To improve Chinese hysteroscopic surgeons′ awareness of fluid management risks and standardize the prevention and treatment of operative hysteroscopy intravascular absorption syndrome (OHIA), these expert recommendations summarize the pathogenic factors of OHIA, standardized management of uterine distension media, as well as unified diagnosis, treatment and prevention strategies. The recommendations propose adhering to the principle of minimum effective intrauterine distension pressure during hysteroscopy, clarify influencing factors and monitoring key points of fluid deficit, and conclude clinical manifestations, auxiliary examinations of OHIA-related fluid overload and acute dilutional hypokalemia/hyponatremia, alongside the standardized emergency management workflow for OHIA. This paper highlights that prevention is the priority for OHIA control, and puts forward the "4L" rule and "4E" rule for clinical prevention. Finally, it highlights the critical value of fully automated intraoperative hysteroscopic fluid management in reducing OHIA risk, and prospects future research and development directions in this field.