Office Procedures

Office Procedures

At Gwinnett OB/GYN, we offer in-office procedures. If a procedure has been recommended by the provider, please do not be alarmed. Most are minor, well-tolerated and only take a few minutes to complete.

Sonohysterogram

A sonohysterogram is an ultrasound of the uterus that combines infusion of saline into the endometrial cavity to detect abnormalities such as endometrial polyps or fibroids. It is often used to evaluate infertility or bleeding abnormalities that can affect women of different ages.

Risks

There is minimal risk of infection. Antibiotics are not usually required prior to procedure.

Pre-procedure preparation

We require that you remain abstinent for at least 14 days. If postmenopausal, we may prescribe a medication called cytotec to take by mouth several hours prior to procedure.

Procedure

After the usual transvaginal pelvic ultrasound is performed, the doctor places a speculum in the vagina, the cervix is cleansed with a cleaning solution and a catheter is introduced into the cervix. At times, an instrument may be placed on the cervix to straighten the uterus. Saline is infused and the ultrasound probe replaced. The endometrial cavity is then evaluated. Afterwards, the probe and catheter are removed. You may experience cramping.

Aftercare

Please contact us if you develop severe cramping or unusual bleeding. You may have bloody or watery discharge for a few days.

 

Endometrial biopsy 

This is procedure is done to obtain cells from the lining of the uterus. It is used to evaluate bleeding abnormalities. We often perform this procedure right after a sonohysterogram but sometimes it is done by itself.

Procedure

A speculum is placed in the vagina and long swabs used to clean the cervix with cleaning solution. A small catheter is then introduced into the uterus and cells obtained. A few passes may be necessary to obtain enough tissue. This tissue is then sent to pathology. Results take about 1 week or less to become available. We always call with results.

After care

You may experience light bleeding and mild cramps. You may take NSAIDs such as ibuprofen or naproxen as needed. Please contact us with unusually heavy bleeding or severe cramping.

Nexplanon

This is a progestin-only contraceptive implant used to prevent pregnancy. It is one of the most effective reversible forms of contraception. It is placed underneath the skin of the upper arm and is effective for 3 years. Its insertion and removal is conveniently done in our office.

Pre-procedure preparation

Use another form of contraception or abstain prior to insertion. You may take an NSAID or Tylenol prior to procedure.

Insertion

After you are positioned, the site of insertion is marked. The skin overlying this area is cleaned thoroughly. A local anesthetic is then injected to numb the area. The device is placed using a small needle-introducer. Care is taken to ensure device is placed superficially and can be felt by you and the provider. Sterile dressings are then applied.

Removal

After device has been palpated. The skin is cleaned thoroughly and injected with local anesthetic agent. A small incision is then made with a scalpel. The tip of the implant is grasped with an instrument and then removed from surrounding tissue. Please note that scar tissue is often present and may need to be separated before the implant is removed. Sterile dressings are then applied.

After care

Please contact us with any signs of infection such as redness, swelling or fever. It is very rare that you will experience this. It is normal to have some bruising around the site of insertion or removal. You may continue to take NSAIDs or Tylenol as needed for pain. Use a back-up method of contraception for 1 month. If implant was removed and pregnancy is not welcome, ensure to use an alternative form of contraception.

 

Intrauterine Device 

An intrauterine device is placed inside the uterus to prevent pregnancy. It is a form of long-acting, reversible contraception. We offer all FDA-approved IUDs. The mirena and lilletta IUDs contain progesterone-like hormone and are effective for 5 years. Kyleena IUD is designed for women who do not have children and is also effective for 5 years. The paragard IUD is non-hormonal and lasts for 10 years. All IUDs are 99% effective in preventing pregnancy and are be placed/removed in the office. On a rare occasion, removal is difficult needs to be done under ultrasound guidance or in the operating room.

Pre-procedure preparation

You will need to ensure that you are not pregnant prior to the procedure. Please abstain from intercourse or use another form of contraception. Take an NSAID such as ibuprofen or naproxen prior to your appointment to allow for more comfortable procedure. For certain patients, you may be given cytotec which softens the cervix, to take prior to insertion.

Procedure

The provider examines your uterus first, then a speculum is placed in the vagina and the cervix cleansed with cleaning solution. An instrument is placed on the cervix to help hold the uterus in place and maintain proper alignment. The length of the uterine cavity is then measured. After this, the IUD is placed using an applicator and the strings are cut. All instruments are then removed. You may experience cramping, nausea or dizziness during placement. However, most women tolerate insertion well without severe discomfort. Slowly sit up from the examining table. It is okay if you need some time to lay down afterwards.

After care

IUDs, while effective immediately, do not protect against STIs, so it is important to always practice safe sex practices. You may be asked to avoid intercourse or tampon use for some days after procedure. Your provider will educate on how to check for the IUD strings periodically. You will be scheduled for a follow-up visit in 4-6weeks to ensure you are doing well and not having any problems with the IUD.

 

Colposcopy 

Colposcopy is done when an abnormal pap smear result is obtained during routine screening. During a pap smear, cells obtained from the cervix are sent in a liquid solution to the lab for examination. If abnormal cells are present, they are given different gradations, some more serious than others. The human papilloma virus (HPV) is the major cause for cervical dysplasia and colposcopy is the first step to treating the condition. Once diagnosed with HPV and/or an abnormal pap smear, it is important to pursue additional testing as recommended by your provider.

