Hysterosalpingography

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Hysterosalpingography
Hysterosalpingography Normal.png
A normal hysterosalpingogram. Note the catheter entering at the bottom of the screen, and the contrast medium filling the uterine cavity (small triangle in the center).
Other namesUterosalpingography
ICD-9-CM 87.8
MeSH D007047
MedlinePlus 003404
HSG test to know the blockage of the fallopian tubes Hysterosalpingogram (HSG).jpg
HSG test to know the blockage of the fallopian tubes

Hysterosalpingography (HSG), also known as uterosalpingography, [1] is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. It is a special x-ray procedure using dye to look at the womb (uterus) and fallopian tubes. [2] In this procedure, a radio-opaque material is injected into the cervical canal, and radiographs are taken. A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with the injection material. To demonstrate tubal patency, spillage of the material into the peritoneal cavity needs to be observed. Hysterosalpingography has vital role in treatment of infertility, especially in the case of fallopian tube blockage.

Contents

Uses

HSG is considered a diagnostic procedure. It is used in the workup of infertile females to assess the patency of fallopian tubes, assess the competency of the cervix or congenital abnormality of the uterus in multiple miscarriages, assess the patency of fallopian tubes after surgery or tubal ligation, or before reversal of tubal ligation. Rarely, HSG is used to assess the integrity of a Caesarean scar. [3]

Occasionally, HSG may also have therapeutic benefits for infertility treatment. When oil-based contrast is used, rates of pregnancy increase by about 10% compared to water-based contrast. [4] A meta-analysis revealed 3.6 times greater odds (OR = 3.6) of pregnancy with oil-based contrast compared to no hysterosalpingography. [5] This effect is thought to be due to the flushing action of the contrast into the uterus that causes dislodgement of mucus plug, debris, or opening of mild adhesions in the fallopian tubes. [6]

HSG is contraindicated during menstruation, suspected cancer, pregnancy, unprotected sexual intercourse during the menstrual cycle, any purulent discharge from the vagina, or if the individual was diagnosed with pelvic inflammatory disease six months previously. For those with hypersensitivity to contrast, HSG is relatively contraindicated.

Procedure

Either high osmolar contrast material (HOCM) or low osmolar contrast material (LOCM) can be used. 10 to 20 ml of LOCM can be used at a concentration of 270 to 300 mg/ml. The contrast media should be prewarmed to room temperature before administered into the cervix, so as to prevent spasm of fallopian tubes. 5Fr to 7Fr hysterosalpingogram balloon catheter can be used. Margolin HSG cannula is used if the cervix is narrow or stenosed. [3] HSG appointment is usually made during the 4th to 10th days of regular menstrual cycle (follicular phase). [7] The subject should not undergone any sexual intercourse before HSG. Anxious subjects may need painkillers or other medications. Informed consent should be taken before the procedure. [3]

The subject lies down on table in supine position with legs flexed and abducted. Vulva is cleaned with chlorhexidine or normal saline. A speculum is inserted to the vagina with the help of sterile jelly, and the cervix is exposed. The cervical opening is identified using a bright light. The HSG catheter is then inserted into the cervical canal. Occasionally, Vulsellum forceps may be used to hold the cervical lips open. If cervical weakness is suspected, the catheter should be left inside the lower cervical canal. [3] Air bubbles should be expelled from the syringe and the catheter, otherwise it will cause confusion of interpretations on HSG. Contrast medium is injected slowly into the uterine cavity with intermittent fluoroscopic screening. If there are no spills from bilateral fallopian tubes bilaterally, intravenous buscopan and glucagon can be given to relieve spasm of fallopian tubes. [3] Opiates should not be given, as it may increase pain because of increased smooth muscle contractions. [3]

The procedure involves x-rays (fluoroscopy). [7] Images are taken to demonstrate the filling of endometrial cavity, which shows full view of the fallopian tubes demonstrating the spillage of contrast material into peritoneum, the extent of the block if no spillage is present, or a delayed view in the case of abnormal cavities (locule) within. Subject may have vaginal spotting for one to two days, accompanied with pain that may persist for up to two weeks. Some medical centres routinely give prophylactic antibiotics before subject is allowed home. [3]

Complications

Possible complications of the procedure include infection, [2] allergic reactions to the materials used, [2] intravasation of the contrast material, pain during the procedure, nausea, vomiting, and headache. Some subjects may develop vasovagal syncope during the inflation of balloon in the cervical canal. [3]

History

For the first HSG, Carey used collargol in 1914. Lipiodol was introduced by Sicard and Forestier in 1924, and remained a popular contrast medium for many decades. [8] Later, water-soluble contrast material was generally preferred as it avoided the possible complication of oil embolism.

