Reproductive system

Published on 12/06/2015 by admin

Filed under Radiology

Last modified 12/06/2015

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Reproductive system

Hysterosalpingography

Technique

1. The patient lies supine on the table with knees flexed, legs abducted.

2. The vulva can be cleaned with chlorhexidine or saline. A disposable speculum is then placed using sterile jelly and the cervix is exposed.

3. The cervical os is identified using a bright light and the HSG catheter is inserted into the cervical canal. It is usually not necessary to use a Vulsellum forceps to hold the cervix with a forceps, but occasionally this may be necessary. The catheter should be left within the lower cervical canal if cervical incompetence is suspected.

4. Care must be taken to expel all air bubbles from the syringe and cannula, as these would otherwise cause confusion in interpretation. Contrast medium is injected slowly into the uterine cavity under intermittent fluoroscopic observation.

5. Spasm of the uterine cornu may be relieved by intravenous (i.v.) glucagon if there is no tubal spill bilaterally.

N.B. Opiates increase pain by stimulating smooth muscle contraction.

Complications

Due to the technique

1. Pain may occur at the following times:

2. Bleeding from trauma to the uterus or cervix

3. Transient nausea, vomiting and headache

4. Intravasation of contrast medium into the venous system of the uterus results in a fine lace-like pattern within the uterine wall. When more extensive, intravasation outlines larger veins. It is of little significance when water-soluble contrast medium is used. Intravasation may be precipitated by: direct trauma to the endometrium, timing of the procedure near to menstruation or curettage, tubal occlusion or congenital abnormalities

5. Infection – which may be delayed. Occurs in up to 2% of patients and is more likely when there is a previous history of pelvic infection.