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Hysteroscopy of the uterus is a minimally invasive surgical technique that allows diagnostic and surgical interventions in the pelvic area to be carried out as accurately and informatively as possible. Despite the fact that this operation is considered one of the most gentle, and regardless of the purpose for which the intervention is planned, you need to know about a number of rules of behavior in the postoperative period and symptoms of possible complications.
A hysteroscope consists of a very thin tube with a camera inside. This tube is used to safely insert surgical instruments into the uterus. During the procedure, an enlarged image is transmitted directly from the uterus to a monitor. This is what allows diagnostic or surgical intervention to be carried out as clearly and safely as possible.
The characteristics of the postoperative period and the risks of complications depend on which procedure is performed. There are two types of procedures using a hysteroscope:
– examination of the uterine cavity, cervix and vaginal walls. This procedure is carried out on days 6-10 of the menstrual cycle on an outpatient basis. The procedure does not require anesthesia, and local anesthesia is also not usually used. Diagnostic hysteroscopy takes no more than half an hour and does not require subsequent hospitalization.
Indications:
Diagnostic hysteroscopy– the most informative method for studying postoperative and postpartum complications.
Operative hysteroscopy carried out for the purpose of correcting pathologies. Through the hysteroscope tube, the surgeon inserts into the uterine cavity the instruments that are necessary to remove the tumor, curettage the uterine cavity, or collect material for histological examination. The operation using a hysteroscope is performed in the gynecology department of the hospital under general (intravenous) anesthesia. The entire procedure, depending on the complexity, takes from 30 to 60 minutes. After its completion, during the postoperative period, the patient must stay within the hospital walls from two hours to several days to monitor her condition.
Operative hysteroscopy can be carried out immediately after diagnosis, in this case the patient is initially prepared for surgery.
Indications:
The period after diagnostic hysteroscopy of the uterus, despite the fact that the patient is quickly sent home, is characterized by some inconveniences:
Both pain and discharge during the postoperative period of hysteroscopy should not cause much discomfort, Most patients can lead a normal lifestyle and start working the very next day.
After the operation under general anesthesia, the woman will stay in the hospital for at least two hours. Further length of stay depends on the degree of surgical intervention and is determined by the attending physician.
Most often, the patient is discharged the next day after surgery.
May be observed in the period after surgery.
Discharge after cleaning the uterus through hysteroscopy, on the first day they are characterized as “spotting”, then within three to six days they can be yellow or “scratchy”.
All unpleasant sensations after surgery in the uterus disappear on average within 5-7 days. Any other symptoms: “breakthrough” bleeding, discharge of pus from the genital tract, severe pain and cramps that do not go away after taking medications, an unexpected increase in body temperature (after the first day after surgery and above 38 degrees) may indicate postoperative complications. It is necessary to consult a doctor as soon as possible.
Hysteroscopy of the uterus is one of the safest surgical methods of diagnosis and treatment, however, it is necessary to be aware of the possible risks of complications in the postoperative period. These include.
We must not forget that the operation may proceed differently for patients. The timing of the postoperative and recovery period, the risks of complications and the result of treatment depend on a huge number of factors (the reason for the intervention-diagnosis, the patient’s medical history, age, health status, etc.). However, it is not for nothing that hysteroscopy of the uterus is considered the “gold standard” for the treatment and diagnosis of many gynecological problems. Video camera control, the absence of incisions, a gentle method of insertion with an instrument with minimal expansion of the cervical canal and an experienced gynecologist - all this guarantees a better result and an easy postoperative period.
Inserts a tiny hysteroscope through the cervix and into the uterus. A hysteroscope allows the surgeon to visualize the inside of the uterine cavity on a video monitor. The uterine cavity is then checked for any abnormalities. The doctor examines the shape of the uterus, uterine tissue, and looks for any evidence of intrauterine pathology (fibroids, or polyps). The doctor also tries to visualize the openings in the fallopian tubes. The advantage of this method is that the recovery time is very fast. Almost all patients return home the same day after hysteroscopic surgery. There is no abdominal wound, so postoperative pain is minimal and there are no wound infections.
After general anesthesia (this procedure can also be done in a doctor's office with local anesthesia, but is usually limited to diagnostic purposes only), the hysteroscope is inserted into the uterus using a saline solution (NaCL) or a sugar solution (sorbitol) to stretch the uterus and provide visualization of the uterine cavity.
