Hysterosalpingography

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Hysterosalpingography
contrast medium filling the uterine cavity (small triangle in the center).
Other namesUterosalpingography
ICD-9-CM87.8
MeSHD007047
MedlinePlus003404
]
HSG test to know the blockage of the fallopian tubes

Hysterosalpingography (HSG), also known as uterosalpingography,

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.

Uses

HSG is considered a

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

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

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 (

prophylactic antibiotics before subject is allowed home.[3]

Complications

Possible complications of the procedure include

vasovagal syncope during the inflation of balloon in the cervical canal.[3]

History

For the first HSG, Carey used collergol 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

References

  1. ^ "Hysterosalpingography (Uterosalpingography)". RadiologyInfo. June 8, 2016.
  2. ^ a b c "Hysterosalpingography: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2019-05-06.
  3. ^
    ISBN 9780702071669
    .
  4. PMID 28520519
    .
  5. S2CID 222421134
    .
  6. S2CID 238249552
    .
  7. ^
    PMID 15950625
    .
  8. PMID 20265114
    .

External links
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