Outpatient Procedures

We offer a number of minor outpatient procedures which can be safely performed in outpatient environment without the use of general anaesthesia:

Endometrial biopsy
Saline infusion sonohysterography (SIS)
Removal of cervical polyps
Insertion of Mirena coil and other intrauterine contraceptive devices (IUCD)
Removal of intrauterine contraceptive devices when the threads are lost
Fallopian tube patency testing (HyCoSy)
Aspiration of ovarian cysts
Surgical treatment of miscarriage under local anaesthesia
Outpatient hysteroscopy

Outpatient procedures

We offer a number of minor outpatient procedures which can be safely performed in outpatient environment without the use of general anaesthesia:

Endometrial biopsy is a simple procedure which is sometimes used to investigate causes of abnormal uterine bleeding. A small sample of the uterine lining is obtained and sent for histological examination, which helps to advise women on the best treatment to control their symptoms.

Saline infusion sonohysterography (SIS) is a procedure which involves putting of a small amount of fluid into the uterine cavity. This improves quality of ultrasound imaging of the uterus and help with the diagnosis of subtle abnormalities of the uterine lining such as polyps or intra-uterine adhesions. The procedure is sometimes offered when a conclusive diagnosis cannot be reached on a standard ultrasound examination. Some fertility specialists routinely request SIS in women considering complex fertility treatment such as IVF.

Removal of cervical polyps. Cervical polyps are sometimes detected during routine cervical smear tests. Most of them can be easily removed in the outpatient clinic. Ultrasound examination is always performed first to assess the size of polyps and the site of attachment to ensure the success and safety of the procedure.

Insertion of Mirena coil and other intrauterine contraceptive devices (IUCD). We always perform these procedures under ultrasound guidance to ensure that they are done safely and successfully. We are able to offer a choice of both standard Copper containing devices and hormone releasing devices such as Mirena, Kyleena and Jaydess coil.

Removal of intrauterine contraceptive devices when the threads are lost. All intrauterine contraceptive devices have fine plastic threads attached to their tail. When a device is inserted the threads are cut long and left to stick out into the vagina. This is done to help women and their doctors to check that the coil remains in the right place. It also makes it easier for the coil to be removed by simply pulling on the threads. However, sometimes the threads can either detach from the coil or fold inside the womb so that they are not visible of the examination. In such cases removing the coil can be difficult and many women end up having the coil taken out under general anaesthesia. We have developed an original technique for removing lost intrauterine devices under ultrasound guidance which is very effective, safe and virtually painless. By using this technique, we can remove most coils in the clinic which is more convenient, faster and less costly compared to the procedures under general anaesthesia.

Fallopian tube patency testing (HyCoSy). Approximately 25% of women with fertility problems will have either a blockage or distortion of their Fallopian tubes which will could make conception difficult or increase the risk of ectopic pregnancy. Conventionally, the assessment of Fallopian tube function was performed using x-ray (hysterosalpingography – HSG) or at surgery (laparoscopy and dye test). A more recent method to assess tubal patency using ultrasound (HyCoSy – hysterosalpingography) has been shown to be as good as a laparoscopy and dye and less painful than an HSG. Our Centre is one of a very few in the UK who are able to offer three-dimensional HyCoSy to our patients. The use of three-dimensional technology increases diagnostic accuracy and shortens the time of examination by enabling storage, review and re-examination of all images.

Aspiration of ovarian cysts* Persistent ovarian cysts diagnosed on ultrasound often need to be removed surgically. However, in some women, surgery is best avoided, either because of the risk of complications or to preserve ovarian tissue. This is often the case pregnant women and it those undergoing fertility treatment. In these cases, it is possible to aspirate the cyst content under ultrasound guidance. This can be done in the outpatient clinic either transabdominally or transvaginally. Some women develop chronic pelvic pain due to build up of fluid within thick pelvic adhesions, which can form after previous extensive pelvic surgery. In these women symptoms can only be relieved by ultrasound-guided fluid aspiration, which we are able to offer in our clinic.

Surgical treatment of miscarriage under local anaesthesia*. Miscarriage is the most common complication of early pregnancy and it is estimated that one in six pregnancies is lost through miscarriage. Surgical removal of pregnancy tissue retained within the uterine cavity after miscarriage is often required to help women’s’ recovery and to restore their normal menstrual cycles. These procedures are routinely performed under general anaesthesia. Our consultants, however, have also been trained to perform these procedures under local anaesthesia too. Procedures under local anaesthesia are safer and women recover faster compared to the procedures performed under general anaesthetic. Procedures under local anaesthesia are performed in the outpatient setting and therefore the costs are much lower compared to operations under general anaesthetic which require admission to hospital.

Outpatient hysteroscopy* is a surgical procedure which involves insertion of a small telescope into the uterine cavity. In the past, this procedure was often used to diagnose abnormalities of the uterine cavity such as polyps or small fibroids. With recent advances in ultrasound, hysteroscopy is nowadays used less for the diagnosis and more for the treatment of abnormalities of the uterine cavity such as endometrial polyps which are detected on ultrasound scans. Modern hysteroscopes are very thin, which makes the procedure easier to tolerate. In many cases the procedure can be performed in the outpatient setting under local anaesthesia, which increases the safety of the procedure and reduces the costs.

