Evaluation of Na and Hgb Changes Post Hysteroscopy and Communication with Duration of Surgery

Document Type : Original Article


1 Assistant Professor of Anesthesiology, Imam Khomeini Hospital, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran.

2 Assistant Professor of Obstetrics & Gynecology, Imam Khomeini Hospital, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran.

3 Resident of Anesthesiology, Imam Khomeini Hospital, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran.


Introduction: Hysteroscopy is used increasingly for assessment and treatment of uterine disorders. However, the application of new technology mandates the study of the related complications of the procedure .The aim of this study is evaluation of Na and Hgb changes due to hypotonic disturbance and bleeding following hysteroscopy and their correlation with duration of procedure.
Methods: This cross-sectional study enrolled 100 women in ASA 1 and ASA 2 class (American Society of Anesthesiologists) in the age range of 17-50 years old who were candidate of hysteroscopy in Imam Khomeini hospital of Ahwaz in a one year period.(from September2007 to September 2008) .Random sampling was done. After primary clinical evaluation that included serum Na and Hgb, patients were anesthetized by a classic method and hysteroscopy was done by a single expert surgeon. Glycin 1.5% was used for uterine dilatation. Serum Na soon after surgery and Hgb 4-6 hours after surgery were rechecked. Duration of surgery, vital signs and the presence of nausea and vomiting were recorded in recovery room. Then data were analyzed by Spss software (13 versions) and analyzed by t test and chi- square test. P value of 0.05 was considered significant.
Results: Abnormal uterine bleeding and infertility were the most common causes of admission of patients. No patient had allergy to glycin as uterine dilator. The mean serum sodium before surgery was 137. 48±7.2 meq/dl and it was 137±6.2 meq/dl (p>0.05) after operation. The average of Hgb before surgery was 11.007±1.2 gr/dl and mean Hgb was 10.97±1.1gr/dl after operation. There was no relationship between duration of the operation and change in the level of sodium and Hemoglobin. The procedure lasted 45±5.5 minutes on average. No nausea and vomiting was observed in the recovery room
Conclusion: Hysteroscopy doesn’t cause any problems due to the decreased serum sodium and hemoglobin concentration within 45 minutes of the procedure. It can be regarded as a safe and effective procedure in diagnosis and treatment of common uterine diseases especially uterine bleedings and symptomatic benign uterine diseases.


1. Jansen Fw, Vredevoogd CB, van Ulzen K, Hermans J, Trimbos JB, Trimbos­Kemper TC. Complications of
hysteroscopic: a prospective , multicenter study . Obstet Gynecol 2000 Aug; 96(2):266­270.
2. Cooper JM, Brady RM. Intraoperative  and  early postoperative  complications of operative  hysteroscopy. Obstet Gynecol Clin North Am 2000 Jun; 27(2) : 347­66 . 3. Morrison DM. Management of hysteroscopic surgery complications. AORN J 1999 Jan;69 (1):194­7,199­
4. Cooper JM, Brady RM. Late complications of operative hysteroscopy. Obstet Gynecol Clin North Am 2000 
Jun; 27 (2) : 367­74.
5. Hulka  JF, Peterson  HB, Phillips  JM, Surrey MW. Operative  hysteroscopy.American  Association  of
Gyncologic Laparoscopisists 1991 membership survey. J Reprod Med 1993 Aug;38(8):572­3.
6. Hines RL, Marschall KE.  Stoelting’s  anesthesia  and  co­existing disease. 5  th  ed.
7. Borten M, Seibert CP, Taymor ML. Recurrent anaphylactic reaction to intraperitoneal dextran 75 used for prevention of postsurgical adhesions. Obstet Gynecol 1983 Jun;61(6):755­7 . 8. Kim AH, Keltz MD,  Aric A, Rosenberg M, Olive  DL. Dilutional hyponatremia  during hysteroscopic  myomectomy with  sorbital­mannitol distention  medium. J  Am Assoc Gynecol Laparosc 1995  Feb 
2(2):237­42 .
9. Estes CM, Maye JP. Severe intraoperative hyponatremia in a patient scheduled for elective hysteroscopy: a  case report. AANAJ 2003 Jun;71(3):203­5 . 10. Pasini A, Belloni C. [Intraoperative complications of 697 consecutive operative hysteroscopies] [Article in 
Italian]. Minerr a Gynecol 2001 Feb;53(1):13­20.
11. Liu  MB, He YL, Zong LL, Yang F. [Clinical application of hysteroscopic electroresection of 775 cases]
[Article in Chinese]. Di Yi Jun Yi Da Xue Bao 2004 Apr;24(4):467­9.
12. Cooper BC, Murray CA. Syndrom of inappropriate  antidiuretic hormone  in  a  healthy woman  after diagnostic laparascopy and hysteroscopy: a case report. J Reprod Med  2006 Mar;51(3):199­201.
13. Istre O, Bjoennes J, Naess R, Hornbaek K, Forman A. Postoperative cerebral oedema after transcervical
endometrial resection and uterine irrigation with 15% glycin. Lancet 1994 Oct 29;344(8931):1186­9.
14. Schmitz MJ, Nahhas WA. Hyserocopy may transport malignment cells  into the  peritoneal cavity. Case 
report. Eur J Gynaecol Oncol 1994;15(2):121­4.
15. Loverro G, Nappi L, Vicino M, Carriero C, Vimercati A, Selvaggi L. Uterine cavity assessment in inferitile  women: comparison of transvaginal sonography and hysteroscopy. Eur J Obstet Gynclo Reprod Biol 2001 
Dec 10;100(1):67­71.
16. Gianninoto A, Morana  C, Campione  C. [Diagnostic hysteroscopy in  abnormal uterine  bleeding. Five­ years’ exprince] [Article in Italian]. Minerva Ginecol 2003 Feb;55(1):57­61.
17. Birinyi L, Kalamasz NZ, Major T, Borsos A, Bacsko G. [Evalution of results in transcervical hystroscopic  myoma resection]. Over Hetil 2002 Dec 8;143(49):2735­40. Hungarian. 18. Shushan  A, Revel A, Laufer N, Rojansky N. Hystroscopic treatment of intrauterine  lesions  in  premenopausal and postmenopausal women. J Am Assoc Gynecol Laparosc 2002 May;9(2):209­13.