Complications in hysteroscopy: prevention, treatment and legal risk.

PURPOSE OF REVIEW: Fortunately, gynecologists are enthusiastically embracing diagnostic and operative hysteroscopy as a means to evaluate women with menstrual disorders, infertility, post-menopausal bleeding, recurrent pregnancy loss, and for ultrasound images. In general, operative hysteroscopy is a safe procedure, is easily learned, and has excellent surgical outcomes. As more obstetricians/gynecologists perform hysteroscopy, they must remain cognizant about the salient complications. The recognition of complications and prompt intervention will prevent adverse sequelae as well as minimizing undesirable patient outcomes and reducing legal risks.

RECENT FINDINGS: Hysteroscopy remains a relatively safe procedure. Diagnostic hysteroscopy has the fewest risks, followed by operative hysteroscopic adhesiolysis, metroplasty, and myomectomy. Fluid management is critical for intraoperative safety. Meticulous detail should be paid to fluid management, and consultation sought with a critical care specialist when fluid overload or hyponatremia is suspected. Lingering pain, fever, or pelvic discomfort after surgery requires prompt evaluation. Women becoming pregnant after operative hysteroscopic procedures need careful antepartum and intrapartum care. Special attention to unusual pain complaints during pregnancy or with fetal distress in labor need prompt intervention.

SUMMARY: The preoperative use of misoprostol or laminara decreases the risk of uterine perforation. Expert preoperative evaluation is essential in determining the surgical skill and expertise needed, surgical time, and the likelihood of completing the operative procedure. Overall, complications in operative hysteroscopy are infrequent and are usually easy to manage. This knowledge should help physicians perform more procedures.