Does temperature of distending medium matter in outpatient hysteroscopy? A pilot case control observational study

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<span style="font-size: 10pt;">Background Anecdotally, outpatient hysteroscopy should be performed with saline distension medium at body temperature to prevent vasovagal episodes and potential cervical spasms. However, there only has been one study assessing the efficacy of room vsbody temperature warmed distention fluid. The aim of our study was to see if the temperature of the distending fluid affects the clarity of the view, ease of technique and patient discomfort during the procedure. Methods Patients attending two outpatient hysteroscopy clinics where both consultants use the vaginoscopic approach were allocated to receive saline distention medium at either room or body temperature. The data were collected prospectively and outcome data included patient acceptability, discomfort, and clarity of view were analysed. Results There were 16 patients in the room temperature (control) group (median 27.5oCelsius) and 10 patients received warmed saline (median 37.5oCelsius). Indications for hysteroscopy were similar in both groups and included PMB, irregular bleeding and lost coil threads. The median parity was statistically similar in both goups (2.7 vs 1.3; p=0.01) and good panoramic views were visualised in 100%. There were more polyps noted in the room temperature vs warmed groups (13% vs 10%; p=0.3) and the proportion of patients having taken pre-procedure oral analgesia were similar (20% vs 30%; p=0.23). The median discomfort (VAS) during the procedure was 6.8 in the room temperature vs 7.4 in the warmed saline group (p>0.05); similarly, there was no statistical difference in median discomfort 5 mins following procedure (VAS 4.6 vs 3.7; p>0.05). Proportion of women who would recommend the outpatient procedure to friends/relatives were similar in both groups (8.6/10 vs 8.5/10; p>0.05). 94% in the room temperature group found the water temperature about right while 100% in the warmed saline group found the temperature about right. Conclusions In this pilot study (we anticipate 75 patients in each arm eventually), we noted no statistical differences in patient discomfort or clarity of panaromic view, irrespective of whether the distension fluid was warmed to body temperature or not. [Conference Abstract]</span>