A local anesthetic cervical block is often performed first to provide local anesthesia. Once the examination of the uterine cavity is complete, several different instruments can be inserted through the hysteroscope to treat uterine fibroids, heavy menstrual bleeding (periods), and polyps.
Systemic health problems, especially cardiopulmonary problems, which may be aggravated by general anesthesia, may be a contraindication to hysteroscopy. Anesthesia consultation is recommended if there is any uncertainty regarding women's surgical status. Often this procedure can be performed without general anesthesia, but rather with regional anesthesia (epidural/spinal) or local anesthesia. The anesthesiologist will help you choose the safest method of anesthesia.
Many gynecologists will use a hysteroscope to examine the inside of the uterus and look for intrauterine abnormalities, such as fibroids or polyps, that may be causing abnormal or heavy menstrual bleeding. Cavity assessment is also performed for women who are having difficulty getting pregnant.
Other conditions suitable for hysteroscopy include:
Hysteroscopy can be used for:
A procedure called dilation and curettage was commonly used to examine the uterus and remove abnormal tumors, but hysteroscopy is now being performed.
Before the procedure, you need to tell the doctors about all the medications the patient is taking. Some may increase the risk of bleeding or interact with anesthesia. If the patient is taking medications such as Warfarin (Coumadin), Clopidogrel (Plavix), or Aspirin, it is important to talk to the doctor, as the doctor will definitely advise whether to stop taking these medications before the procedure. You may need to stop taking certain medications a week or more before your procedure. Before the procedure, anesthetic options can be discussed, including the risks, benefits, and alternatives to each.
On the day of the procedure:
Before hysteroscopy, you should undergo the following tests:
Hysteroscopy is usually performed in outpatient or day hospitals. This means that the patient does not have to stay in the hospital overnight. Hysteroscopy is routinely performed on days 7-9 of the cycle, and menstrual bleeding (periods) is a relative contraindication to the procedure
It may not be necessary to use an anesthetic for the procedure, although local anesthesia (where medications are used to numb the cervix) is sometimes used. General anesthesia (narcosis) may be used if the patient is scheduled for hysteroscopy for treatment during the procedure.
During hysteroscopy:
A hysteroscopy can take up to 30 minutes, although it may only last 5-10 minutes if it is only done to diagnose a condition, or investigate symptoms.
During the procedure, patients may experience some discomfort, similar to periods of cramping, while it is performed, but it should not be painful.
Most women feel able to return to their normal activities the next day, although some women return to work the same day.
During the recovery period:
Recovery tends to be very fast since there are no incisions. Most patients will require some pain medication in the immediate postoperative period, but an anti-inflammatory drug is often sufficient. Sexual intercourse should be postponed, as well as active sports for two weeks. It is advisable not to insert anything into the vagina for at least 2 weeks, including tampons. Most women can return to work within two weeks.
You should see a doctor if any of the following symptoms occur:
Hysteroscopy is generally very safe, but like any procedure there is a small risk of complications. The risk is higher in women who undergo treatment during hysteroscopy.
Some of the main risks associated with hysteroscopy are as follows:
Bleeding or infection can occur after any surgery. Sometimes the surgeon cannot complete the procedure safely due to excessive bleeding, fluid absorption, or the size of the fibroid. Complications common with hysteroscopy include uterine perforation and disproportionate fluid retention. The liquid is used to stretch the uterine cavity during hysteroscopy. Sometimes this fluid can be absorbed into the general circulation (lungs and brain). If excessive fluid absorption occurs, the procedure should be discontinued.
Emboli and death are rare but potential complications of any surgery.
Hysteroscopy will only be performed if the benefits are considered to outweigh the risks.
The uterus can also be examined using:
These alternatives can be performed alongside a hysteroscope, but do not provide as much information and cannot be used to treat problems in the same way as hysteroscopy.
Office hysteroscopy is one of the options for performing hysteroscopy, it is performed in the gynecologist’s office, which is where its name comes from, and differs from the classical one in that it is mainly a diagnostic procedure, rather than a surgical intervention.
