Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

Elegante, Marco; Hamera, Joseph; Xiao, Jane; Berger, David

doi:10.5811/cpcem.2019.4.41878

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…Each complication had similar symptoms, and we followed the same course of treatment as in the prior reports [ 44 , 45 ]. Our research outcomes were comparable to those of several other reports [ 44 , 46 , 47 ], where hysteroscopic perforation was the most common complication, as well as Indian research with a 2.7% complication rate. However, it was higher than the prior studies, ranging from 0.8 to 1.6% [ 48 – 51 ].…”

Section: Discussionsupporting

confidence: 90%

Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting

Siferih,

Gebre,

Hunduma

et al. 2024

BMC Women's Health

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Background Asherman syndrome is one of the endometrial factors that influence a woman’s reproductive capacity. However, in our context, it needs to be well-documented. This study aimed to evaluate the clinical characteristics and hysteroscopic treatment outcomes of Asherman syndrome. Method A retrospective follow-up study from January 1, 2019, to December 31, 2022, was conducted on cases of Asherman syndrome after hysteroscopic adhesiolysis at St.Paul’s Hospital in Addis Ababa, Ethiopia. Clinical data were collected via telephone survey and checklist. Epidata-4.2 and SPSS-26 were employed for data entry and analysis, respectively. Result A total of 177 study participants were included in the final analysis. The mean patient age was 31 years (range: 21–39) at the initial presentation, and 32.3 years (range: 22–40) during the phone interview. The majority of the patients (97.7%) had infertility, followed by menstrual abnormalities (73.5%). Among them, nearly half (47.5%) had severe, 38.4% had moderate, and 14.1% had mild Asherman syndrome. The review identified no factor for 51.4% of the participants. Endometrial tuberculosis affected 42 patients (23.7%). It was also the most frequent factor in both moderate and severe cases of Asherman syndrome. Only 14.7% of patients reported menstrual correction. Overall, 11% of women conceived. Nine patients miscarried, three delivered viable babies, and six were still pregnant. The overall rate of adhesion reformation was 36.2%. Four individuals had complications (3 uterine perforations and one fluid overload) making a complication rate of 2.3%. Conclusion Our study revealed that severe forms of Asherman syndrome, which are marked by amenorrhea and infertility, were more common, leading to incredibly low rates of conception and the resumption of regular menstruation, as well as high recurrence rates. A high index of suspicion for Asherman syndrome, quick and sensitive diagnostic testing, and the development of a special algorithm to identify endometrial tuberculosis are therefore essential. Future multi-centered studies should focus on adhesion preventive techniques.

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Section: Discussionsupporting

confidence: 90%

Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting

Siferih,

Gebre,

Hunduma

et al. 2024

BMC Women's Health

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“…The classic syndrome itself is rare (<%1 incidence); however, it can be life-threatening. [3,6,7] Commonly, the absorption of fluid distension media can cause unpredictable complications such as volume overload, dilutional hyponatremia, water intoxication, and cerebral edema. General anesthesia could mask early signs of hyponatremia and water intoxication such as bradycardia, hypertension, headache, nausea, and mental status change.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Edema Associated with Hyponatremia after Hysteroscopic Myomectomy

Uyar¹

2022

Lokman Hekim Health Sci

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The hypotonic fluid used for distention of the uterus during hysteroscopic myomectomy creates hyponatremia and hypervolemia with resulting cerebral edema. This situation is called operative hysteroscopy ıntravascular absorption syndrome. A 33-year-old woman was admitted for elective hysteroscopic myomectomy with general anesthesia. Sorbitol/mannitol solution was used as a distending solution for surgical hysteroscopy. The patient did not wake up after the operation and generalized seizures had been started. Hyponatremia was detected in her blood tests and started to be corrected rapidly with hypertonic saline. Brain edema was considered in her cranial magnetic resonance imaging. The patient was completely recovered after the treatment. This case is the case of brain edema caused by hyponatremia occurring after hysteroscopic surgery. It was presented with rarely reported symptoms such as seizures and psychosis, which resulted in a good prognosis. A case of acute cerebral edema progressing in this way has been rarely reported in the literature.

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“…Like the other hypotonic nonelectrolytic solutions, patients may present with electrolyte disturbances and hypervolemia. Hyponatremia is the most common electrolyte abnormality when using hypotonic solutions 45. Hyponatremia associated with hypo‐osmolality should be considered an emergency because of its high mortality rate 46.…”

Section: Distending Media For Hysteroscopymentioning

confidence: 99%

“…The systemic absorption of distending media occurs via intravasation and extravasation25,27 and is directly related to the surgeon's disruption of the integrity of venous sinuses in the deep endometrium and myometrium during operative hysteroscopy 3,20,27. The size and number of lesions removed, the depth of the resection, the number of myometrial sinuses exposed, and the intrauterine pressure all affect fluid absorption 25,27,45. When NS is suspended 60 cm above the uterus, the fluid will flow at a rate between 125 and 200 mL/min and will enter the uterine cavity with a pressure of 45 mm Hg.…”

Section: Perioperative Nursing Implications For Hysteroscopymentioning

confidence: 99%

Distending Media Used During Hysteroscopy: Perioperative Nursing Implications

Donan¹,

Pace²,

Ruiz³

et al. 2020

AORN Journal

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CPT, USA, have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article. The behavioral objectives for this program were created by Courtney Shay, MPH, BSN, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN, NPD-BC, director, Perioperative Education. Ms Shay and Ms Bakewell have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article. SPONSORSHIP OR COMMERCIAL SUPPORT No sponsorship or commercial support was received for this article. DISCLAIMER AORN recognizes these activities as CE for RNs. This recognition does not imply that AORN or the American Nurses Credentialing Center approves or endorses products mentioned in the activity.

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Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

Cited by 11 publications

References 14 publications

Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting

Review of Asherman syndrome and its hysteroscopic treatment outcomes: experience in a low-resource setting

Cerebral Edema Associated with Hyponatremia after Hysteroscopic Myomectomy

Distending Media Used During Hysteroscopy: Perioperative Nursing Implications

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