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  • Title: Carbon dioxide hysteroscopy immediately after second trimester abortion.
    Author: van Lith DA, Beekhuizen W, van Schie KJ, van der Pas H, Lindemann HJ.
    Journal: Int J Gynaecol Obstet; 1983 Apr; 21(2):125-31. PubMed ID: 6136431.
    Abstract:
    The use of hysteroscopy has been restricted a.o. by the need for general anesthesia. This applies in particular to the pre- or post-partum period, because the hyperemic atonic uterus is easily over-inflated to a dangerous level. Over-inflation did not occur following 50 aspirotomy D & E procedures in the second trimester, using a para- and intracervical block with lidocaine 1% with adrenaline 1:200,000 only. The uterine cavity was always thoroughly evacuated in these cases in which final check suction had been performed. We recommend that postabortum hysteroscopy should be performed preferably under local anesthesia. 50 aspirotomy dilatation and evacuation (D and E) procedures in women whose durations of gestation varied from 14-18 menstrual weeks were followed by hysteroscopy in a test to determine whether the use of local anesthesia with uterotonic drugs could alleviate the problem of low intrauterine pressure caused by anesthesia-related uterine atony. Anesthesia was achieved by paracervical and intracervical block with lidocaine 1% with adrenaline 1:200,000, which provides a vasoconstrictive effect on the vessels of the lower uterine segment. Routine hysteroscopy was performed. The rate of flow of CO2 averaged 50-75 ml/min and never exceeded 75 ml/min. The average amount of CO2 used was 300 ml. Intrauterine pressure varied from 40-60 mmHg and the time required to complete the procedure ranged from 2-5 minutes. The major hysteroscopic observation was that the uterine cavity was almost always thoroughly evacuated. In 6 cases blood obscuring the hysteroscope lens seriously impaired visibility. 4 patients developed a cough shortly after the initiation of CO2 insufflation, probably due to CO2 microembolization. Although no incidence of serious morbidity or side effects occurred, further well documented studies are necessary to assess the safety of CO2 hysteroscopy after 2nd trimester abortion. It is however recommended that postabortion hysteroscopy be performed under local anesthesia to which adrenaline has been added.
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