* These procedures are performed on private basis in the outpatient theatre at King Edward Hospital, 5-10 Beaumont Street, London 

Services
Ultrasound scanning
Laboratory Investigations
General Gynaecological Consultations
Have questions?
Is it possible to diagnose ectopic pregnancy on the scan?
Experienced operators are able to detect almost all ectopic pregnancies measuring more than a few millimetres in size on ultrasound scan. It is important to emphasize; however, that ectopic pregnancies tend to develop more slowly than intrauterine pregnancies and it often takes them longer to grow to the size which makes them visible on the scan. Most women with a positive pregnancy test in whom ultrasound cannot identify a pregnancy have either normal pregnancies which are younger than expected from the date of their last period or they have already suffered a miscarriage. A small proportion of these women; however, may develop small ectopic pregnancies. A blood test is usually arranged in these cases to measure the levels of pregnancy hormones in women’s blood. Based on the result of the blood test we can advise women on the likely outcome of their pregnancy and on the need for further follow up.
Read full answer
Experienced operators are able to detect almost all ectopic pregnancies measuring more than a few millimetres in size on ultrasound scan. It is important to emphasize; however, that ectopic pregnancies tend to develop more slowly than intrauterine pregnancies and it often takes them longer to grow to the size which makes them visible on the scan. Most women with a positive pregnancy test in whom ultrasound cannot identify a pregnancy have either normal pregnancies which are younger than expected from the date of their last period or they have already suffered a miscarriage. A small proportion of these women; however, may develop small ectopic pregnancies. A blood test is usually arranged in these cases to measure the levels of pregnancy hormones in women’s blood. Based on the result of the blood test we can advise women on the likely outcome of their pregnancy and on the need for further follow up.
When can you see the baby’s heartbeat?
The earliest ultrasound can confirm the presence of a heartbeat is two weeks after a missed menstrual period or four weeks after conception. In women who conceive after IVF the heartbeat can be seen four weeks after the day of oocyte collection. Again, in order to avoid coming for the scan too early it is best to delay the attendance until two and a half to three weeks after the missed period or four and a half to five weeks after conception/oocyte collection.
Read full answer
The earliest ultrasound can confirm the presence of a heartbeat is two weeks after a missed menstrual period or four weeks after conception. In women who conceive after IVF the heartbeat can be seen four weeks after the day of oocyte collection. Again, in order to avoid coming for the scan too early it is best to delay the attendance until two and a half to three weeks after the missed period or four and a half to five weeks after conception/oocyte collection.
How soon after a missed period can pregnancy be seen on the scan?
A normal intrauterine pregnancy can be first seen on the scan three days after a missed menstrual period. In women who fall pregnant after fertility treatment such as ovarian stimulation the pregnancy can be seen 17 days after ovulation. In women who conceive after IVF the pregnancy can be seen 17 days after the day of oocyte collection. There are, however, small variations in the timing of conception and women who wish to confirm that their pregnancy is located within the uterus are advised to delay their attendance until a week after the missed period (or three weeks after conception) to avoid coming for the scan too early. This is particularly important in women with uterine abnormalities such as fibroids or adenomyosis, which make it harder to see the pregnancy and sometimes the diagnosis may be delayed for several days.
Read full answer
A normal intrauterine pregnancy can be first seen on the scan three days after a missed menstrual period. In women who fall pregnant after fertility treatment such as ovarian stimulation the pregnancy can be seen 17 days after ovulation. In women who conceive after IVF the pregnancy can be seen 17 days after the day of oocyte collection. There are, however, small variations in the timing of conception and women who wish to confirm that their pregnancy is located within the uterus are advised to delay their attendance until a week after the missed period (or three weeks after conception) to avoid coming for the scan too early. This is particularly important in women with uterine abnormalities such as fibroids or adenomyosis, which make it harder to see the pregnancy and sometimes the diagnosis may be delayed for several days.
Is it safe to have a scan in early pregnancy?
There is no evidence that ultrasound scans can harm pregnancies. It is important to ensure, however, that the energy of ultrasound beam is kept low. Use of pulsed Doppler devices to measure blood flow should be avoided in the first weeks of pregnancy as their energy output is higher compared to the ultrasound beam used for standard imaging. Our equipment is fully compliant with the international standards for safe use in pregnancy and the machine energy output is continuously monitored during the examination.
Read full answer
There is no evidence that ultrasound scans can harm pregnancies. It is important to ensure, however, that the energy of ultrasound beam is kept low. Use of pulsed Doppler devices to measure blood flow should be avoided in the first weeks of pregnancy as their energy output is higher compared to the ultrasound beam used for standard imaging. Our equipment is fully compliant with the international standards for safe use in pregnancy and the machine energy output is continuously monitored during the examination.
Is it possible to detect ovarian cancer on the scan?
Ovarian cancer can be accurately diagnosed on ultrasound scan. The best and most accurate way to diagnose ovarian cancer is by an expert performing a systematic and detailed examination of the tumour and the adjacent structures in the pelvis and abdominal cavity. The advantage of this approach is that it provides the information about the nature of the tumour instantly in the vast majority of cases, without the need of additional blood tests such as CA125 or MRI.
Read full answer
Ovarian cancer can be accurately diagnosed on ultrasound scan. The best and most accurate way to diagnose ovarian cancer is by an expert performing a systematic and detailed examination of the tumour and the adjacent structures in the pelvis and abdominal cavity. The advantage of this approach is that it provides the information about the nature of the tumour instantly in the vast majority of cases, without the need of additional blood tests such as CA125 or MRI.
Can you see Fallopian tubes on the scan?
Normal Fallopian tubes are very thin and they cannot be routinely seen on the scan. If the tubes are damaged, they tend to fill with fluid which makes it possible to see them. Tubal patency can be tested using a procedure called HyCoSy which is described in the section on the services we offer to women with concerns about their fertility.
Read full answer
Normal Fallopian tubes are very thin and they cannot be routinely seen on the scan. If the tubes are damaged, they tend to fill with fluid which makes it possible to see them. Tubal patency can be tested using a procedure called HyCoSy which is described in the section on the services we offer to women with concerns about their fertility.