BSGE-ESGE guideline on management of fluid distension media in operative hysteroscopy
M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 3 – C O R E S U R G I C A L S K I L L S
BSGE/ESGE Guideline: Fluid Distension Media in Operative Hysteroscopy Umranikar S et al. BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy. TOG 2018;20:197–200. doi:10.1111/tog.12503
285 mOsm/l 1000 vs 2500 ml 750 vs 1500 ml NORMAL PLASMA OSMOLALITY FLUID OVERLOAD: HYPOTONIC VS ISOTONIC SUGGESTED UPPER DEFICIT LIMITS
DO N' T-M IS S FA C TS
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Fluid overload = deficit > 1000 ml (hypotonic) or > 2500 ml (isotonic); suggested action limits 750 ml / 1500 ml (GPP)
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Hypotonic overload → hyponatraemia + cerebral oedema; isotonic overload → pulmonary oedema/cardiac failure (no hyponatraemia)
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Glycine/sorbitol/dextrose = hypotonic, electrolyte-free → monopolar only; saline/Ringer’s = isotonic, electrolyte- containing → mechanical/bipolar only, not monopolar
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Symptomatic hyponatraemic hypervolaemia: 3% hypertonic saline in HDU/ICU, multidisciplinary team
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Measure fluid deficit at least every 10 minutes; use closed systems + reservoir drapes
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CO₂ gas must never be used for operative hysteroscopy distension
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Premenopausal women are more susceptible to electrolyte imbalance – consider GnRH agonist before myomectomy; consider intracervical vasopressin before dilatation
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Consider air/gas embolism if sudden O₂ desaturation or cardiovascular collapse during hysteroscopy
MEDIUM VS ENERGY SOURCE
Isotonic (saline/Ringer's/mannitol): mechanical, bipolar, laser Hypotonic (glycine/sorbitol/dextrose): monopolar only
ABBREVIATION KEY
BSGE — British Society for Gynaecological Endoscopy HDU — high dependency unit
ESGE — European Society for Gynaecological Endoscopy ICU — intensive care unit
GPP — good practice point CXR — chest X-ray
GnRH — gonadotrophin-releasing hormone
Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — 2018;20:197–200. doi:10.1111/tog.12503
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