Hemorrhage risk during operative hysteroscopy.
BACKGROUND
To evaluate the risk of hemorrhage during hysteroscopic surgery.


METHODS
Cases of hemorrhage during hysteroscopic surgery were assessed in a single center, observational, prospective study conducted from 1990 to 2000, including 2116 surgical hysteroscopies. Risk of hemorrhage was evaluated according to the hysteroscopic procedure. The management of this complication was also noted.


RESULTS
Thirteen cases (0.61%) were reported. In six cases, hemorrhage stopped spontaneously. For six patients, a Foley (no. 10) probe was introduced into the uterine cavity and inflated for 24 h to stop hemorrhage. For one patient, immediately from the start of the procedure, the uterine arteries were ligatured through the vaginal route in order to stop bleeding. Haemorrhage risk was higher during hysteroscopic adhesiolysis compared with endometrial ablation (Relative risk [RR] 5.22 (1.26-21.64); p = 0.02), polyp [RR 5.3 (1.04-27.09); p = 0.04], and fibroid resections [RR 6.55 (1.58-27.17); p = 0.01]. Haemorrhage risk was however, comparable for endometrial ablation, uterus septa section, polyp, and fibroid resections (p = 0.92).


CONCLUSIONS
Hemorrhage risk is higher during synechiolysis compared with other procedures. An inflated Foley probe may be an efficient means of stopping hemorrhage.
Agostini
Aubert
A
Department of Obstetrics and Gynecology, La Conception Hospital, 147 Boulevard Baille, 13385 Marseille Cedex 05, France. AAGOSTINI@mail.ap-hm.fr
Cravello
Ludovic
L
Desbrière
Raoul
R
Maisonneuve
Anne Sophie
AS
Roger
Valérie
V
Blanc
Bernard
B
D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D015994:Incidence; D011446:Prospective Studies; D012307:Risk Factors; D014591:Uterine Diseases / Q000601:surgery; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000209:etiology*