How is a pipel biopsy done? Pipelle endometrial biopsy - what is it? Diagnostic procedure in gynecology. How is the procedure performed?

Many gynecological pathologies require special types examinations. To prescribe adequate treatment, you need to have complete clinical picture diseases. For example, problems with the endometrium of the uterus require examination of its tissues, which can be taken for analysis by biopsy. Pipe endometrial biopsy is one of the most preferred methods of taking a biopsy (sample) of the inner uterine lining for further research. Such an analysis is considered informative and has a high level of reliability for establishing an accurate diagnosis.

The menstrual cycle, in accordance with its phases, consistently changes the state of the endometrium, and in the presence of deviations, the level of pathology present can only be detected when examining samples of the inner lining of the uterus under a microscope. Who is a biopsy indicated for? Analysis with a biopsy is prescribed in the following cases:

• presence of uterine bleeding of unknown etiology;
• development of hormone-dependent pathologies (uterine fibroids);
• if there is bloody discharge;
• finding out the reasons why conception is problematic;
• uterine bleeding during menopause;
• the need to take a scraping if uterine cancer is suspected;
• in the presence of complications after abortions and other gynecological interventions.

Contraindications to the procedure

An endometrial biopsy is not performed if:

• there is a suspicion of pregnancy;
• there is purulent discharge from the genital tract;
• in the presence of an identified inflammatory process in the pelvic organs;
• there is an infectious pathology;
• The woman was diagnosed with hemophilia, severe anemia.

The essence of the biopsy method

A biopsy, in essence, is a microsurgical intervention into the uterine cavity, its purpose is to obtain a scraping from inner surface uterus. The traditional method of taking a sample involves first dilating the cervical canal and then scraping out the endometrial tissue with a uterine curette, which is quite traumatic and painful. The aspiration method allows you to separate the scraping of the functional layer of the endometrium by introducing a special syringe with a vacuum action with an existing catheter at the end. It is considered a more gentle procedure, but is still accompanied by some pain. The traditional and aspiration methods require the woman to be given anesthesia.

What are the advantages of pipel biopsy?

Having heard the name of the research method from the doctor, many women ask the question: how necessary is pipell endometrial biopsy and what is it? Below you can watch a video detailing the procedure. This allows the woman to imagine how the manipulation itself goes and why there is no need to worry.

Diagnosis of endometrial pathology using the Peipel method is carried out using an innovative tool. Therefore, pipel endometrial biopsy is an improved aspiration technique.

What is pipel? This is the name given to a special elastic disposable tube that has the ability to bend in different directions and has a tiny piston. The advantage of the Pipel method is that, due to its high flexibility and very small diameter of the instrument (approximately 3 mm), no preliminary expansion of the cervical canal is required.

The technique of performing a pipel biopsy involves inserting an instrument into the uterus and “suctioning” endometrial cells. Using a piston, the required level of negative pressure is created in uterine cavity, and an aspirate of endometrial tissue is taken. This method does not lead to the formation of significant wound defects and does not injure the cervical canal. Thanks to this, the patient does not experience significant pain. The whole procedure takes just a few minutes. The results obtained during a pipel biopsy make it possible to most accurately confirm or exclude existing suspicions of a certain type of endometrial pathology.

Preparation for the procedure

How to prepare for a biopsy? Preparation for a pipel biopsy does not require any special effort. It is enough to avoid sexual intercourse 2-3 days before the procedure. It is advisable not to use hygienic tampons and vaginal suppositories, and also stop taking any medications that may affect the condition of the endometrium. All these issues need to be agreed upon with your gynecologist on the eve of the procedure.

What days are chosen to perform the manipulation? Is it important to consider what day of the cycle to do a biopsy? It depends on what goals the doctor pursues when prescribing this test:

• in case of anovulatory disorders and other abnormalities that can cause infertility, it is advisable to perform a biopsy before the onset of menstruation;
• in the absence of menstruation, a biopsy is done to obtain a streak scraping;
• in case of disorders when there is a delay in the detachment of the functional layer of the mucous membrane, the analysis is done on the 5th day of menstruation;
• when determining the reaction to hormonal treatment a biopsy is done between the 17th and 25th days of the cycle;
• acyclic bloody issues need diagnostics using the pipell method during their absence;
• if there is a suspicion of the presence of cancer inside the uterine cavity, then the diagnosis should be done without reference to the days of the cycle.

An endometrial biopsy before IVF is included in the scheme of systemic diagnostic measures to determine the state of the patient’s reproductive function.

How is a pipel biopsy performed?

The selection of biological materials from endometrial tissue is carried out by a gynecologist. Before the procedure, the patient must perform hygiene procedures to ensure that everything is clean. The gynecological chair is brought into a position convenient for the doctor, the patient’s vaginal vault is expanded and the cervix is ​​fixed motionless. The size of the uterus is measured to select the appropriate pipette instrument. The aspiration tube is very carefully inserted into the uterine cavity, but not all the way, so as not to damage the fundus of the organ.

