Operative hysteroscopy intravascular absorption syndrome is more than just the gynecological transurethral resection of the prostate syndrome: A case series and literature review

• Main Authors: Ming-Tse Wang (Author), Chuen-Chau Chang (Author), Ming-Hui Hsieh (Author), Ching-Wen Chang (Author), Yu-Hsuan Fan Chiang (Author), Hsiao-Chien Tsai (Author)
• Format: Book
• Published: Elsevier, 2020-09-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1028-4559; 10.1016/j.tjog.2020.07.022
• Keywords: Fluid overload; Gynecological TURP syndrome; OHIA syndrome; Operative hysteroscopy=> hysteroscopic surgery; Net irrigation & total irrigation amount=> therapeutic irrigations; Gynecology and obstetrics; RG1-991
• Source: Taiwanese Journal of Obstetrics & Gynecology, Vol 59, Iss 5, Pp 748-753 (2020)

Objective: Operative hysteroscopy intravascular absorption (OHIA) syndrome refers to fluid overload complications from operative hysteroscopies. Despite guidelines for safe operative hysteroscopies, instances of OHIA syndrome have been reported. Case report: We reported three cases of OHIA syndrome. A 48-year-old female patient presented net irrigation fluid of 11,900 mL and developed severe metabolic acidosis, conscious disturbance, acute pulmonary edema, and unexpected intensive care unit admission. A 49-year-old female patient presented net irrigation fluid of 4500 mL and developed desaturation and acute pulmonary edema. A 45-year-old female patient presented net irrigation fluid of 2400 mL and developed hyponatremia, increased hilum lung marking, and prolonged postanesthesia care unit observation. Conclusion: For safety, clinicians should use isotonic electrolyte-containing distension media and bipolar electrosurgical instruments in operative hysteroscopies, and fluid status should be monitored closely, particularly at net and total irrigation amounts >3000 and > 8000 mL, respectively. Intrauterine pressure should also be minimized to reduce intravascular and intraperitoneal absorption.