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Hysterosalpingography

Hysterosalpingography: hystero means uterus, salpingo means fallopian tube and graphy means study.

Hysterosalpingography is the study of uterus and fallopian tube under guidance of x-ray or fluoroscopy machine. It is an invasive procedure. It is quite uncomfortable and painful also.

Equipment used in HSG:

  1. Fluoroscope unit or x-ray unit.
  2. Table
  3. Sterile HSG procedure tray that contains 10ml syringe, cup, gauze, speculum, HSG cannula, lubricating jelly, cotton balls, sponge holding forceps, drapes.
  4. Sterile gloves.
  5. Normal saline
  6. Antiseptic solution
  7. Radio-opaque and water-soluble iodinated contrast media e.g. omnipaque 300.  

Indications for HSG:

  1. Infertility is the main indication for HSG.
  2. Repeated spontaneous abortion.
  3. Suspected uterine tuberculosis.
  4. Pre and post tubal ligation.
  5. Congenital or acquires uterus abnormalities.
  6. Before artificial insemination.
  7. Patency of uterine tube.

Contraindication for HSG:

  1. Suspected pregnancy.
  2. Contrast media sensitivity.
  3. Recent surgery of the uterus or the fallopian tubes.
  4. Active vaginal bleeding and suspected malignancy.
  5. It is advised not to perform this procedure during the menstruation.
  6. Unprotective sexual intercourse.

Patient preparation for HSG:

  1. It is done during the proliferative phase, 2-3 days after periods that means 8th-12th day of menstruation cycle.
  2. Patient must avoid unprotected sexual intercourse after periods to the day of examination.
  3. Patient should be fasting for four hours before the procedure.
  4. Ask patient to empty the bladder before the procedure.
  5. If the patient having irregular menses than she has to recommended get a beta HCG test before the procedure.
  6. Premedication (5-10mg Diazepam) that patient needs before the 30 minutes of procedure to prevent tubal spasm and anxiety.
  7. Patient should be advised to take laxatives on the night prior procedure to empty bowel, to see the parts clearly.

Procedure:

  • Explain the procedure to the patient.
  • Informed consent must be taken by the patient before stating the procedure.
  • Diazepam given prior the procedure.
  • Scott or plain film of pelvis is taken.
  • Patient lies supine in lithotomy position, both knee flexed, legs abducted.
  • By using antiseptic solution (beta dine) clean the perineum.
  • By using povidone-iodine solution cervix is cleaned.
  • A speculum is introduced into vagina by the gynecologist.
  • Cervical OS is recognized by using torch and HSG cannula.
  • By using HSG cannula around 2ml of the contrast media in injected into the cervical canal initially.
  • Slowly contrast media is injected into the cervical canal according to the patient’s tolerance until the oviducts become visible
  • 3ml of contrast media is given to filling uterine cavity and another 3ml is given to filling the tubes.
  • After the procedure antibiotics are prescribed and it is necessary to inform the patient about vaginal spotting for 2-3days.

Filming technique:

Minimal four films are taken

  1. The first film is taken is the plain film with empty bladder.
  2. The next film is taken when cannula is introduced into the cervix.
  3. The third film is taken when uterus is fully distended.
  4. The next phase is the tubal filling phase.
  5. The last film is taken after peritoneal spillage.