Then the doctor uses the outer end of the device, like a probe, where there is a piston, to pull it outward, which creates a difference in pressure, and a small amount of biopsy material is taken inside the tube. At the end of the procedure, the instrument is removed from the uterine cavity, and the collected biomaterial is transferred to a special glass and sent to the laboratory.

How to track the dynamics of the endometrium during hormone therapy? In this case, the biopsy sample is taken 2-3 times, before the onset of menstruation and after the last menstruation, after which the results of the effectiveness of the prescribed treatment can be assessed.

Evaluation of results

Decoding the result can sometimes take up to 10 days and is carried out by a histologist or pathologist. If the result is necessary for a gynecologist to clarify the scope of surgical intervention, then a special note is made and such a sample is examined as a matter of priority.

What does the study show? In case of inflammatory pathology, the degree of fibrosis and other changes in the endometrial layer are identified in order to prescribe appropriate therapy. The detection of hyperplastic growths gives the doctor grounds to conduct further diagnostics in search of endocrine and hormonal abnormalities.

The presence of atypical cells or the endometrial condition determined to be precancerous raises the question of the need for surgical interventions.

Possible complications and other consequences of the procedure

Since the pipel endometrial biopsy procedure is a gentle technique, serious consequences and complications threatening the patient’s health are extremely rare. After the manipulation, the discharge quickly stops; patients hardly complain about uterine spasms, which happens after curettage.

If your period is slightly delayed after an endometrial biopsy, this is not considered a deviation from the norm. If they pass normally, without clots or a sharp unpleasant odor, it means that the doctors did everything correctly and all the rules of the procedure were followed. As a rule, menstruation after a gentle procedure of endometrial biopsy begins in accordance with the schedule.

Complications in the form of endometritis or other serious pathologies are very rare and are mainly caused by violation of the manipulation technique or neglect of the list of contraindications.

Price

How much does a pipel biopsy cost? Prices vary widely depending on the region, the level of the clinic, the qualifications of the staff, and the volume of material taken (single or multiple). On average, such a procedure will cost 4-5 thousand rubles. It should be noted that before you make a choice in favor of a particular clinic for this procedure, you need to find out reviews from patients who have already received service in this commercial institution and undergone the corresponding procedures.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

An endometrial biopsy is an operation in which the surgeon removes small sections of the lining of the uterus for pathohistological examination. The material is sent to the laboratory, and after microscopy the attending physician receives accurate information about the condition of the endometrium and its changes.

Histological examination of tissue fragments is an integral stage in the diagnosis of a wide variety of pathologies. In some cases, only microscopic analysis of tissue allows one to accurately determine the nature of the changes and their cause, which means that treatment prescribed taking into account the specific histological picture will be the most effective.

In gynecology, biopsy examination has been used very widely for many decades, during which tissue sampling techniques have been improved, which may differ depending on the diagnostic purpose. Each method has its own indications and contraindications, which the gynecologist takes into account based on the expected diagnosis.

If necessary, conventional microscopy can be supplemented with modern immunohistochemical techniques, which make it possible to detect malignant tumors and accurately differentiate their origin, determine the degree of differentiation and prognosis for the patient.

endometrial biopsy

Endometrial biopsy is an operation, albeit a minimally invasive one, so it requires careful preparation, assessment of possible risks, and a balanced approach to determining indications. Today, the operation is performed on a wide range of women due to its relative safety, ease of performance and the highest diagnostic value.

As a rule, biopsy sampling is performed routinely, as an independent study, but in some cases there may be a need for an urgent biopsy performed during surgery for pathology of the female genital organs. The main purpose of a biopsy is diagnostic, but sometimes it is also therapeutic, leading to an improvement in the patient’s well-being after removal of the pathological lesion.

Types of endometrial biopsy

The endometrium is the inner layer of the uterine body, its mucous membrane, which undergoes cyclic changes under the influence of female sex hormones. Its structure is different not only in different phases, but also on different days menstrual cycle. Pathology of the endocrine system, ovaries, and the uterus itself inevitably affects the structure of the mucous membrane, by the characteristics of which the doctor judges the nature of the pathology.

You can “extract” the endometrium only by penetrating the uterine cavity. In the first half of the last century, attempts to obtain a sample were accompanied by expansion of the cervical canal and curettage of the entire mucous membrane. Modern techniques biopsies mean they are minimally invasive and have low morbidity, as well as a low risk of complications, which makes it possible to expand the indications for the study. The clinic uses several types of endometrial biopsy surgery:

• Classic curettage of the mucous membrane;
• Aspirate biopsy with vacuum or aspirator;
• Pipe endometrial biopsy is one of the least traumatic methods;
• CG biopsy;
• Targeted biopsy during hysteroscopy allows you to obtain tissue from the most altered areas of the endometrium, but has limited use due to the high cost of hysteroscopy itself and the lack of equipment in many hospitals.

