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Should outpatient hysteroscopy replace conventional diagnostic dilatation and curettage in gynecologic practice?

Three hundred fifty patients attending gynecology outpatient clinics between 1984 and 1989 warranting a diagnostic D & C were offered instead a diagnostic hysteroscopy under local anesthesia (with or without intravenous Midazalom) or under general anesthesia. Subjective assessment of complications was performed by direct questioning of the patient during the procedure when the hysteroscopy was done under local anesthesia and by asking the patient to complete a questionnaire in the first 48 h after the operation. Objective assessment was performed by monitoring the pulse and blood pressure before and during the procedure and for an hour postoperatively. Subjective assessment of complications was significantly more in patients who had the hysteroscopic examination under general anesthesia (pain p less than 0.0001, nausea and/or vomiting p less than 0.0001, headache p < 0.0001, and general malaise p < 0.0001). There was no difference in objective measures of complications in the two groups. Patient acceptability was significantly higher for hysteroscopic examination under local anesthesia (p less than 0.0001). Diagnostic hysteroscopy under local anesthesia is a reliable and uncomplicated procedure. Patient acceptability is excellent. Hence, this examination can be performed in gynecologic outpatient clinics under local anesthesia.