HSG (Hysterosalpingography) Quiz

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Questions and Answers

What is the primary indication for performing HSG in cases of infertility?

To diagnose congenital anomalies of the uterus

To confirm the presence of pelvic inflammatory disease

To assess tubal patency (correct)

To evaluate the integrity of a cesarean uterine scar

What is a relative contraindication for performing HSG?

Pregnancy

Menstruation

Contrast sensitivity (correct)

Recurrent miscarriages

What type of contrast material is used for HSG?

High osmolar non-iodinated contrast material

Low osmolar iodinated contrast material (LOCM) (correct)

Low osmolar non-iodinated contrast material

High osmolar iodinated contrast material (HOCM) (correct)

What is the purpose of pre-warming the equipment to body temperature before performing HSG?

To avoid tubal spasm Signup and view all the answers

What is the ideal time to schedule an HSG appointment in a patient with a regular 28-day cycle?

Between days 4-10 of the cycle Signup and view all the answers

What is the purpose of using a Margolin HSG cannula in some patients?

To provide tight occlusion of the cervix for contrast injection Signup and view all the answers

Why is it important to obtain informed consent from the patient before performing HSG?

To ensure the patient understands the procedure Signup and view all the answers

What is the primary role of the vaginal speculum during HSG?

To visualize the cervix Signup and view all the answers

What is the purpose of using sterile jelly when placing the disposable speculum?

To facilitate the insertion of the HSG catheter Signup and view all the answers

Why is it occasionally necessary to use Vulsellum forceps to hold the cervix?

To facilitate the insertion of the HSG catheter Signup and view all the answers

What is the purpose of expelling all air bubbles from the syringe and cannula?

To prevent confusion in interpretation Signup and view all the answers

What is the effect of opiates on the patient during the HSG procedure?

They increase pain by stimulating smooth muscle contraction Signup and view all the answers

What is the purpose of intermittent screening during the HSG procedure?

To reduce the radiation dose to the patient Signup and view all the answers

What is the purpose of a delayed view in the HSG procedure?

To show abnormal loculation of contrast Signup and view all the answers

What should be ensured before the patient leaves after the HSG procedure?

All of the above Signup and view all the answers

Why are prophylactic broad-spectrum antibiotics routinely given in some centers?

To reduce the risk of infection Signup and view all the answers

Study Notes

Hysterosalpingography (HSG)

HSG is indicated for:
- Infertility to assess tubal patency
- Recurrent miscarriages to investigate suspected incompetent cervix or congenital anomaly of uterus
- Following tubal surgery to establish tubal patency
- Post sterilization to confirm obstruction and prior to reversal of sterilization
- Assessment of the integrity of a cesarean uterine scar (rare)

Contraindications

HSG is contraindicated during:
- Menstruation
- Pregnancy or unprotected intercourse during the cycle
- Purulent discharge on inspection of the vulva or cervix, or diagnosed pelvic inflammatory disease (PID) in the preceding 6 months
- Contrast sensitivity (relative)

Contrast Medium and Equipment

High osmolar iodinated contrast material (HOCM) or low osmolar iodinated contrast material (LOCM) is used
Contrast medium should be pre-warmed to body temperature to avoid tubal spasm
Equipment includes:
- Fluoroscopy unit with spot film device
- Vaginal speculum
- Vulsellum forceps
- Hysterosalpingography balloon catheter (5-F to 7-F)

Patient Preparation

Appointment should be made before day 21 or between the 4th and 10th days in a patient with a regular 28-day cycle
Patient should abstain from unprotected intercourse between booking the appointment and the time of the examination
Apprehensive patients may need premedication
Informed consent should be obtained

Technique

Patient lies supine on the table with knees flexed, legs abducted
Vulva is cleaned with chlorhexidine or saline
Disposable speculum is placed using sterile jelly, and the cervix is exposed
Cervical is identified using a bright light, and the HSG catheter is inserted into the cervical canal
Care must be taken to expel all air bubbles from the syringe and cannula
Contrast medium is injected slowly into the uterine cavity under intermittent fluoroscopic observation

Images

Radiation dose should be kept as low as possible
Intermittent screening should be performed to the minimal requirement
Images should demonstrate:
- Endometrial cavity, demonstrating or excluding congenital abnormalities or filling defects
- Full view of the tubes demonstrating spill
- If there is abnormal loculation of contrast, a delayed view may be useful

Aftercare

Patient should be ensured to be in no serious discomfort nor have significant bleeding before leaving
Patient should be advised that she may have spotting or occasional vaginal bleeding for 1–2 days and pain which may persist for up to 2 weeks
Prophylactic broad-spectrum antibiotics are routinely given in several centers and are good practice

Complications

Allergic phenomena may occur due to the contrast medium
Complications may occur due to the technique

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Description

Learn about the indications, contraindications, and procedure of Hysterosalpingography (HSG) in medical imaging diagnosis.