Before IVF, hysteroscopy is a recommended procedure to ensure that the uterus is healthy and ready to bear a child. Failed IVF attempts are usually due to embryonic factors such as genetic problems or problems with the woman's uterus. In the past, many fertility clinics routinely performed hysteroscopy on women who had not had IVF cycles to look for abnormal uterine growths or scar tissue and remove them. There are other, non-invasive methods to evaluate the uterine cavity, including hysterosonography, where a small amount of salt water is injected into the uterus and an ultrasound is performed to evaluate the uterus. Hysteroscopy is usually performed in cases where the abnormality has already been identified during other studies.
Sometimes, when indicated, patients undergo laparoscopy and hysteroscopy at the same time; these two procedures are endoscopic and are performed with minimal intervention. Used to treat endometriosis, uterine polyps, and tubal obstruction. Laparoscopy is often performed simultaneously with hysteroscopy, especially in women undergoing infertility treatment. Endometrial ablation
Endometrial ablation is an outpatient surgery that can reduce or stop heavy uterine bleeding and is performed using hysteroscopy. During ablation, the endometrium is destroyed. The endometrium is destroyed using a gentle electrical current or heat. This process inhibits tissue growth. Endometrial removal may be an alternative to hysterectomy in patients with severe and irregular uterine bleeding. The gynecologist must first rule out any intrauterine pathology that may contribute to this bleeding. An endometrial biopsy is often done to make sure there is no cancer. Ablation is not recommended if: the uterine cavity is very large (more than 12 centimeters), endometrial cancer or hyperplasia (precancerous condition) is present, a submucosal polyp or fibrosis is detected, the patient has severe dysmenorrhea (menstrual cramps).
After ablation, bleeding should decrease. For some women, it may stop altogether. Even if the bleeding does not stop completely, it will likely be much easier. Rarely there is no improvement in bleeding after ablation.
Recommendations after hysteroscopy help you recover faster and return to your normal lifestyle. Recovery after a diagnostic procedure is conventionally divided into two stages. First, there is a primary restoration of tissues that have been damaged, in addition to this, the tissues of the uterus, mucous membranes, and the entire muscle layer are restored. At the first stage, healing of microdamages and incisions occurs. Treatment after hysteroscopy is prescribed by the doctor.
After the procedure, the cervical canal is restored. The first stage of recovery lasts about 20 days. As a result, the damage becomes less noticeable; Scarless tissue begins to form. The second stage of recovery after hysteroscopy of the uterus lasts longer: a renewed endometrium is formed (the mucous membrane of the uterus must have its own structure and its own biological functions). The second recovery stage lasts up to 5 months.
After this type of diagnosis, discharge in the form of blood may appear: they are usually observed on the 3rd day. The discharge occurs due to the fact that the mucous membrane of the uterus is damaged as a result of medical manipulations and the uterine solution is used for hysteroscopy. At first, the discharge is bloody, then it becomes yellow in color; Their approximate duration is two weeks. The discharge is due to the fact that during the procedure the uterine cavity expands. The liquid used during manipulation is able to penetrate into the vessels, thus their walls are damaged and the woman observes discharge.
If you notice excessive blood clots, be sure to seek help! As for the menstrual cycle, it all depends on the purposes of hysteroscopy. If it was carried out for diagnostic purposes, menstruation will occur without delay. There may be delays of several days: this is normal. If hysteroscopy is performed for diagnostic purposes, the endometrium is not damaged, so it does not require much recovery time. In the case of therapeutic hysteroscopy, everything is different. If curettage of the uterine cavity has occurred, menstruation will most likely be delayed. In this case, the menstrual cycle will begin the day after the operation: this means that menstruation should be expected in a month.
You should pay attention to the nature of the first menstruation after therapeutic hysteroscopy. Pay attention to the color and consistency of your periods. If you notice that your bleeding is increasing, be sure to consult your gynecologist. After hysteroscopy, pain often occurs. This is normal, but if it is intense, you should consult a gynecologist. In a normal state, a woman has pain in the lower abdomen along with the lower back. The duration of such pain is 3 days. They are explained by the fact that during manipulation the uterine cavity is stretched (it is affected by liquid or gas).
The pain is caused not only by this reason: the fact is that the tissue of the cervix is injured by medical instruments. If a woman has a low pain threshold, she will complain of severe pain. In this case, the doctor recommends a medicine with a powerful analgesic effect. If a woman feels unbearable cramping pain, her temperature may rise, and symptoms of intoxication may appear. If a woman feels that the pain is radiating to the perineum or legs, she needs to urgently call an ambulance, otherwise complications will arise. Be sure to follow your doctor's recommendations.
