Uterine perforation — Uterine perforation is the most common complication of hysteroscopy. A uterine perforation can occur during mechanical cervical dilation or insertion of the hysteroscope. Such a perforation may be recognized when an instrument passes beyond depth of the uterine fundus, when there is sudden loss of visualization, when bowel or peritoneal structures can be visualized at the uterine fundus, or when there is a sudden increase in the fluid deficit.

Urinary tract or bowel injury — Bowel or bladder injury are rare but may occur in association with uterine perforation.

Cervical laceration — Cervical lacerations can occur, particularly in women with cervical stenosis. Lacerations that are large or are bleeding require sutures.

Embolism — Embolism (air or carbon dioxide) can occur with any hysteroscopic technique and can cause cardiovascular collapse.

Haemorrhage — Potential sources of intraoperative bleeding include operative sites, uterine perforation, and cervical laceration. Bleeding from cervical lacerations that is recognized at surgery can be controlled using the operative instruments.

Electrosurgical injury — Thermal effects of radiofrequency or laser energy can cause injuries to the uterine cavity, as well as bowel, urinary bladder, and large pelvic vessels.

Sepsis - Sepsis generally results from unrecognized thermal bowel injury. Fistulae or urinary ascites can occur from an unrecognized bladder injury. Such complications require consultation with a colorectal surgeon, urologist, or infectious disease specialist.