The operation of collecting endometrial fragments is only First stage diagnostic search, since without microscopy it is impossible to determine what structural changes occur in the uterine mucosa. The exact answer will be given by analyzing histological sections of the endometrium under a microscope.

Indications and contraindications for biopsy

Pathomorphological examination of the uterine mucosa is carried out for women of different ages regardless of whether they have given birth to children or not. The reason for the procedure may be:

1. Dysfunctional bleeding;
2. Intense uterine bleeding or scanty menstruation;
3. Amenorrhea (absence of menstruation) for an unknown reason (pregnancy must be excluded!);
4. Possible tumor growth;
5. Internal endometriosis;
6. Suspicion of a chronic inflammatory process in the uterine mucosa;
7. Infertility to clarify the cause;
8. Planning an IVF procedure;
9. Miscarriages, pathology of short term pregnancy (after medical abortion).

Contraindications to endometrial biopsy are:

• Pregnancy is an absolute contraindication to the study, since intervention in the uterus will provoke a miscarriage;
• Pathology of hemostasis due to the risk of bleeding;
• Treatment with anticoagulants and antiplatelet agents, anti-inflammatory drugs (require discontinuation in advance);
• Severe anemia;
• General infectious diseases (ARVI, intestinal infections, etc.);
• Acute or exacerbation of chronic genital tract infections;
• Allergy to anesthetics.

Since a biopsy is not performed for health reasons, in case of serious contraindications it can be abandoned in favor of other, safer diagnostic methods. If there are relative obstacles, the doctor will try to choose the most optimal method of tissue collection that eliminates complications.

Preparing for the study

Preparation for an endometrial biopsy includes general clinical tests (blood, urine), coagulation studies, determination of blood group and Rh factor, tests for HIV, hepatitis, and syphilis. During a gynecological examination, the doctor takes smears from the cervix for cytology and microflora from the vagina. If it is impossible to exclude pregnancy, a human chorionic gonadotropin test is performed.

After undergoing examinations and setting a date for the biopsy, the patient must abstain from sexual activity, douching, and vaginal tampons 2 days before the procedure, and stop taking blood thinners 7-10 days before. If curettage is planned under general anesthesia, then the day before from 6 pm, food and liquid intake is stopped.

In the morning on the day of the study, the patient takes a shower, removes hair from the external genital tract, if any varicose veins The doctor may prescribe elastic bandaging of leg veins to prevent thromboembolic complications.

Timing and technique of performing a biopsy

Since the endometrium clearly reflects hormonal effects, the information content of the analysis depends on what day of the cycle it was received. For different pathologies, the timing of the biopsy may differ. Thus, when diagnosing the causes of infertility, anovulation, and disorders of the second phase of the cycle, young women are recommended to undergo a biopsy the day before their expected period or on the first day of their onset.

In case of heavy menstruation, it is more advisable to carry out the operation from 5 to 10 days of the cycle. If the bleeding is not associated with menstruation, then a biopsy will be prescribed in the first 2 days from the moment of its occurrence. During one cycle, the procedure can be performed several times - in case of hormonal imbalance, for example.

In the second half of the cycle, from days 17 to 25, a biopsy is indicated to assess the effectiveness of conservative hormone therapy. If a malignant process is suspected, the study is carried out regardless of the day of the cycle and without delay.

The woman will be able to find out the result of the pathological examination 7-10 days after the operation, but if it is necessary to perform additional staining techniques, this period may increase. For detailed explanations, you should contact a gynecologist, who will either prescribe treatment for the pathology or refer you to an oncologist if a malignant neoplasm is detected.

The technique for collecting endometrium for microscopic examination differs depending on in different ways procedures. It may include the stage of expanding the cervical canal, after which sharp instruments are inserted into the organ cavity, cutting off areas or the entire mucosa. This route is the most traumatic, although it provides the largest amount of information, so it is preferred if cancer is suspected or diffuse hyperplasia diagnosed by ultrasound. In the second case, the procedure will become therapeutic.

A purely diagnostic biopsy is often performed using gentle methods that can be performed without dilating the cervical canal - the most painful stage of the entire operation, which improves the tolerability of the study by women and reduces the risk of complications.

Scraping

curettage

The most radical method of collecting endometrial tissue is curettage - a classic technique used for half a century. To penetrate into the organ cavity, it is necessary to expand the neck, for which special dilators are taken from the smallest to the maximum diameter, the neck is fixed with forceps, and then the surgeon removes the mucous membrane with a sharp curette. The method is traumatic and requires great care due to the risk of damage to the basal layer of the endometrium and the uterine wall.