For the purpose of prevention, the doctor may prescribe anti-inflammatory drugs, including antibiotics. The course of treatment will be 7-8 days. Antibiotics are prescribed taking into account the patient's health condition. Body temperature must be monitored. You should not take aspirin: it is a painkiller. The medicine can thin the blood and increase blood discharge. It is important to know that ordinary aspirin can cause bleeding. During the rehabilitation period, you should not overload, both mentally and physically. Try to rest on time and don’t get nervous. If we talk about health-improving sports exercises, they can be done after 3 weeks.
What should you not do after hysteroscopy? You should stop using tampons and it is recommended to replace them with pads. It is prohibited to administer tablets intravaginally. All kinds of suppositories and douching creams are contraindicated. You need to eat rationally, not drink strong drinks, and especially alcohol. It is worth emptying your intestines on time, giving up all harmful foods: these include salty, spicy, pickled, fried, and too fatty foods. You need to take medications with the permission of a gynecologist: uncontrolled use is fraught with consequences.
Women are interested in: when pregnancy occurs after a diagnostic procedure. If a diagnostic hysteroscopy was performed and the doctor did not perform surgical intervention, for example, removal of polyps, you can begin conception in the next cycle. Some doctors are sure that there is no need to rush into pregnancy. It is necessary to pay attention to the features of the menstrual cycle, as well as to the frequency and regularity. Other gynecological diseases should also be taken into account. For a successful pregnancy, you need to lead a healthy lifestyle.
It is recommended to do moderate exercise for three months. It is necessary to be examined for the presence of sexually transmitted infections. Treatment is mandatory if chlamydia, papillomavirus and other unpleasant infections are detected. Pregnancy can be planned no earlier than 4 months after the medical procedure. If a woman is going to do IVF, she needs to undergo a long and very complex examination. It is important to know that IVF after hysteroscopy can end badly: a woman may have a miscarriage.
When undergoing an examination in order to prepare for in vitro fertilization, you may be faced with the need to conduct additional research. Hysteroscopy before IVF– this is one of the types of surgical diagnostics that allows you to increase the effectiveness of the protocol, provide additional information about the condition of the endometrium (presence/absence of polyps, nodes and neoplasms), tell the doctor the correct treatment tactics, etc.
In simple terms, this is an examination of the uterine cavity, its cervix and the mouths of the fallopian tubes using fiber-optic devices:
The last two devices have wider capabilities for surgical manipulations.
If pathological changes are identified that can be eliminated using the optical system used, this procedure is easily transformed from a diagnostic method to a surgical one - hysteroresectoscopy.
Based on this, hysteroscopy, as a method of examination and treatment, is divided into:
One of the advantages of hysteroscopy for IVF is the rapid transition from diagnosis to surgical treatment, allowing you to avoid strip operations.
The procedure is performed on a gynecological chair using drugs for intravenous anesthesia or epidural anesthesia (used less frequently). Duration – 20 minutes. Bypassing the vagina, a hysteroscope is inserted through the cervix. Depending on the model, a physiological saline solution or air is supplied into the uterine cavity under controlled pressure. This is necessary to expand the walls of the uterus from the inside and study the structure of the endometrium. The optical system displays the image on a screen monitor and allows you to enlarge the image to the size required by the doctor.
Using flexible scissors, an electrocoagulator, forceps enclosed in a metal tube of a hysteroresectoscope, a gynecologist surgeon can remove polyps, adhesions and tumors, collect tissue for biopsy, stop bleeding, and perform diagnostic curettage.
Is hysteroscopy required before IVF? Unfortunately, doctors are ambiguous on this issue. In some institutions this is a mandatory procedure, in others it is carried out taking into account the data obtained during research and is recommended based on anamnesis (medical history).
It is also impossible to say that some are right and others are wrong. By examining the inside of the uterus at the very beginning of preparation for IVF, you can diagnose and eliminate the cause of infertility, thereby preventing artificial insemination, preparing the endometrium for implantation (remove polyps, adhesions, fibrous cords, and nodes that almost always interfere). There are cases in which the elimination of endometrial “troubles” led to the onset of natural pregnancy.
