O-32: Pain Experienced during Sonohysterography :Cervical to Uterine Catheter Placement

Background: The aim of this study is to evaluate whether the location of the balloon placement into either the cervical canal or uterine cavity during sonohysterography can affect the intensity of pain. Materials and Methods: A total of 300 infertile women undergoing sonohysterography were randomized to intracervical or intrauterine balloon placement. The examination was scheduled in the early follicular phase of menstrual cycle, before day 10. The primary outcome measures included the degrees of perceived pain after inflation and then after deflation of the balloon catheter. The secondary outcomes were duration of procedure and total volume of required saline for adequate visualization of endometrial cavity. Pain was quantified with 10-point visual analog scale. Results: One hundred and forty eight subjects were randomly assigned to intracervical balloon insertion and 152 to intrauterine placement. There were no significant differences in inflation and deflation pain and total procedure time between two groups. The total volume of required saline for adequate distention of cavity was significantly lower in cervical group than intrauterine group. The nulliparous women experienced significantly more pain after initial inflation of balloon compared to multiparous women (p= 0.04). Pain scores were not associated with patient’s age, volume of saline infused and presence of pathology. But pain scores were significantly correlated with total procedure time. Conclusion: Intracervical catheter placement does not reduce pain during or after SHG. But intracervical balloon insertion requires less significant volume of saline compared with intrauterine placement which reduces the risk of intrauterine infection and spread of malignant endometrial cells into the peritoneal cavity at the time of procedure