Hysteroscopy: Managing fluid and gas distending media
- Linda D Bradley, MD
Linda D Bradley, MD
- Obstetrics and Gynecology
- Cleveland Clinic Lerner College of Medicine
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 .
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".)
CHARACTERISTICS OF DISTENDING MEDIA
Types of media, biochemical properties, adverse effects, and safety measures are summarized in the table (table 1).
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- CHARACTERISTICS OF DISTENDING MEDIA
- Ideal characteristics
- Fluid media
- - Electrolyte
- - Electrolyte-poor
- - Inflow and monitoring
- Gaseous media
- Effects on operative visualization
- COMPLICATIONS AND ADVERSE EFFECTS
- Fluid overload
- - Prevention of fluid overload
- - Diagnosis and management of fluid overload
- Gas embolism
- - Prevention of gas embolism
- - Diagnosis and management of gas embolism
- Shoulder pain
- CHOOSING A DISTENDING MEDIUM
- SUMMARY AND RECOMMENDATIONS