Table 2.

Key-points for management of cervical stenosis

Step	Key-points
1	Identify patients at risk for cervical adhesions
2	Perform adequate patients’ counseling
3	Use the “vocal local” approach (Talk to the patient during the procedure)
4	Choose the adequate instrumentation. Favor miniaturized instruments when available
5	Apply pressure with the hysteroscopic grasper or intrauterine palpator in order to identify the opening of the ECO
6	Increase the pressure of the fluid distension medium
7	Ensure adequate pain management
8	When navigating the stenotic cervix, move back the hysteroscope to obtain a panoramic view of the cervical canal
9	Use of ultrasound guidance when available
10	Consider the use of an ultrasound-guided trocar-containing 18-gauge needle

ECO external cervical os