Optimum uterine filling pressure for outpatient diagnostic hysteroscopy: a double-blind, randomized controlled trial

This study designed a double-blind, randomized controlled trial to assess whether adequate visibility can be achieved with lower uterine filling pressures using normal saline for diagnostic outpatient hysteroscopy and whether patient discomfort can be reduced. A total of 234 patients were randomized to 40 mmHg (77 patients), 70 mmHg (78 patients) or 100 mmHg (79 patients) of uterine filling pressures. The primary outcome measure was the proportion of procedures where adequate visibility was achieved during diagnostic outpatient hysteroscopy. The secondary outcome was the level of pain experienced by the patient as assessed using a visual analogue scale. There was adequate visibility in 87.0% of cases in 40 mmHg group, 94.9% in 70 mmHg group and 97.5% in 100 mmHg group. Visibility was lower with 40 mmHg compared with 70 and 100 mmHg (P < 0.05). The mean pain score in each group was not significantly different. In conclusion, this study showed that there was a higher trend towards inadequate visibility with lower filling pressures. Pressures of 70 and 100 mmHg may be equivalent to each other but not to a pressure level of 40 mmHg. Pain scores do not differ significantly with the pressure options used.