Hypervolemic pulmonary edema and severe coagulopathy after intrauterine dextran instillation

A healthy young woman with recurrent spontaneous abortion and septate uterus underwent hysteroscopic metroplasty with intracavitary instillation of 1350 mL of 10% dextran 40 in normal saline. After the operation, the patient developed acute hypervolemic pulmonary edema and severe coagulopathy due to temporary impairment of platelet function. Fluid overload, which could have been caused by the hyperosmolar properties of dextran, worsened progressively as fluids were drawn from the interstitial space and urine output was reduced. The use of a dilute and/or low-molecular-weight dextran solution to distend the uterine cavity during operative hysteroscopy is not without risk of complications.