- Uterine perforation: Immediate cessation of the procedure. Ultrasound examination to confirm the perforation. In mild cases, conservative monitoring may be sufficient; in cases of extensive injury or suspicion of injury to adjacent organs (e.g., bowel, bladder), immediate laparoscopy or laparotomy is necessary.
- Cervical tear (cervical laceration): A tear of the cervix, usually caused by the insertion of instruments with inadequate dilation. Immediate hemostasis by suturing the cervical laceration. In severe tears, electrosurgical coagulation may be necessary. In cases of heavily bleeding tears, tamponade may be required.
- Severe bleeding: Local hemostasis by applying hemostatic agents (e.g., adrenaline solution) or electrocoagulation. In cases of uncontrollable bleeding, tamponade may be applied, or in severe cases, an emergency hysterectomy may be necessary.
- Fluid overload (TUR syndrome): Occurs due to absorption of irrigation fluid, especially when using electrolyte-free solutions. Immediate cessation of fluid supply, monitoring of vital signs and electrolytes. Treatment of electrolyte disturbances and fluid overload (e.g., hyponatremia) with appropriate medications and diuretics.
- Instrument breakage: Immediate removal of the broken instrument part under visual control. If foreign bodies remain in the uterus, further hysteroscopy or laparoscopy may be necessary.
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Intraoperative Complications
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Postoperative complications
- Postoperative infections, such as endometritis or pelvic inflammatory disease (PID): Early administration of broad-spectrum antibiotics. If a more severe infection is suspected, hospitalization for intravenous antibiotic therapy may be necessary. In severe cases, drainage of abscesses or repeat curettage may be required.
- Postoperative bleeding: Monitoring of bleeding, possibly repeat curettage to remove remaining tissue or blood clots. If bleeding persists, the use of uterotonic drugs or tamponade may be necessary.
- Intrauterine adhesions (Asherman's syndrome): Formation of scar tissue in the uterine cavity, which can lead to menstrual disorders and fertility problems. If adhesions are suspected, a diagnostic hysteroscopy can be performed to release the adhesions. In severe cases, long-term hormone therapy (e.g., estrogens) may be used to promote endometrial regeneration.
- Uterine atony: Insufficient contraction of the uterus after the procedure, leading to persistent bleeding. Administration of uterotonic drugs (e.g., oxytocin, methylergometrine (market withdrawal)) to promote uterine contraction. In severe cases, intrauterine balloon compression or surgical intervention may be necessary.
- Pain: Administration of analgesics, depending on the severity of the pain (NSAIDs, opioids). In case of severe pain that may indicate a complication (e.g., hematometra, infection), a repeat medical examination is required.
- Hematometra: Accumulation of blood in the uterine cavity due to cervical occlusion after curettage. Immediate evacuation of the blood by dilating the cervical canal and possibly repeat curettage. The patient should be monitored for further signs to prevent recurrence.