Classic uterine curettage is quite painful and therefore requires anesthesia; general anesthesia - mask or intravenous - is considered optimal. Due to the need for anesthesia, the woman is advised to prepare similar to that for any other surgical intervention (examination, discontinuation of certain groups of drugs, refusal of food and water the evening before the operation).

Curettage of the uterine cavity is usually carried out in case of hyperplastic processes in the mucous membrane, non-developing pregnancy, prolonged and heavy bleeding, or suspected cancer. Removing the mucous membrane from all the walls of the organ and the area of ​​​​the tubal angles in some cases allows not only to make an accurate diagnosis, but also at the same time to remove the pathological process itself, that is, it is a therapeutic procedure.

Aspiration biopsy

Endometrial aspiration biopsy involves removing the mucosa using a vacuum. The method is not as traumatic as curettage, does not require expansion of the cervical canal, so the pain and risk of complications is much lower. In nulliparous patients, aspiration can cause subjective discomfort, so the surgeon may offer short-term general anesthesia to especially sensitive women.

When preparing for a study using vacuum aspiration, a woman should exclude sexual activity, douching and the use of tampons 3 days before the biopsy date, and an enema is indicated the day before to cleanse the intestines. Due to the risk of infection upon penetration into the uterine cavity, it is important at the preparation stage to exclude inflammatory and infectious processes in the genital tract.

Aspiration biopsy can be performed for any pathology in the uterus, and is also indicated for questionable ultrasound findings. Its disadvantage can be considered to be the smaller volume of aspirate compared to curettage, which can make diagnosing a malignant neoplasm difficult, so if cancer is suspected, it is better to do curettage.

Video: endometrial aspiration biopsy

Pipelle biopsy

pipel biopsy

Pipelle biopsy resembles aspiration, but has the advantage that tissue is collected using a thin tube, the diameter of which is about 3 mm. The method is low-traumatic, does not require cervical dilatation, and has virtually no complications.

Pipelle biopsy can be performed on an outpatient basis, in a antenatal clinic; you need to prepare for it in the same way as for aspiration. During the procedure, the doctor places a Pipel tip into the uterus and then pulls on a plunger, releasing a small piece of endometrium by creating negative pressure in the syringe.

Pipelle biopsy does not cause trauma to the mucous membrane, does not cause the formation of an open wound surface with the risk of infection, and is practically painless, therefore it is preferred for young patients who do not have children, with endometrial pathology, infertility, for tissue collection for immunohistochemical determination of hormone receptors.

CUG biopsy

A CUG biopsy is performed without dilating the cervical canal, using a special small curette, with which the surgeon scrapes off the narrow cavities of the mucous membrane, starting from the fundus to the internal os of the uterus. This type of biopsy is indicated mainly to determine the effectiveness of hormone therapy, the degree of endometrial maturation at the natural level of hormones in different phases of the cycle, so the study may include several procedures during one menstrual cycle.

CUG biopsy is considered a safe and low-traumatic procedure, since only small areas of the mucous membrane are removed in the form of “stripes”. The information content of the study is increased by collecting several strips of mucous membrane from different parts of the organ.

Evaluation of biopsy results

To adequately assess the condition of the endometrium, the pathologist must know, if possible, the exact day of the patient’s menstrual cycle, therefore, the date of the last menstruation is always indicated in the referral for examination. It is also important to indicate the woman’s age, the nature of the treatment being taken (especially if it is hormonal drugs), the expected diagnosis based on the results of ultrasound and other examination methods.

Deciphering the results of an endometrial biopsy can show the norm, and then the pathologist in conclusion will indicate the specific phase of the cycle and its stage corresponding to the day of the menstrual cycle. These parameters are determined based on the structure of the glands, characteristics of the vessels and endometrial stroma.

The pathology most often detected by biopsy is:

1. Hyperplastic processes - simple or complex non-atypical, as well as hyperplasia with atypia;
2. Endometrial polyps with or without epithelial atypia;
3. Malignant tumors;
4. Atrophic processes (in older women - a variant of the age norm);
5. Inflammation (acute or chronic).

Hyperplastic changes are more often diagnosed in patients whose age is approaching menopause, since during this period fluctuations in sex steroids occur, and many cycles are anovulatory in nature. Endometrial cancer occurs in both young and elderly women, and mucosal atrophy is a variant of the normal structure during the menopausal period.

One of key points assessing the morphological features of the endometrium is to identify or exclude cell atypia, which may indicate a high risk of malignant transformation. Atypia can be found in areas of overgrown endometrium with hyperplasia, in polyps.

