| Abstract: |
The aim of this work is to compare between normal saline versus carbon dioxide as distension media in outpatient hysteroscopy in infertile patient.The study involved 100 infertile patients at the reproductive period, the age varied from 18 to 45 years, all patients complained from infertility either primary infertility 66% or secondary infertility 34%, patients were chosen from the infertility unit and inpatients department of Obstetrics and Gynecology, zagazig university hospital during the period from January 2004 to September 2004.The patients are divided into 2 groups:• First group ”52 patients” where normal saline was the distension medium.• Second group ”48 patients” where carbon dioxide was the distension medium.Although diagnostic hysteroscopy had its beginning in 1805, the use of carbon dioxide as a distension media in 1972 revolutionized the test, in the past 30 years ,hysteroscopy has underwent great improvement. Because of it high success rate (94.6%) and low morbidity rate (2.3%); hysteroscopy is used routinely to diagnose diverse uterine diseases.The success of diagnostic hysteroscopy is based on three fundamental criteria: the ability and experience of the operator, instrument quality, and the characteristics of the distension medium.The search for a ”gold standard” distension medium continuous the choice have been reduced to a gas(CO2), or a low molecular weight liquid, normal saline. One great advantage of normal saline is its low cost. Normal saline can be administered by gravity bag or automatic pump.It was found that hysteroscopy using normal saline as distension media in outpatient hysteroscopy in infertile patient offers all the advantage of CO2 as distension media. However its better accepted by the patient and offers the possibility of easily finding and treating in situ many of the lesions observed. Moreover, the safety, efficacy, and low cost make normal saline a good uterine distension medium for outpatient hysteroscopy in infertile patients. All these advantages are especially evident in infertile patients that could better benefit from the rapidity and minimal invasiveness of this approach.In conclusion, it was found that normal saline reduced procedure time and abdominal discomfort with significant reduction in both abdominal and shoulder tip pain in comparison with CO2. Thus normal saline should be considered the most appropriate distension medium in outpatient hysteroscopy.RecommendationsNo uterine distending media is best suited for all cases. Each option has its own advantages and drawbacks. As a result, the hysteroscopist should be aware of the advantages and potential problems of each distending medium and be comfortable with each as a method for uterine distention in panoramic hysteroscopy.ReferencesAhmed, N.; Falcone, T. and Tulandi, T. et al. (1991): Anaphylactic reaction because of intrauterine 32% dextran 70 instillation. Fertile Steril; 55: 1014-1016.
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