Endometrial biopsy (EMB) is a safe, efficient, and cost-effective means of evaluating the uterine endometrium. The procedure is usually associated with minimal discomfort and is easily accomplished in the outpatient setting. Midwives possess the educational background needed to make the decision of whether a biopsy is necessary; therefore, incorporating this procedure into the expanded scope of midwifery practice serves a useful purpose.
For patients being evaluated for endometrial cancer, timing within the menstrual cycle is not important (Apgar, Newkick, 1997). The optimal time to obtain an endometrial sample for confirmation of ovulation is on day 22-23. Timing of the procedure is critical when evaluating luteal phase defects commonly associated with infertility (Apgar, Newkick, 1997).
A thorough history must be obtained before performing an EMB by a physician. An appropriate gynecologic examination must be performed, and any necessary labs should be ordered. Ideally, the procedure is discussed at a visit that is separate from the day of the biopsy. Before performing the biopsy, the reason for the EMB, possible causes of the problem, side effects, and potential complications should be reviewed with the woman with the help of midwives.
If the client is not allergic to aspirin or ibuprofen, she may take 600 to 800 mg of ibuprofen or another nonnarcotic nonsteroidal anti-inflammatory drug about 30 to 60 minutes before the procedure to decrease her discomfort during the EMB. Midwives who perform paracervical blocks may offer it, although they are rarely necessary. If a tenaculum is required, topical benzocaine gel 20% may be applied to the tenaculum site to relieve any discomfort experienced when the cervix is grasped (Apgar, Newkick, 1997).
Before the biopsy, the women is placed in the lithotomy position and bimanual examination is performed to document the size, shape, and position for the uterus.........