About the presence of a dysplastic process and high risk cancer is indicated by increased cell division with an increase in their number, polymorphism of the nuclei and epithelial cells of the endometrial glands themselves, and the appearance of pathological mitoses. In cancer, cells acquire malignant features (polymorphism, hyperchromic nuclei, many abnormal mitoses), characterized by foci of necrosis (death), hemorrhages, altered tissue grows into the underlying structures and vessels, which serves as the basis for metastasis.

The main question that a morphologist examining a biopsy often has to answer is whether there is cancer or whether it can be completely excluded. If there is a tumor, then the degree of its differentiation is indicated (well-differentiated adenocarcinoma, for example).

A biopsy for infertility is carried out not only to compare the morphological picture with the day of the cycle, established by the date of the last menstruation, but also for an immunohistochemical search for receptors for sex hormones, which may give a chance to determine the genesis of infertility and choose a way to combat it.

Consequences of endometrial biopsy and possible complications

Regardless of which way the mucous membrane was taken, the procedure inevitably injures the tissue, so there will be bleeding in any case. Their intensity and duration are determined by the method of manipulation.

After curettage, the bleeding is most profuse, often painful, but it is still lighter than during normal menstruation, since the mucous membrane is almost completely removed. The discharge should not contain large clots or pus-like fragments, it should not emit an unpleasant odor, otherwise the woman should contact the doctor again to exclude postoperative inflammation. E If the temperature rises, you need to go to the gynecologist immediately.

The first menstruation after the biopsy comes on time or a little later, it can be more abundant or more scanty. Most often, a delay occurs after a pipel biopsy, but to rule out pregnancy you should still do a test and go to the doctor.

If a woman is planning a pregnancy, then she can count on it in the next cycle. The functional layer will have time to recover, the work of the ovaries is not disrupted, so the fertilized egg can be safely implanted in the uterus. However, experts advise abstaining from sexual intercourse until the discharge completely stops, and in the next cycle use barrier methods.

Further actions of the patient and the doctor will depend on the data of the morphological analysis. If cancer or atypical changes are diagnosed, a consultation with an oncologist is scheduled with the possibility of repeated surgical intervention, but this time radical. For inflammation, anti-inflammatory and antibiotic therapy is indicated; dishormonal processes may require the prescription of sex hormones.

Negative consequences after a biopsy are rare. Most often, patients complain of menstrual irregularities, painful menstruation, and discomfort during sexual intercourse. The most dangerous complication of the intervention is acute endometritis, which occurs with fever, abdominal pain, symptoms of intoxication, and foul-smelling pus-like discharge. This condition requires immediate treatment with repeated curettage of the uterine cavity.

In the presence of chronic inflammation in the genital tract, miscarriages or abortions for medical reasons, broad-spectrum antibiotics are prescribed before surgery to prevent endometritis.

To prevent complications, a woman should maintain sexual rest until the discharge stops, carefully perform genital hygiene, and refrain from visiting the pool, sauna and bathhouse, as well as home hot baths.

Endometrial biopsy is usually performed free of charge, in antenatal clinics or inpatient clinics, but paid diagnostics are also possible. On average, the price of the procedure is 3-5.5 thousand rubles, depending on the qualifications of the personnel, the conditions of stay, the method used and additional treatment.

If a histological examination of the uterine mucosa is prescribed, then it is impossible to refuse it without compelling reasons. The risk of complications if you follow your doctor's recommendations is minimal, but the amount of information that can be obtained from a biopsy is not comparable to any other non-invasive methods. Only an accurate diagnosis will help to truly prescribe effective treatment, get pregnant, normalize health or avoid the consequences of a malignant tumor.

In the field of gynecology, one of the most popular methods for identifying histological problems is endometrial biopsy. The technique is aimed at examining a piece of uterine tissue under a microscope.

Thanks to this, it is possible to accurately determine the presence of morphological changes in the mucosa. To date, developed certain types endometrial biopsies, which have different capabilities, purposes and contraindications.

Pipelle biopsy - what is it?

So, the diagnostic procedure involves taking a sample (during the patient’s lifetime) of mucosal tissue, so that chemical and histological studies can be subsequently carried out.

The event is an important component of minor surgical intervention, carried out as an independent intervention. But in severe cases, endometrial biopsy is performed intraoperatively, urgently.

This is a procedure performed solely for diagnosis and histology determination. Although, it rarely happens that an endometrial biopsy is a therapeutic procedure.

Before the event, there must be appropriate preparation; this directly determines whether the patient will feel painful and uncomfortable sensations during the process.

Types of diagnostic tests in gynecology

• Do not drink alcoholic beverages;
• Avoid physical overexertion;
• Do not take hot baths or warm procedures.

Before the biopsy, the patient is asked to administer an anesthetic (this is optional, optional).

It is imperative to refrain from using medications that can affect the endometrium. If one of the rules is violated, you should not be shy - you need to tell the doctor everything.

