Use of carbon dioxide versus normal saline for diagnostic hysteroscopy

Abstract

Objective: To compare CO2 and normal saline as distention medium in diagnostic hysteroscopy.

Design: Prospective randomized study.

Setting: University-based artificial insemination and sterility center in Italy.

Patient(s): Seventy-four women who underwent hysteroscopy.

Intervention(s): Hysteroscopy was performed with CO2 or normal saline.

Main outcome measure(s): Quality of intrauterine images, cervical dilatation, local anesthesia, and duration of the test. In addition, each patient evaluated pain during and after the examination, irritation of the phrenic plexus, analgesic use, and side effects.

Result(s): The quality of the hysteroscopic image was statistically similar for both media. Dilatation of the cervical canal and use of local anesthesia was more often necessary in the CO2 group. The procedure time was 5.96 +/- 1.55 minutes in the CO2 group and 3.12 +/- 0.96 in the normal saline group. The CO2 group reported pain more frequently during and after the examination, shoulder pain, greater analgesic use, and more side effects.

Conclusion(s): For hysteroscopy, normal saline is technically equal to CO2 in terms of image quality and ease of use but offers more advantages. Hysteroscopy with normal saline is more acceptable to patients, quicker to perform, and entails fewer additional procedures.