Uterine Evacuation before Operative Hysteroscopy in Patients with Active Uterine Bleeding: A randomized controlled trial

Abstract

BackgroundConcurrent bleeding or existing clots usually obscure the vision field and decrease the success rate in hysteroscopy. Therefore, any effort to have a clear view during the hysteroscopy will meliorate the diagnostic or treatment outcomes. We examined the effect of preoperative clot evacuation on hysteroscopy and patient outcomes.MethodsIn this parallel-group trial, 114 patients with uterine bleeding were randomly assigned to receive either clot evacuation before standard operative hysteroscopy or standard hysteroscopy alone. The primary endpoints were the clarity of vision, amount of bleeding, the volume of consumed media, duration of the procedure, and postoperative complications.ResultsAll 114 participants completed the study. There were statistically significant differences in the frequency of the clear vision (p < 0.001), the severity of bleeding (p = 0.0006), mean procedure time (p < 0.001), mean serum volume used (p < 0.001), and the postoperative hematocrit levels [95% CI (-3.00, -1.88)] (p < 0.001) between groups. There was no difference related to in-hospital stay (p = 0.081) and anesthetic complications among the patients (p = 0.182). The procedure was successfully performed on all patients of both groups with zero postoperative complications.ConclusionRemoval of clots and other uterine contents before the insertion of the hysteroscope rendered better and faster access to the uterine wall to observe existing abnormalities. This method of starting the hysteroscopy procedure has a significant impact on surgical outcomes.Trial registration: Clinical trial registry name: Iranian Registry of Clinical TrialsUrl: https://en.irct.ir/trial/33369The registration number: IRCT20101130005283N13Date of registration: 2018-11-16