Contraindications for surgery

Despite the simplicity and ease of performing a biopsy, it is nevertheless a surgical intervention, and therefore has a number of contraindications:

• Development of inflammation;
• The presence of pathologies of the uterine cavity;
• Incoagulability of blood;
• Infectious venereal diseases.

Also, the doctor may prohibit the procedure due to personal, individual illnesses that will be determined in advance.

The event is quite simple, so no consequences or side effects are observed. However, in specific, individual situations, slight short-term bleeding may occur, appearing on the day the biopsy is taken. It is worth knowing that in this case no inpatient examination or observation is required, so the woman can immediately go home.

The advantage of the procedure is high level accuracy and information content, compared to the fact that the intervention from a biopsy is minimal. In practice, this event does not yet have negative reviews or the manifestation of any side effects or deterioration in health.

How is this procedure carried out?

The diagnostic event Pipelle biopsy is a modernized method of examining the endometrium and uterine cavity. The technique is based on the standard method of endometrial aspiration.

The procedure is carried out as follows:

Previously, when standard curettage was performed, when a small amount of a diagnostic sample was taken, almost the entire endometrium disappeared, and a large wound appeared on the membrane.

Important, that modern way diagnostics is quite possible for use in case of suspected formation of malignant or benign tumors in the uterine cavity or for metrorrhagia after a miscarriage.

The process of separating the endometrium for diagnosis and analysis is carried out by vacuum separation created in the uterine cavity.

If a more detailed examination and subsequent tests, laboratory tests are required, before performing a biopsy, the uterine cavity is sometimes irrigated with a special solution in order to subsequently perform washouts.

Professional experts recommend that before the procedure, as a preparation, ensure sexual rest and abstain from intimacy, do not do any douching, and do not use vaginal tampons for 2-3 days before the biopsy. To exclude STDs and all kinds of acute urogenital diseases, a qualified doctor must prescribe a preliminary examination.

After endometrial biopsy

Despite the fact that the procedure is minimally invasive and simple, it is nevertheless associated with a violation of the integrity of the mucous tissues of the uterine cavity. Therefore, it is not uncommon for slight bleeding that does not cause pain to appear during the first 24 hours after an event.

After a diagnostic curettage of Pipel, heavy, menstrual-like discharge may be observed for some time, accompanied by short-term pain in the lower abdomen.

It is worth immediately clarifying that the pain is not prolonged, and the rate of discharge after the procedure is much less than during the menstrual cycle and should not include blood clots, impurities of pus and any unpleasant putrefactive aroma. When any of the above symptoms appear, this is a signal to contact a specialized medical institution for advice.

Immediately after the study

When the diagnostic procedure is completed, the doctor recommends using a sanitary pad; discharge is possible. But, under no circumstances use tampons, they can irritate the mucous membrane, causing discomfort. Minor pain in the abdomen or lower back is considered normal; this fact is due to spasms in the uterus.

Important symptoms that you should be concerned about are the following characteristics:

• Heavy bleeding;
• Prolonged severe pain;
• Unpleasant odor of discharge;
• Increased body temperature.

If symptoms do not go away even after taking painkillers, you should immediately consult a doctor.

In order to prevent serious consequences and various complications, the following rules must be followed after a biopsy:

In addition, to prevent the development of infections and pathogens in the uterine cavity, it is recommended to take a course of antibiotics. If necessary, the leading doctor may prescribe hormonal medications.

The recovery period lasts no more than 3-4 days, depending on the individual characteristics of the woman’s body.

Periods after biopsy

When using the gentle Pipel biopsy method to diagnose possible pathologies of the uterus, menstruation may begin with a slight delay of 8-10 days. The meager volume and period of menstruation also differs somewhat from standard indicators. This is not a reason to worry, there is nothing wrong with it.

If the delay continues for more than 10 days, you should take a pregnancy test and then consult a specialist.

Planning to conceive a child is recommended only in the next menstrual cycle after the Pipel biopsy.

This is done so that the uterus rests and the mucous membrane undergoes a full course of restoration of functionality. It is worth knowing that the diagnostic procedure does not affect the functioning of the ovaries.

Considering that Peipel biopsy is a gentle method for diagnosing diseases female organs, the remaining endometrial layer is quite enough to undergo the IVF fertilization procedure in the next ovulation cycle.

Often, leading experts advise women not to resort to intimacy with their spouse during the period while spotting appears. In the subsequent menstrual cycle, it is recommended to use barrier method contraception.

Possible complications

Before the day for the procedure is set, specialists together with the patient will choose the most appropriate diagnostic method, based on the woman’s personal testimony, body characteristics, etc. Depending on this, preparation requirements and various risks after the event are regulated.

Despite the fact that bleeding and minor pain are possible after a pipel biopsy, you should not immediately say “No” to this event, because no other methodology will provide such an accurate histological analysis.

