What questions should be asked in a pre-operative assessment for a patient undergoing hysteroscopy?

Pre-Operative Assessment Questions for Hysteroscopy

A comprehensive pre-operative assessment for hysteroscopy should systematically address general health status, procedure-specific contraindications, anesthetic risk factors, and pregnancy status using inclusive, non-gendered language. 1, 2

Essential Medical History Questions

General Health Assessment

• Rate your overall health status (excellent/good/fair/poor) and whether there has been any recent change in your health 3
• Cardiovascular history: Ask specifically about heart attack, heart failure, unstable angina, recent myocardial infarction (within 30 days), stroke, high blood pressure, or significant arrhythmias, as these active cardiac conditions mandate postponing elective surgery 4
• Pulmonary conditions: Inquire about asthma, pneumonia, emphysema, or other chronic lung disease 3
• Metabolic disorders: Document diabetes mellitus, liver disease, hepatitis, or renal dysfunction 3
• Hematologic issues: Ask about bleeding disorders, anemia, or abnormal clotting history 3
• Neurologic history: Screen for seizure disorders 3
• History of rheumatic fever 3

Medication Review

• List all current medications including prescription drugs, over-the-counter medications, aspirin, oral contraceptives, and hormone therapy with specific dosages and frequency 3
• Document any hormone therapy (particularly relevant for transgender and gender-diverse patients, as this may affect drug metabolism and volume of distribution) 3

Allergy History

• Ask about allergies or sensitivities to medications, adhesive tape, latex, or other substances, with description of the reaction that occurred 3
• Previous anesthetic complications: Inquire whether the patient or close relatives have had problems with anesthesia or sedation 3

Procedure-Specific Contraindications

Absolute Contraindications to Proceeding

• Pregnancy status: Ask "Is there any chance you could be pregnant?" using non-gendered, factual language rather than assuming based on appearance 3
• Active genital tract infections: Screen for current pelvic inflammatory disease, cervicitis, or vaginitis 1, 2
• Active herpetic infection: Document any current genital herpes outbreak 1, 2

These three conditions are absolute contraindications and the procedure must be postponed if present. 1, 2

Gynecologic History

• Menstrual pattern: Document bleeding patterns, menorrhagia, or postmenopausal bleeding 3
• Previous uterine procedures: Ask about prior dilation and curettage, endometrial biopsy, hysteroscopy, or other intrauterine procedures 5
• Presence of intrauterine device (must be removed before hysteroscopy) 6
• History of uterine fibroids, polyps, or endometrial pathology 7
• Previous cesarean sections or uterine surgery (increases perforation risk) 6, 8

Inclusive Patient-Centered Questions

Gender Identity and Preferred Communication

• Ask about sex recorded at birth as a separate question from gender identity using a two-step approach 3
• Inquire about gender identity and document preferred name and pronouns in a private, sensitive environment 3
• For transgender or gender-diverse patients: Ask about current hormone therapy, previous gender-affirming surgical procedures, and whether they consent to this information being documented and shared with relevant medical personnel 3

Pregnancy Risk Assessment (Non-Gendered Approach)

• Use factual language about reproductive organs rather than gendered terms when assessing pregnancy risk 3
• Recognize that masculinizing hormone therapy does not provide adequate contraception, so some transgender or gender-diverse patients remain at risk of pregnancy 3
• Offer pregnancy testing to all patients with potential for pregnancy regardless of gender presentation, explaining that this is for safety rather than discrimination 3

Anesthetic Risk Stratification

ASA Classification Assessment

Document factors that determine American Society of Anesthesiologists physical status classification 3:

• Class I: No systemic disturbance beyond the localized pathology
• Class II: Mild to moderate systemic disturbance (mild diabetes, controlled hypertension, mild anemia)
• Class III: Severe systemic disturbance limiting activity
• Class IV: Life-threatening systemic disorders
• Class V: Moribund patient

Functional Capacity

• Assess ability to perform 4 METs of activity (climbing two flights of stairs, walking up a hill, running a short distance), as poor functional capacity with clinical risk factors warrants further cardiac evaluation 4

Pre-Operative Imaging and Laboratory Review

Required Documentation

• Review transvaginal ultrasound findings for uterine size, fibroid location, endometrial thickness, and cavity abnormalities 3, 7
• Confirm endometrial sampling results (Pipelle biopsy or dilation and curettage) to exclude malignancy 3, 5
• Document complete blood count to assess for anemia 3
• Review liver and renal function tests 3

Common Pitfalls to Avoid

Never use the phrase "cleared for surgery" as this oversimplifies the nuanced risk assessment and fails to communicate specific perioperative recommendations 4. Instead, document cardiovascular stability, optimal medical condition within the surgical context, and provide specific recommendations for medication changes, monitoring levels, or postoperative care 4.

Do not assume pregnancy risk based on gender presentation alone, as this leads to non-disclosure and safety concerns 3. Always use inclusive, non-gendered screening questions about pregnancy potential 3.

Avoid proceeding if active cardiac conditions are present (unstable angina, recent MI within 30 days, decompensated heart failure, significant arrhythmias, severe valvular disease), as these mandate postponement 4.

Post-Assessment Documentation

Essential Elements to Record

• Patient's preferred name and pronouns 3
• Specific perioperative recommendations for anesthesia team regarding monitoring, medication adjustments, or special considerations 4
• Arrangements for responsible adult escort home for day cases with written discharge instructions 3
• Clear documentation of informed consent including discussion of risks (hemorrhage, uterine perforation, cervical laceration, fluid overload) 1, 2, 6