Valeria Tagliaferri1, Luigi Ricciardi2, Raffaele Ricciardi3, Lauro R Pinto4, Antonio Lanzone5, Giovanni Scambia5, Maurizio Guido6. 1. Department of Obstetrics and Gynaecology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti (BA), Italy; Department of Obstetrics and Gynaecology, Fondazione policlinico universitario A. Gemelli IRCCS- Università Cattolica del Sacro Cuore, Largo "A. Gemelli" 8, 00168, Roma, Italy. Electronic address: tagliaferrivale@libero.it. 2. Department of Obstetrics and Gynaecology, Fondazione Giovanni Paolo II, Campobasso, Italy. 3. Department of Obstetrics and Gynaecology, Policlinico Abano Terme, Italy. 4. Department of Obstetrics and Gynaecology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti (BA), Italy. 5. Department of Obstetrics and Gynaecology, Fondazione policlinico universitario A. Gemelli IRCCS- Università Cattolica del Sacro Cuore, Largo "A. Gemelli" 8, 00168, Roma, Italy. 6. Department of Obstetrics and Gynaecology, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti (BA), Italy; Department of Obstetrics and Gynaecology, Fondazione policlinico universitario A. Gemelli IRCCS- Università Cattolica del Sacro Cuore, Largo "A. Gemelli" 8, 00168, Roma, Italy.
Abstract
OBJECTIVE: to compare carbon dioxide and saline solution distension in diagnostic hysteroscopies with regards to patient discomfort and procedural time and in accordance with the instrument diameter (5 mm vs 3.5 mm). The secondary outcome was to evaluate the role of the patient age and the obstetrical history on perception of pain and procedural time. STUDY DESIGN: This is a prospective multicenter randomized study including 1982 patients that underwent office diagnostic hysteroscopy in: Policlinico Abano Terme, Università Cattolica del Sacro Cuore in Rome and Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli" in Acquaviva delle Fonti. They were firstly randomized according to distension medium and secondly according to instrument diameter. Pain perception after the procedure was assessed by VAS (Visual Analogue Scale) score and procedural time was registered. Mann-Whitney U test was used to compare data. RESULTS:Lower pain score and procedural time were recorded with the employment of Carbon Dioxide (p < 001). Patient discomfort and procedural time were significantly influenced by the instrument diameter independent of the distension medium used, though in the subgroup where gas was employed VAS score after 1 min (VAS1) resulted lower compared to saline solution in both the traditional and mini-hysteroscopy procedures (p < 001). CONCLUSION:Carbon dioxide and saline solution are both suitable distension media for outpatient diagnostic hysteroscopy; nonetheless, carbon dioxide confers advantages in terms of pain perception and procedural time.
RCT Entities:
OBJECTIVE: to compare carbon dioxide and saline solution distension in diagnostic hysteroscopies with regards to patient discomfort and procedural time and in accordance with the instrument diameter (5 mm vs 3.5 mm). The secondary outcome was to evaluate the role of the patient age and the obstetrical history on perception of pain and procedural time. STUDY DESIGN: This is a prospective multicenter randomized study including 1982 patients that underwent office diagnostic hysteroscopy in: Policlinico Abano Terme, Università Cattolica del Sacro Cuore in Rome and Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli" in Acquaviva delle Fonti. They were firstly randomized according to distension medium and secondly according to instrument diameter. Pain perception after the procedure was assessed by VAS (Visual Analogue Scale) score and procedural time was registered. Mann-Whitney U test was used to compare data. RESULTS: Lower pain score and procedural time were recorded with the employment of Carbon Dioxide (p < 001). Patient discomfort and procedural time were significantly influenced by the instrument diameter independent of the distension medium used, though in the subgroup where gas was employed VAS score after 1 min (VAS1) resulted lower compared to saline solution in both the traditional and mini-hysteroscopy procedures (p < 001). CONCLUSION:Carbon dioxide and saline solution are both suitable distension media for outpatient diagnostic hysteroscopy; nonetheless, carbon dioxide confers advantages in terms of pain perception and procedural time.
Authors: Greg J. Marchand; Wesam Kurdi; Katelyn Sainz; Hiba Maarouf; Kelly Ware; Ahmed Taher Masoud; Alexa King; Stacy Ruther; Giovanna Brazil; Kaitlynne Cieminski; Nicolas Calteux; Hollie Ulibarri; Julia Parise; Amanda Arroyo; Diana Chen; Maria Pierson; Rasa Rafie; Mohammad Abrar Shareef Journal: J Turk Ger Gynecol Assoc Date: 2021-12-06