Possible complications:

How long should I wait for biopsy results?

As a standard, the diagnostic process and subsequent interpretation of the results takes at least 14 days. This should be performed exclusively by a pathologist or histologist. If the leading specialist has made an appropriate note in the referral for analysis, an additional immunohistochemical analysis is possible.

How long the results will be made depends on the capabilities of the laboratory and the experience of the specialist, as well as on the volume of research and additional analyzes performed.

Cost of the procedure

Another important aspect today is the cost of the manipulation. Most clinics have already included this procedure in their list of services.

The price will vary depending on the region, level of the clinic and other circumstances. In Moscow average price for this procedure is 3,000 rubles. In the regions, the price for Pipelle endometrial biopsy is lower.

When a Paypel endometrial biopsy is performed, the price includes payment for histological or cytological examination. On average it fluctuates from 4,000 to 5,000 rubles. So the final cost of the entire survey will be in the area 7,000-8,000 rubles.

When diseases of the uterus occur, some research methods (ultrasound, x-ray) may not be informative. In this case, a biopsy is performed. This is usually a painful procedure that does not require lengthy preparation, administration of anesthetics, or dilation of the cervix. Now there is a more gentle research method - Pipel endometrial biopsy.
Paypel is a thin plastic tube with a piston; it has a small hole at the end through which endometrial tissue is absorbed.

1. Female infertility - to identify the causes
2. Bleeding that occurs during hormonal therapy
3. Heavy uterine bleeding during menopause
4. suspicion of malignant neoplasms in the uterine cavity

Carrying out a Pipelle biopsy significantly increases the chances of successful implantation of the embryo during the IVF procedure.
Contraindications:
- Pregnancy
- Inflammatory processes in the body
- Poor blood clotting
- Infectious diseases genitals
Preparation for the procedure:
This procedure does not require special preparation. During the day before the procedure, the use of vaginal tampons and ointments is not recommended. If you have an increased pain threshold and to reduce discomfort during the procedure, an hour or two before the examination, take a painkiller tablet, for example “ ibuprofen ».
On what day of the cycle is this procedure performed?

To exclude chronic endometritis, an endometrial biopsy is necessary on days 9-13 of the menstrual cycle (with a 28-day cycle) - on these days, there are normally no inflammatory cells in the endometrium. To assess the secret transformation of the endometrium (its readiness for embryo implantation) - 21-23 days of the cycle; also on these days, endometrial hyperplasia can be excluded.

The procedure begins with an examination by a gynecologist. Then the external genitalia, vagina and cervix are treated with an antiseptic. Next, the doctor inserts a pipel tube into the uterine cavity and makes several movements with the piston; material is collected for research. The prepared material is placed in a special container with a liquid medium and sent to the laboratory.
Complications after the procedure:
Pipelle biopsy gives a very small percentage of complications (0.5%) compared to traditional material sampling. But there is still a risk of complications.
1. Damage to the walls of the uterus. The doctor must take into account the data from previous manipulations and also avoid rough manipulation of the instrument.
2. Minor damage to the affected areas of the uterus can cause bleeding.
3. Infection into the uterine cavity. To prevent this from happening, a vaginal smear is examined for microflora.

Pipelle endometrial biopsy is an informative and fairly safe procedure. You will get the result in the shortest possible time. Such a study allows us to identify pathologies such as endometritis, metritis, fibroids, polyps, various hormonal diseases, and so on. If deviations are identified and corrected in a timely manner, a woman gets rid of her problems quite quickly. In some cases, a pipell biopsy of the endometrium can reveal the cause of female infertility. After just a few correction cycles, such patients become pregnant on their own and safely give birth to children.

Good health and wellness!

Pipelle endometrial biopsy is the removal of a small fragment of the mucous membrane from the uterine cavity for subsequent analysis. The manipulation is carried out using a special catheter, a small flexible plastic tube with a diameter of about 3 mm. Compared to traditional aspiration biopsy, which is performed using a special syringe or vacuum instrument, the pipell procedure is more gentle, does not require anesthesia and takes 7-10 minutes.

Indications for use

Indications for the study are:

• bleeding during menopause;
• lack of menstruation (amenorrhea);
• scanty periods (dysmenorrhea);
• long, heavy periods;
• acyclic uterine bleeding;
• infertility;
• recurrent miscarriage;
• endometrial polyps;
• myoma;
• endometrial hyperplasia;
• endometrial tumors to determine their malignancy;
• suspected endometriosis;
• suspicion of an inflammatory disease of the uterine mucosa (endometritis);
• assessment of the effectiveness of hormonal treatment.

Contraindications for carrying out

Pipelle biopsy is not performed in the following conditions:

• pregnancy due to a high risk of miscarriage;
• pelvic inflammatory processes in acute form, as they can cause the spread of infection;
• pathologies of hemostasis;
• severe anemia.

