Predictors of vasovagal symptoms or syncope during outpatient diagnostic hysteroscopy: A prospective observational study

Abstract

Objective

To analyze factors conditioning the apparition of vasovagal prodromic symptoms or vagal syncope during or immediately after a diagnostic hysteroscopy performed in an outpatient setting.

Study Design

Prospective observational study including 1255 patients who received an outpatient diagnostic hysteroscopy in the Hysteroscopy Unit of Quirón Dexeus University Hospital, Barcelona, Spain since April 2019 until December 2021. Data such as fasting, smoking, analgesic or anxiolytic treatment intake, parity and menopausal status were collected. Patients with pathologies or treatments that could modify pain tolerance were excluded.

Results

Mean age was 42.7 ± 9.03 years. An 84.3 % of patients were premenopausal, while 15.7 % were smokers and 59 % of them had smoked 30 min before the procedure. Thirty-three point three percent of patients were fasting and 56.5 % had taken analgesic or anxiolytic pre-medication. A total of 79 patients (6.3 %) developed symptoms of vasovagal reaction. Pain was reported as 7.56 ± 1.97 in the Visual Analogic Scale (VAS) in patients with vagal symptoms versus 4.95 ± 2.66 in patients without vagal symptoms (p < 0.001). In the multivariate logistic model only a higher VAS score and a previous history of vasovagal symptoms during medical procedures were associated to a higher probability of developing vagal symptoms after adjusted by covariates [Odds Ratio (OR): 1.67 (95 % confidence interval (CI):1.45;1.93), OR:3.44 (95 % CI: 2.04;5.79) respectively].

Conclusions

When performing an outpatient hysteroscopy, patients should be asked about their previous history of vagal symptoms during medical procedures. Painful procedures should be immediately stopped in order to prevent discomfort, avoid the apparition of vagal prodromes or syncope and improve satisfaction with the procedure.