immediately after the procedure are shown in Table 1. Kolmogorov Spirnov and Shapiro Wilk tests revealed normal distribution of the continuous data of the study. Student t test revealed a significant difference in age, gravidity, and parity between

Discussion

Cesarean delivery is the most common laparotomy performed worldwide [7], and the incidence has been showing a global increase, described as a “cesarean epidemic” [8]. This means more women with cesarean scars will be encountered in the gynecologic practice, thus reflecting the importance of addressing patients' concerns and expectations regarding pain experience when they undergo diagnostic outpatient hysteroscopy.

Several predictive factors for pain evoked by outpatient hysteroscopy have been

References (17)

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The authors declare that they have no conflict of interest.

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