hysteroscopic intraop complications

Question 1

what are possible intraop complications of hysterosocopy?

Answer 1

• volume overload with sequelae
• perforation
• hemorrhage
• gas embolization

Question 2

what risk factors associated with perf?

Answer 2

• postmenopause
• prior uterine/cervical surgery
• retroverted uterus
• cervical stenosis

Question 3

measures to reduce risk of uterine perf?

Answer 3

tricks of managing cervical stenosis:

• pretx with misprostol
• hsc hydrodistention/shears
• LEEP/cruciate incision
• avoid lacrimal duct probe- can create false tract

Question 4

signs of uterine perf?

Answer 4

• loss of resistance
• fluid deficit rapidly increasing
• visualization of intraperitoneal organs

Question 5

management with uterine perf?

Answer 5

• if fundal/no electrosurgery/suction - observe

- if lateral posterior or anterior low -> lsc

Question 6

how do you manage hemorrhage?

Answer 6

• electrosurgical electrodes for smaller vessles
• intracervical injection of dilute vasopressin
• 30 cc foley in uterine cavity

Question 7

assessment/management if volume overload?

Answer 7

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