On the other hand, if there are no problems with the endometrium, why put each patient under anesthesia and conduct a paid study?
The operation does not require special preparation. The main recommendation is not to eat food before the procedure. You must first undergo tests that may reveal contraindications to the procedure, and a gynecological examination.
Tests without which hysteroscopy will not be taken:
These same studies are included in the mandatory list before artificial insemination. If the results are satisfactory, there is no need to retake them a second time. If diseases are detected, therapy is prescribed, after which repeated laboratory control is performed.
Contraindications to hysteroscopy:
Hysteroscopy before IVF clearly increases the effectiveness of the procedure. The deviations found are taken into account in the protocol scheme, the mini-operation allows you to prepare the endometrium for embryo transfer in subsequent cycles, eliminating the need for abdominal operations.
Endoscopic research methods are one of the most developing areas of diagnostic medicine, allowing not only to visually assess the condition of the organ being examined, but also to perform various surgical procedures with minimal damage to the body.
Hysteroscopy, as one of the types of minimally invasive intervention, has significantly expanded the possibilities for diagnosing intrauterine pathologies, the detection of which using other diagnostic methods was quite difficult. Due to the fact that any endoscopic manipulation for the purpose of research or treatment is often accompanied by minor tissue damage, the consequences of hysteroscopy also depend on the purpose of the intervention and the volume of surgical procedures performed.
Hysteroscopy is a method of visual examination of the uterine cavity, carried out through the natural genital tract using a hysteroscope. The hysteroscope is a multifunctional optical device, the design of which includes a channel for inserting surgical instruments, which makes it possible not only to identify existing pathologies, but also to perform various surgical procedures:
Diagnostic and operational hysteroscopes differ in the thickness of the working part
Depending on the purpose of the procedure, one of the stages of hysteroscopy is to increase the patency of the cervix through the gradual introduction of Hegar dilators into the cervical canal. In this case, purely diagnostic manipulations can be carried out without preliminary dilation of the cervix with a hysteroscope having a thickness of no more than 3 mm. The use of a hysteroscope, which has an operating canal in its structure for inserting surgical instruments, requires significant dilatation of the cervical canal (up to 9-10 mm).
Depending on the type of equipment used, surgery can be performed in the following ways:
Carrying out diagnostic hysteroscopy
Due to the fact that hysteroscopy, despite its relative safety, is a surgical intervention, after it is performed certain consequences may arise that can cause some discomfort to the patient. However, it is necessary to distinguish between consequences that are a normal reaction of the body to medical actions (artificial dilation of the cervix, curettage, etc.) and complications caused by incorrect actions of the doctor, characteristics of the body, or the patient’s failure to comply with postoperative recommendations.
Pain after the procedure is a completely natural reaction to surgical procedures. As a rule, the pain is spasmodic in nature and is a consequence of increased contractile activity of the muscular layer of the uterus and forced expansion of the cervical canal. Complaints of aching pain in the lumbar region are also common.
The intensity and duration of pain depends on the pain threshold of the individual patient and the goals of hysteroscopy. If hysteroscopy was performed solely for diagnostic purposes, then recovery takes no more than 4-6 hours, and even minor surgical procedures can cause longer-term pain, which can be successfully relieved with anesthetics.
Important! Regardless of the nature of the hysteroscopy performed, pain should not last more than 7 days (optimally 2-3 days).
Intramuscular injection of baralgin will help eliminate pain
Slight spotting is normal even after diagnostic hysteroscopy. There should be no heavy discharge even after resection of polypous formations. The appearance of ichor after hysteroscopy, and then mucous discharge, may indicate minor damage to the mucous surface of the cervix or be a consequence of surgical actions to remove tumors or take a tissue sample for a biopsy.
If diagnostic curettage was performed for medical reasons, then the amount of blood after the procedure, as well as the duration of bleeding, should not differ significantly from menstruation and will end within the appropriate time frame, that is, after 4-7 days.
The temperature after hysteroscopy should not exceed the threshold of 37º-37.2º. As a rule, a similar reaction of the body to intervention occurs in a fairly large percentage of women and differs from the temperature associated with complications in that it occurs on the same day and repeats in the evening for 2-3 days. Temperature caused by inflammatory processes or other complications is characterized by exceeding a threshold of 37.2º, is not related to the time of day and usually occurs 2-3 days after hysteroscopy.
