title: The impact of altering filling pressures in diagnostic outpatient hysteroscopy on the procedure completion rates and associated pain: a randomised double-blind controlled trial.
abstract: BACKGROUND
  Several studies have compared different distension media and analgesics to optimise the efficiency of outpatient hysteroscopy. However, studies comparing different uterine filling pressures are scarce.
  
  
  OBJECTIVE
  The objective of this study was to evaluate and compare different uterine filling pressures during diagnostic outpatient hysteroscopy in an attempt to find the optimal pressure allowing adequate visualisation while minimising pain and increasing patient satisfaction.
  
  
  METHODS
  This was a double-blind randomised controlled trial. A total of 240 women who had diagnostic outpatient hysteroscopy were randomly divided into three equal groups: the uterine filling pressure was 30 mm Hg in group 1, 50 mm Hg in group 2 and 80 mm Hg in group 3. The primary outcome was adequate visualisation, and secondary outcomes were the proportion of completed procedures, pain perceived during the procedure, immediately after the procedure and 30 min later.
  
  
  RESULTS
  Adequate visualisation was lower in group 1 (88.7% vs 97.5% and 98.7%; P = 0.009), but was not different between groups 2 and 3 (P > 0.999). The proportion of completed procedures was not different among the groups. There was a progressive increase in pain scores from the lower to the higher pressure groups during the procedure, immediately after the procedure and 30 min after completing the procedure.
  
  
  CONCLUSIONS
  Uterine filling pressure of 50 mm Hg was associated with better visualisation than 30 mm Hg and lower pain scores than that of 80 mmHg with no difference in the proportion of completed procedures.
authors.affiliation: Faculty of Medicine, Cairo University, Cairo, Egypt.|Department of Obstetrics and Gynecology, University of Saarland, Homburg, Germany.
authors.forename: Hisham M
authors.initials: HM
authors.lastname: Haggag
authors.affiliation: Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: AbdelGany M A
authors.initials: AM
authors.lastname: Hassan
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods*; D057194:Intention to Treat Analysis; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011247:Pregnancy; D011312:Pressure / Q000009:adverse effects*; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage
chemical_list: D012965:Sodium Chloride
keywords: filling pressure; hysteroscopy; pain