Preparation for the procedure

During the last menstrual cycle before the biopsy, it is necessary to protect against pregnancy, as it is a contraindication to the study.

Since the research method is a surgical intervention, the following tests will be required:

On the eve of the procedure, it is necessary to maintain sexual rest, do not use suppositories, tampons, or douche. The doctor may recommend taking No-Shpa 40 minutes before the examination to relieve possible spasm of the uterine pharynx. The dosage of the medicine is selected individually. Immediately before the procedure, you must empty your bladder.

How the research is carried out

The doctor appoints a day for the procedure according to the indications. For example, to assess the condition of the endometrium and identify insufficiency of the second phase of the cycle, a biopsy is performed on days 21-23 from the start of the last menstruation, and to exclude chronic endometritis, it is necessary to carry out the procedure on days 9-13 of the cycle - during this period there are normally no inflammatory cells in the endometrium.

The procedure is performed on an outpatient basis and almost always without anesthesia. At the first stage, a gynecological examination is performed on a chair and the vagina and cervix are sanitized with special medicines, while the latter is fixed with bullet forceps.

The biopsy technique involves inserting a sterile disposable pipell instrument, which is a flexible plastic tube with a piston, like a syringe, into the uterine cavity through the vagina and cervix. When pulling the piston, negative pressure is created, as a result of which the catheter is suctioned to the wall of the uterus and endometrial particles are aspirated through the side hole in the tube. Tissue is collected from three different areas of the mucosa. The resulting material is placed in a formaldehyde solution and sent for histological examination.

After the procedure

After the biopsy, there may be bloody discharge, which should not contain clots, pus or an unpleasant odor. If these phenomena still appear, you should immediately consult a doctor. Normally, minor bleeding stops quickly, as it is a reaction to mechanical stress. Contractions of the uterus are also possible, but they disappear during the day or after taking antispasmodics.

During the recovery period, which lasts 2 weeks, you cannot:

• engage in sexual activity until the bleeding stops;
• take a bath, you should limit yourself to a shower;
• lift weights;
• visit the bathhouse and sauna;
• perform douching;
• use tampons.

Decoding the results

The results of an endometrial biopsy will be ready in 7-14 days, it all depends on the clinic where the research is carried out and the overall workload of the laboratory. The conclusion, which is issued after a histological examination of the biopsy, consists of 4 parts.

Information content of the sample:

• an uninformative, inadequate sample is determined by the fact that the obtained material does not contain a sufficient number of endometrial cells; blood cells, squamous stratified epithelium of the vagina, columnar epithelium of the cervical canal may be present;
• An informative, adequate sample is characterized by the fact that a sufficient number of mucosal cells are present in the biopsy specimen.

Macroscopic description of the biopsy:

• weight of submitted samples;
• size of fragments (large, small);
• color (from gray to bright red);
• consistency (loose, dense);
• blood clots, blood clots;
• slime.

Microscopic description of the biopsy:

• type of epithelium (cylindrical, cubic, flat, indifferent), its size, number of layers;
• stroma (its presence, density, homogeneity);
• size and shape of stromal cells;
• fibroplasticity of the stroma, that is, the number of connective fibers;
• decidu-like stroma, that is, accumulation of fluid and nutrients;
• uterine glands, their shape, description of the epithelium lining them;
• the shape and size of the lumen of the glands, the presence of secretions inside the glands, branching;
• lymphoid accumulations as signs of inflammation;
• chorion cells, the presence of edema or dystrophic changes in them, indicating that the woman had a frozen pregnancy or an incomplete spontaneous abortion.

Making a diagnosis after receiving the results

Often the conclusion contains only one phrase: “Normal endometrium in the proliferation/secretion/menstruation phase.” It means that the endometrium is normal, no signs of disease or changes in cell structure have been detected, there are no polyps or hyperplasia. It is important that the condition of the endometrium corresponds to the phase of a woman’s menstrual cycle and the period of her life.

The results of the study reveal:

After receiving the conclusion, you can contact your doctor to prescribe a therapy regimen or other treatment methods.

Possible complications

As after any surgical intervention, complications are possible after a pipel biopsy:

• prolonged bleeding;
• accession or activation of latent infection;
• long-term painful sensations;
• damage to the uterine wall.

The following symptoms indicate their development and the need to see a doctor:

• heavy bleeding (more than 3 pads in 2 hours);
• severe pain in the lower abdomen and lower back that does not subside after taking painkillers;
• bleeding for more than 5 days;
• discharge with an unpleasant odor;
• temperature rise above 37.5ºС.

Most dangerous complication biopsy is endometritis. It is characterized by abdominal pain and the appearance of foul-smelling uterine discharge with signs of suppuration. Its development is associated with hypothermia or non-compliance with the regimen after the procedure and the doctor’s recommendations.