Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Hysteroscopy: Managing fluid and gas distending media

Linda D Bradley, MD
Section Editor
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG


Hysteroscopy is a procedure in which a telescope is used to inspect the cervical canal and uterine cavity. This technology has provided a minimally invasive option for diagnosis or treatment of women with common gynecologic issues, such as abnormal uterine bleeding or uterine fibroids.

Panoramic hysteroscopy is the most common method. A uterine distending medium is used to allow a global view of the endometrial cavity. Carbon dioxide and low viscosity fluids are the most frequently used distending media. Each medium has advantages and disadvantages, including specific safety concerns.

Contact hysteroscopy is another method, but it is rarely performed. Since no distending medium is used, only tissue in direct contact with the scope can be viewed [1].

Use of and prevention and management of complications from hysteroscopic distending media will be reviewed here. Other hysteroscopic topics are discussed in detail separately. (See "Overview of hysteroscopy".)


Types of media, biochemical properties, adverse effects, and safety measures are summarized in the table (table 1).

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 31, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Barbot J, Parent B, Dubuisson JB. Contact hysteroscopy: another method of endoscopic examination of the uterine cavity. Am J Obstet Gynecol 1980; 136:721.
  2. Siegler AM. A comparison of gas and liquid for hysteroscopy. J Reprod Med 1975; 15:73.
  3. McLucas B. Hyskon complications in hysteroscopic surgery. Obstet Gynecol Surv 1991; 46:196.
  4. Grove JJ, Shinaman RC, Drover DR. Noncardiogenic pulmonary edema and venous air embolus as complications of operative hysteroscopy. J Clin Anesth 2004; 16:48.
  5. American College of Obstetricians and Gynecologists. ACOG technology assessment in obstetrics and gynecology, number 4, August 2005: hysteroscopy. Obstet Gynecol 2005; 106:439.
  6. Loffer FD, Bradley LD, Brill AI, et al. Hysteroscopic fluid monitoring guidelines. The ad hoc committee on hysteroscopic training guidelines of the American Association of Gynecologic Laparoscopists. J Am Assoc Gynecol Laparosc 2000; 7:167.
  7. Nezhat CH, Fisher DT, Datta S. Investigation of often-reported ten percent hysteroscopy fluid overfill: is this accurate? J Minim Invasive Gynecol 2007; 14:489.
  8. Ananthanarayan C, Paek W, Rolbin SH, Dhanidina K. Hysteroscopy and anaesthesia. Can J Anaesth 1996; 43:56.
  9. Pellicano M, Guida M, Zullo F, et al. Carbon dioxide versus normal saline as a uterine distension medium for diagnostic vaginoscopic hysteroscopy in infertile patients: a prospective, randomized, multicenter study. Fertil Steril 2003; 79:418.
  10. Raimondo G, Raimondo D, D'Aniello G, et al. A randomized controlled study comparing carbon dioxide versus normal saline as distension media in diagnostic office hysteroscopy: is the distension with carbon dioxide a problem? Fertil Steril 2010; 94:2319.
  11. Gardner FM. Optical physics with emphasis on endoscopes. Clin Obstet Gynecol 1983; 26:213.
  12. Cooper NA, Smith P, Khan KS, Clark TJ. A systematic review of the effect of the distension medium on pain during outpatient hysteroscopy. Fertil Steril 2011; 95:264.
  13. Aydeniz B, Gruber IV, Schauf B, et al. A multicenter survey of complications associated with 21,676 operative hysteroscopies. Eur J Obstet Gynecol Reprod Biol 2002; 104:160.
  14. Jansen FW, Vredevoogd CB, van Ulzen K, et al. Complications of hysteroscopy: a prospective, multicenter study. Obstet Gynecol 2000; 96:266.
  15. Hahn RG. Fluid absorption in endoscopic surgery. Br J Anaesth 2006; 96:8.
  16. Olsson J, Berglund L, Hahn RG. Irrigating fluid absorption from the intact uterus. Br J Obstet Gynaecol 1996; 103:558.
  17. Paschopoulos M, Polyzos NP, Lavasidis LG, et al. Safety issues of hysteroscopic surgery. Ann N Y Acad Sci 2006; 1092:229.
  18. Corson SL, Brooks PG, Serden SP, et al. Effects of vasopressin administration during hysteroscopic surgery. J Reprod Med 1994; 39:419.
  19. Goldenberg M, Zolti M, Bider D, et al. The effect of intracervical vasopressin on the systemic absorption of glycine during hysteroscopic endometrial ablation. Obstet Gynecol 1996; 87:1025.
  20. Phillips DR, Nathanson HG, Milim SJ, et al. The effect of dilute vasopressin solution on blood loss during operative hysteroscopy: a randomized controlled trial. Obstet Gynecol 1996; 88:761.
  21. Taskin O, Buhur A, Birincioglu M, et al. Endometrial Na+, K+-ATPase pump function and vasopressin levels during hysteroscopic surgery in patients pretreated with GnRH agonist. J Am Assoc Gynecol Laparosc 1998; 5:119.
  22. Dyrbye BA, Overdijk LE, van Kesteren PJ, et al. Gas embolism during hysteroscopic surgery using bipolar or monopolar diathermia: a randomized controlled trial. Am J Obstet Gynecol 2012; 207:271.e1.
  23. Imasogie N, Crago R, Leyland NA, Chung F. Probable gas embolism during operative hysteroscopy caused by products of combustion. Can J Anaesth 2002; 49:1044.
  24. Leibowitz D, Benshalom N, Kaganov Y, et al. The incidence and haemodynamic significance of gas emboli during operative hysteroscopy: a prospective echocardiographic study. Eur J Echocardiogr 2010; 11:429.
  25. Groenman FA, Peters LW, Rademaker BM, Bakkum EA. Embolism of air and gas in hysteroscopic procedures: pathophysiology and implication for daily practice. J Minim Invasive Gynecol 2008; 15:241.
  26. Litta P, Bonora M, Pozzan C, et al. Carbon dioxide versus normal saline in outpatient hysteroscopy. Hum Reprod 2003; 18:2446.
  27. Nagele F, Bournas N, O'Connor H, et al. Comparison of carbon dioxide and normal saline for uterine distension in outpatient hysteroscopy. Fertil Steril 1996; 65:305.
  28. Brusco GF, Arena S, Angelini A. Use of carbon dioxide versus normal saline for diagnostic hysteroscopy. Fertil Steril 2003; 79:993.
  29. Shankar M, Davidson A, Taub N, Habiba M. Randomised comparison of distension media for outpatient hysteroscopy. BJOG 2004; 111:57.
  30. Paschopoulos M, Kaponis A, Makrydimas G, et al. Selecting distending medium for out-patient hysteroscopy. Does it really matter? Hum Reprod 2004; 19:2619.