HYSTEROSALPINGOGRAPHY (HSG) - OBG .pptx

Hysterosalpingography (HSG), also known as uterosalpingography, is an X-ray procedure used to visualize the uterus and fallopian tubes.

1. HYSTEROSALPINGOGRAPHY HSG is a diagnostic imaging procedure for female infertility. It uses contrast dye and fluoroscopy to visualize the uterus and fallopian tubes. HSG uniquely evaluates tubal patency and uterine structure. It complements other imaging like ultrasound and hysteroscopy. Despite limitations, HSG remains key in infertility diagnosis.

2. Anatomy and Physiology Assessed by HSG Fallopian Tubes Three segments: infundibulum, ampulla, isthmus. Connect ovaries to uterus. Endometrial Cavity Uterine cavity shape and structure evaluated for abnormalities. Oocyte Transport Oocytes pass through patent tubes into the uterus during ovulation.

3. Indications for HSG Infertility Assessment Check tubal patency and uterine abnormalities. Tubal Factors Detect occlusions from infections like gonorrhea and chlamydia. Uterine Abnormalities Identify synechiae, malformations, and cervical incompetence. Other Diagnoses Detect translocated IUDs, fibroids, polyps, hydrosalpinx, and secondary abdominal pregnancy.

4. Contraindications for HSG Ongoing pregnancy Current pelvic infection or tenderness Heavy uterine bleeding Allergy to iodine contrast History of thyroid disease (consult endocrinologist) Known hydrosalpinges or adnexal mass

5. Timing of the HSG Procedure Schedule HSG during the first half of the menstrual cycle, days 1-14 or 6-10. This reduces pregnancy risk and improves image clarity. Confirm absence of pregnancy with a urine test before the procedure.

6. Medical Management and Preparation Bladder Emptying Patient empties bladder before HSG. Pain Control NSAIDs given pre-procedure; local anesthesia may be used. Antispasmodics Limited evidence; atropine may reduce tubal spasms. Antibiotics Not routine; given if PID history, e.g., doxycycline. Allergy and Thyroid Manage iodine allergy and thyroid disease carefully.

7. Equipment, Personnel, and Technique Patient Positioning Dorsal lithotomy position on exam table. Speculum and Cleaning Visualize cervix and prepare with antiseptic. Cannula Insertion Insert catheter, inject contrast carefully. Imaging Take multiple x-rays to track dye flow. Completion Remove instruments and obtain final images.

8. Contrast Media Used in HSG Water-Soluble Agents Nonionic, iso-osmolar dyes like iodixanol improve safety and tolerance. Rapid absorption No granuloma formation Better tubal mucosa visualization Oil-Based Agents Better resolution and less cramping; may increase pregnancy rates. Better tubal architecture Less uterine pain Potential fertility benefit No consensus on preferred contrast agent currently.

9. Imaging, Interpretation, and Complications Imaging Focus Assess uterine filling, tubal patency, and peritoneal spill. Interpretation Detect occlusions, synechiae, malformations, and other abnormalities. Complications Rare; include cramping, bleeding, infection, allergic reactions, and uterine injury.

10. Clinical Significance and Teamwork Diagnostic Role HSG is vital in infertility evaluation alongside other imaging. Interprofessional Team Gynecologists, radiologists, nurses, and others collaborate for care. Communication Effective teamwork ensures safety and optimal patient outcomes.

11. Hysterosalpingogram showing radio-opaque shadow demarcating the uterine cavity. The radio-opaque dye is visible in the lumen of both the tubes. There is peritoneal spillage on both sides. Diagnosis: Normal hysterosalpingogram (normal cavity) with bilateral patent tubes (free peritoneal spill).

12. Hysterosalpingogram showing radio-opaque shadow demarcating the uterine cavity. No radio-opaque shadow is visible on either tube. Diagnosis: Hysterosalpingogram showing bilateral cornual block.

13. Hysterosalpingogram showing radio-opaque shadow filling the uterine cavity. The tubes of both sides are distended with the radio-opaque dye. There is no evidence of peritoneal spillage. Diagnosis: Bilateral hydrosalpinx (fimbrial block).

14. Reference 1.D C Dutta's Textbook of Gynecology - Hiralal Konar 2. https://www.ncbi.nlm.nih.gov/books/NBK572146/