title: [Prevention of the complications related to hysteroscopy: guidelines for clinical practice].
abstract: OBJECTIVE
  To provide clinical practice guidelines (CPGs) from the French college of obstetrics and gynecology (CNGOF), based on the best evidence available, concerning the adverse events related to hysteroscopy.
  
  
  METHODS
  Review of literature using following Keywords: hysteroscopy; vaginoscopy; infection; perforation; intrauterine adhesions
  
  
  RESULTS
  Vaginoscopy should be the standard technique for outpatient hysteroscopy (grade A) using a miniature (≤ 3.5mm sheath) (grade A) rigid hysteroscope (grade C), using normal saline solution distension medium (grade C), without any anesthesia (conscious sedation should not be routinely used), without cervical preparation (grade B), without vaginal disinfection and without antibiotic prophylaxy (grade B). Misoprostol (grade A), vaginal estrogens (grade C), or GnRH agonist routine administration is not recommended before operative hysteroscopy. Before performing hysteroscopy, it is important to purge the air out of the system (grade A). The uterine cavity distention pressure should be maintained below the mean arterial pressure and below 120 mmHg. The maximum fluid deficit of 2000 mL is suggested when using normal saline solution and 1000 mL is suggested when using hypotonic solution. When uterine perforation is recognized during operative hysteroscopy using monopolar or bipolar loop, the procedure should be stopped and a laparoscopy should be performed in order to eliminate a bowel injury. Diagnostic or operative hysteroscopy is allowed when an endometrial cancer is suspected (grade B).
  
  
  CONCLUSIONS
  Implementation of this guideline should decrease the prevalence of complications related to office and operative hysteroscopy.
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France. Electronic address: xavier.deffieux@abc.aphp.fr.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.forename: T
authors.initials: T
authors.lastname: Gauthier
authors.forename: N
authors.initials: N
authors.lastname: Ménager
authors.forename: G
authors.initials: G
authors.lastname: Legendre
authors.forename: A
authors.initials: A
authors.lastname: Agostini
authors.forename: F
authors.initials: F
authors.lastname: Pierre
mesh_terms: D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000592:standards* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011258:Pregnancy Tests / Q000706:statistics & numerical data; D011364:Professional Practice / Q000592:standards; D014591:Uterine Diseases / Q000175:diagnosis / Q000453:epidemiology
keywords: Complication; Haemorrhage; Hysteroscopy; Hystéroscopie; Hémorragie; Infection; Intrauterine adhesions; Perforation; Synéchie; Vaginoscopie; Vaginoscopy