Follow up

If the HSG indicates further investigations are warranted, a laparoscopy, assisted by hysteroscopy, may be advised to visualize the area in three dimensions, with the potential to resolve minor issues within the same procedure.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Uterus</span> Female sex organ in mammals

The uterus or womb is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more embryos until birth. The uterus is a hormone-responsive sex organ that contains glands in its lining that secrete uterine milk for embryonic nourishment.

<span class="mw-page-title-main">Ectopic pregnancy</span> Female reproductive system health issue

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.

<span class="mw-page-title-main">Asherman's syndrome</span> Medical condition

Asherman's syndrome (AS) is an acquired uterine condition that occurs when scar tissue (adhesions) forms inside the uterus and/or the cervix. It is characterized by variable scarring inside the uterine cavity, where in many cases the front and back walls of the uterus stick to one another. AS can be the cause of menstrual disturbances, infertility, and placental abnormalities. Although the first case of intrauterine adhesion was published in 1894 by Heinrich Fritsch, it was only after 54 years that a full description of Asherman syndrome was carried out by Joseph Asherman. A number of other terms have been used to describe the condition and related conditions including: uterine/cervical atresia, traumatic uterine atrophy, sclerotic endometrium, and endometrial sclerosis.

<span class="mw-page-title-main">Hysteroscopy</span> Medical procedure

Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention.

<span class="mw-page-title-main">Falloposcopy</span>

Falloposcopy is the inspection of the fallopian tubes through a micro- endoscope. The falloposcope is inserted into the tube through its opening in the uterus at the proximal tubal opening via the uterotubal junction; technically it could also be inserted at the time of abdominal surgery or laparoscopy via the distal fimbriated end.

<span class="mw-page-title-main">Uterine malformation</span> Medical condition

A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis. Symptoms range from amenorrhea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect.

Tuboplasty refers to a number of surgical operations that attempt to restore patency and functioning of the fallopian tube(s) so that a pregnancy could be achieved. As tubal infertility is a common cause of infertility, tuboplasties were commonly performed prior to the development of effective in vitro fertilization (IVF) or repair of any type of tube-like structure, including the Eustachian tube in the head and neck.

Iodized oil, also known as ethiodized oil, brand name Lipiodol, is a medication derived from poppyseed oil and iodine. When given by injection, it is a radio-opaque contrast agent that is used to outline structures in radiological investigations. When given orally or by intramuscular injection once or twice a year, it prevents endemic goitre in remote communities. It has an additional use in gastric variceal obliteration as a dilutant that does not affect polymerization of cyanoacrylate.

<span class="mw-page-title-main">Hydrosalpinx</span> Medical condition

A hydrosalpinx is a condition that occurs when a fallopian tube is blocked and fills with serous or clear fluid near the ovary. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility. A fallopian tube filled with blood is a hematosalpinx, and with pus a pyosalpinx.

<span class="mw-page-title-main">Unicornuate uterus</span> Medical condition

A unicornuate uterus represents a uterine malformation where the uterus is formed from one only of the paired Müllerian ducts while the other Müllerian duct does not develop or only in a rudimentary fashion. The sometimes called hemi-uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

A uterine septum is a congenital uterine malformation where the uterine cavity is partitioned by a longitudinal septum; the outside of the uterus has a normal typical shape. The wedge-like partition may involve only the superior part of the cavity resulting in an incomplete septum or a subseptate uterus, or less frequently the total length of the cavity and the cervix resulting in a double cervix. The septation may also continue caudally into the vagina resulting in a "double vagina".

Tubal reversal, also called tubal sterilization reversal, tubal ligation reversal, or microsurgical tubal reanastomosis, is a surgical procedure that can restore fertility to women after a tubal ligation. By rejoining the separated segments of the fallopian tube, tubal reversal can give women the chance to become pregnant again. In some cases, however, the separated segments cannot actually be reattached to each other. In some cases the remaining segment of tube needs to be re-implanted into the uterus. In other cases, when the end of the tube has been removed, a procedure called a neofimbrioplasty must be performed to recreate a functional end of the tube which can then act like the missing fimbria and retrieve the egg that has been released during ovulation.

