THE EFFECT OF PRESSURE ON FLUID ABSORPTION DURING ENDOMETRIAL ABLATION

Excessive absorption of the fluid used to distend the uterine cavity is a major complication of endometrial ablation. In a retrospective study of 197 women treated with endometrial laser ablation, careful control of the intrauterine pressure was shown to reduce the amount of fluid absorbed by 85% and to abolish evidence of hemodilution. A prospective randomized study demonstrated that fluid absorption occurred in an all or nothing manner when the pressure inside the cavity exceeded the mean arterial blood pressure. The critical pressure for fluid absorption and the pathways involved were demonstrated in serial pressure-controlled hysterosalpingogram radiographs taken immediately after endometrial ablation. It is concluded that careful control of intrauterine pressure, preferably in association with direct measurement of this pressure, is important in limiting absorption of fluid during endometrial ablation.