HSG (Hysterosalpingography) Quiz

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