Pre-procedure preparation

You do not have prepare in a special way for this procedure.

Procedure

During a colposcopy, a speculum is placed in the vagina to allow adequate visualization of the cervix. A solution that highlights areas with abnormal cells is then applied on to the cervix. While looking through a special microscope, called the colposcope, the cervix is examined thoroughly. If abnormal areas are seen, biopsies may be taken. You may experience mild pain during biopsies. A gentle scrape of the inside of the cervix, known as an endocervical curettage is also done in most cases. Tissue obtained is then sent to the lab for examination.

After care

Based on results of biopsies and/or endocervical curettage, you may need follow-up care every 6 months until 2 normal results are obtained. It is important to keep all follow-up appointments as scheduled.

 

LEEP

Loop electrosurgical excision procedure (LEEP) is a specialized procedure performed to treat cervical dysplasia. In this procedure, a small piece of the outer cervix is removed using a thin wire loop and electric current, effectively curing dysplasia. This procedure will be recommended if moderate to severe cervical dysplasia is diagnosed after colposcopy. While it can be done in the operating room of the hospital, we can also perform it in our office.

Pre-procedure preparation

You will receive detailed instructions prior to your procedure date. Generally, you need ensure you are not pregnant or use reliable contraception. You may be asked to take some medications for pain control at specific times prior to the procedure.

Procedure

After proper positioning, an insulated speculum is placed in vagina much like in pelvic exams. The cervix is cleaned and local anesthetic injected to create a paracervical block. You may feel a twinge or dull ache during injection but this step ensures that you do not feel pain during the procedure. The thin wire loop is then used to remove a small piece of the cervix. An endocervical curettage is performed. The cervix is cauterized and Monsel’s solution is applied to minimize bleeding. Tissue obtained is sent to the lab.

After care

Expect coffee-ground or mustard-colored discharge for several days after procedure due to cautery and monsel’s solution. Best to avoid intercourse until cleared by physician. Rarely do people develop infections after this procedure. Pathology results will be discussed with you once available. Usually, you will require close follow-up care with pap smears to ensure complete resolution of cervical dysplasia.

 

Hysteroscopy/Endometrial Ablation

Hysteroscopy is a procedure that allows visualization of the endometrial cavity using a small camera that is passed through the cervix. It is performed when abnormalities like polyps or fibroids are suspected. Endometrial ablation is done to burn the lining of the uterus to treat abnormal uterine bleeding in women who are premenopausal and have completed child bearing. An endometrial biopsy is often performed prior to endometrial ablation.

Pre-procedure care

You will receive detailed instructions prior to your procedure date. Generally, you need ensure you are not pregnant or use reliable contraception. You may be asked to abstain from intercourse and to take some medications for pain control at specific times prior to the procedure. For almost everyone, you will be prescribed cytotec which helps to soften the cervix.

Procedure

After proper positioning in stirrups, a sterile speculum is placed in the vagina. The cervix is cleaned thoroughly and injected with a local anesthetic to create a paracervical block. If necessary, the cervix may be dilated to allow placement of the hysteroscope but typically no dilation of the cervix required. The camera is then placed gently into the cervical canal and advanced into the uterus. The endometrial cavity is carefully examined, after which the camera is withdrawn. The ablation device is then assembled, placed into the uterus and ablation completed. The procedure typically takes a few minutes. All instruments are removed at completion of the procedure.

After care

Do not place anything in the vagina and abstain from intercourse for a few days. You may experience mild cramps, watery or brownish discharge for some days after procedure. Be sure to follow- up with physician as scheduled for all postoperative appointments.

 

Essure

Essure is a type of permanent sterilization. The procedure involves placement of coils into the fallopian tubes which cause scarring and permanent occlusion of the fallopian tubes. Procedure is considered permanent and not designed to be reversed. A dye test, hysterosalpingogram(HSG), is usually performed 3 months after the procedure to confirm bilateral and complete tubal occlusion. If you are unsure about permanent sterilization, please use an alternative form of contraception. There are several reversible long-acting and highly effective forms of contraception available such as IUDs or nexplanon.

Pre-procedure preparation

You will receive detailed instructions prior to your procedure date. Generally, you need ensure you are not pregnant or use reliable contraception. You may be asked to abstain from intercourse and to take some medications for pain control at specific times prior to the procedure. For almost everyone, you will be prescribed cytotec which helps to soften the cervix.

Procedure

After proper positioning in stirrups, a sterile speculum is placed in the vagina. The cervix is cleaned thoroughly and injected with a local anesthetic to create a paracervical block. If necessary, the cervix may be dilated to allow placement of the hysteroscope but typically no dilation of the cervix required. The camera is then placed gently into the cervical canal and advanced into the uterus. The endometrial cavity is carefully examined. After normal examination of the endometrial cavity is confirmed and both tubal ostia seen. The Essure device is assembled and under direct visualization, a coil is deployed into each fallopian tube. Procedure is complete and all instruments are removed. You may feel mild cramping during the procedure.

After care

You may experience mild cramps afterwards. Please take NSAIDs such as ibuprofen or naproxen as needed. Continue to use an alternative form of contraception until HSG confirms tubal occlusion.

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