<span class="mw-page-title-main">Fallopian tube obstruction</span> Medical condition

Fallopian tube obstruction, also known as fallopian tube occlusion, is a major cause of female infertility. Blocked fallopian tubes are unable to let the ovum and the sperm converge, thus making fertilization impossible.

The fertiloscope is a type of laparoscope, modified to make it suitable for trans-vaginal application, which is used in the diagnosis and treatment of female infertility.

<span class="mw-page-title-main">Iobitridol</span> Pharmaceutical drug

Iobitridol is a pharmaceutical drug used as an iodine-based radiocontrast agent in X-ray imaging. It is injected into blood vessels, joints, or body cavities such as the uterus, and filtered out by the kidneys. Its most common adverse effect is nausea. Severe allergic reactions are rare.

<span class="mw-page-title-main">Fallopian tube</span> Tubes in the human female reproductive system

The fallopian tubes, also known as uterine tubes, oviducts or salpinges, are paired tubes in the human female body that stretch from the ovaries to the uterus. The fallopian tubes are part of the female reproductive system. In other vertebrates, they are only called oviducts.

Isidor Clinton Rubin was an American gynecologist who developed the Rubin test, a tubal insufflation test. This is an office procedure to check for tubal patency in the infertility investigation.

<span class="mw-page-title-main">Fertility testing</span>

Fertility testing is the process by which fertility is assessed, both generally and also to find the "fertile window" in the menstrual cycle. General health affects fertility, and STI testing is an important related field.

Sonosalpingography (SSG), also known as Sion test, is a diagnostic procedure primarily used for evaluating patency of fallopian tubes. It was introduced as a screening procedure for infertility investigations. It is becoming more popular among practitioners due to absence of side effects.

Chromopertubation is a method for the study of fallopian tube patency for suspected infertility in women caused by fallopian tube obstruction. Occlusion or pathology of the fallopian tubes is the most common cause of suspected infertility. Chromopertubation is sometimes commonly referred to a "laparoscopy and dye" test. It is currently one of the standard procedures in this field. In most cases, chromopertubation is performed to assess and determine the cause of someone's difficulties in getting pregnant.

References

  1. "Hysterosalpingography (Uterosalpingography)". RadiologyInfo. June 8, 2016.
  2. 1 2 3 "Hysterosalpingography: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2019-05-06.
  3. 1 2 3 4 5 6 7 8 Watson N, Jones H (2018). Chapman and Nakielny's Guide to Radiological Procedures. Elsevier. pp. 163–166. ISBN   9780702071669.
  4. Dreyer, Kim; Rijswijk, Joukje van; Mijatovic, Velja; Goddijn, Mariëtte; Verhoeve, Harold R.; Rooij, Ilse A.J. van; Hoek, Annemieke; Bourdrez, Petra; Nap, Annemiek W. (2017-05-18). "Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women". New England Journal of Medicine. 376 (21): 2043–2052. doi: 10.1056/nejmoa1612337 . PMID   28520519.
  5. Wang, Rui; Watson, Andrew; Johnson, Neil; Cheung, Karen; Fitzgerald, Cheryl; Mol, Ben Willem J.; Mohiyiddeen, Lamiya (October 15, 2020). "Tubal flushing for subfertility". The Cochrane Database of Systematic Reviews. 2020 (10): CD003718. doi:10.1002/14651858.CD003718.pub5. ISSN   1469-493X. PMC   9508794 . PMID   33053612. S2CID   222421134.
  6. Grigovich, Maria; Kacharia, Vidhi S.; Bharwani, Nishat; Hemingway, Anne; Mijatovic, Velja; Rodgers, Shuchi K. (October 2021). "Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know". RadioGraphics. 41 (6): 1876–18961. doi:10.1148/rg.2021210033. ISSN   0271-5333. PMID   34597232. S2CID   238249552.
  7. 1 2 Baramki T (2005). "Hysterosalpingography". Fertil Steril. 83 (6): 1595–606. doi: 10.1016/j.fertnstert.2004.12.050 . PMID   15950625.
  8. Bendick A. J. (1947). "Present Status of Hysterosalpingography". Journal of the Mount Sinai Hospital, New York. 14 (3): 739–742. PMID   20265114.