Despite the relative safety of the procedure, the possibility of complications cannot be excluded, the conditional classification of which divides them into two types:
Surgical complications include all complications associated with incorrect performance of the procedure due to the unprofessionalism of the doctor or the characteristics of the patient’s body. The list of pathologies resulting from hysteroscopy includes:
Important! The use of electro- or laser resection with coagulation reduces the risk of bleeding to a minimum, due to the ability to “solder” the vascular bed immediately after tissue excision.
All complications of a surgical nature are prevented by careful compliance with all norms and rules for performing the operation.
Postoperative complications of a physiological nature are divided into the following types. Early - inflammatory processes (endometritis, parametritis, adnexitis). Late - deformation of the uterine wall due to the removal of large fibroids, recurrent growth of previously removed tumors and endometriosis. The removed endometrium after surgery can enter the abdominal cavity due to perforation of the uterine wall or through the fallopian tubes.
If the polyp grows again after removal, this may indicate either incomplete removal during surgery or hormonal disorders in the woman’s body. In this case, hormonal drugs are prescribed as treatment. A characteristic feature of the endometrium is its ability to take root on nearby organs, forming endometriosis cysts in the process of growth.
The recovery period depends entirely on the severity of the intervention and ends during the period of growth of the new endometrium, indicating the beginning of a new menstrual cycle. The most common question asked after hysteroscopy is “How many days until menstruation?” If the procedure was diagnostic in nature, regeneration of damaged tissue does not take much time, so the start of the next cycle should occur at the right time.
If the purpose of hysteroscopy was to restore the functional abilities of the uterus and the treatment procedure was performed within the generally accepted time frame (5-11 days from the start of the cycle), then a delay in menstruation may occur. If during hysteroscopy the uterine cavity was curetted, then the first day of the cycle should be considered the day following the day of the operation.
An integral part of treatment after hysteroscopy is taking antibiotics and broad-spectrum antibacterial drugs
Compliance with the recommendations in the postoperative period after hysteroscopy is of great importance for the speedy recovery of the body. The list of recommendations includes what you can and cannot do after the procedure:
Important! Restrictions are also placed on the use of intravaginal tampons, which not only prevent the normal outflow of blood and mucus, but also do not allow assessing the quality of the discharge (appearance, smell), which may cause untimely consultation with a doctor in case of complications.
It is advisable to use Terzhinan antibacterial suppositories 1-2 days before the procedure in order to reduce the risk of infection
How long after hysteroscopy can you plan a pregnancy? If the procedure was carried out for diagnostic purposes, then it is highly likely that you can become pregnant as early as next month. However, if even minor surgical procedures have been performed, the body requires much more time to recover.
When planning a pregnancy, you should consider the following facts:
If the results are positive, pregnancy may occur within 3 months. However, the optimal period for completely restoring the reproductive functions of the body after hysteroscopy is considered to be 6 months.
The necessity before undergoing IVF is controversial. Due to the fact that the IVF procedure is quite complex in terms of collecting material and preparing the patient, the risk of miscarriage due to possible injuries from the previous diagnostic procedure is quite high. However, given the fact that women who have unsuccessfully tried to get pregnant for quite a long time resort to IVF, undergoing hysteroscopy will identify and eliminate any structural deformations of the uterus (adhesions, septa) that prevent the implantation of the fertilized egg into the endometrium and its subsequent development.
According to statistics, a much larger percentage of women who have not undergone hysteroscopy (12%) have experienced unsuccessful IVF, while women who underwent surgical treatment of intrauterine pathologies using hysteroscopy and underwent IVF have only 5% of failures.
Carrying out hysteroscopy before IVF will help create ideal conditions for the birth of a future life
In all cases, after a certain period of time, it is necessary to do an ultrasound and undergo a full examination to minimize the risk of premature termination of pregnancy.
It is impossible to guarantee a positive outcome of the IVF procedure with 100% certainty, but if after hysteroscopy a woman’s chances of giving birth to her own child increase significantly, this chance has a right to exist.
Hystroscopy today is the most informative method for identifying intrauterine pathologies, the average cost of which ranges from 3,000 to 60,000 rubles, depending on the equipment used, the purpose of the procedure and the prestige of the clinic. Following the recommendations after hysteroscopy will help to avoid the development of complications, minimize the consequences and restore health in a short time.
