Hysterosalpingography (HSG)

Procedure must be scheduled approx. ____ days after onset of menstration; Why?

10; Few days before ovulation: - Endometrium is least congested; - Least risk of irradiating fertilized ovum;

*UTERINE TUBES*

Aka "Fallopian Tubes"; • arise from lateral angle of the uterus on each side; • open into the peritoneal cavity; • when the ova are released by the ovaries, it collects and convey them into the uterine cavity; • 3" - 5" long (7.6 cm);

Distal tubal opening

Aka *Abdominal Ostium*: opening in the infundibulum of uterine tube into the abdominal cavity. • in ovulation, the oocyte enters the Fallopian tube through this opening; • it is surrounded by fimbriae, which help in the collection of the oocyte; • occlusion of this opening is referred to as distal tubal occlusion;

Pathology

Conditions investigated: • tumors/ masses; • adhesions; • uterine fibroids; • uterine tube blockage due to scarring or infection; • success of tubal ligation procedure; • success of reversal of tubal ligation;

Ovarian outer, glandular tissue

Cortex (contains ovarian follicles);

Ovulation

Extrusion of an ovum by rupture of a follicle;

Fully developed ovarian follicle

Graafian follicle;

Endometrium

Inner mucosal lining of the uterine cavity;

Core of ovaries vasculat tissue

Medulla

*Hysterosalpingography* (*HSG*)

Usually performed on patients with hx of repeated miscarriage or inability to conceive; Radiographic examination of: a) *Uterus*; b) *Uterine tubes*;

The *disadvantages* in using water-based contrast are:

pain; decreased radiopacity;

*Body*

part beween fundus and isthmus;

HSG is performed by the _______;

physician (radiologist or ob/gyn);

*Isthmus*

superior part of the cervix constricted area between body and cervix;

*Fundus*

superior portion, blund and rounded;

Exam sequence

• *AP Pelvis* or *AP Bladder*; • Lithotomy position; • Speculum vaginal insertion; • Betadine solution to cleanse the cervix; • Uterine cannula placed just passed the cervix; • Contrast injected under fluoroscopic guidance; • Cannula and speculum removed; • Patient seated; • Post images;

*UTERUS*

• Pear-shaped muscular organ; • Situated in the central part of thr pelvic cavity; • Anterior to urinary bladder; • Receive and retain fertilized ovum until development of *fetus* during birth;

*OVARIES*

• Small, glandular, almond-shaped organs; • Located on each side near lateral wall of the pelvis; • Secrete *estrogen* and *progesteron*; • Develop and release the ova; • Attached to the uterus by ovarian ligaments;

*Cervix*

• cyindric vaginal end of the uterus; • the vagina is attached around circumference of the cervix; • triangular-shaped when in frontal plane;

Hysterosalpingography evaluates

*1*) Shape and structure of the uterus; *2*) Patency of the uterine tubes; *3*) Evidence of scar tissue within the peritoneal cavity;

The traditionally oil-based contrast used is _____;

*Ethiodol*

Currently, the *water-based* contrast media are:

*Hypaque*; *Renographin*; *Omnipaque*;

Contraindications

- infection; - bleeding; - current pregnancy;

Indications

- infertility; - recurrent pregnant loss; - suspected anomalities;

*HSG* risks

- mild pain/cramping; - gonadal radiation exposure; - worsening of Pelvic Inflammatory Disease (*PID*) or untreated Sexually Transmitted Disease (*STD*); - miscarriage if currently pregnant;

*HSG* benefits

- minimally invasive procedure to diagnose abnormalities causing infertility; - blocked uterine tubes can sometimes be opened as a result of the procedure;

4 parts of the Uterus

1) *Fundus*: superior portion, blund and rounded; 2) *Body*: part beween fundus and isthmus; 3) *Isthmus*: superior part of the cervix constricted area between body and cervix; 4) *Cervix*: cyòindric vaginal end of the uterus;

Division of the Uterine Tubes

1) *Isthmus*: short and narrow near uterus; 2) *Ampulla*: majority of the tube; 3) *Infundibulum*: terminal, lateral portion flored in appearance which ends in a series of irregular prolonged processes called *fimbrae*;

Patient preparation

1) a mild sedative may be given; 2) antibiotics prior and /or after procedure may given; 3) voiding prior to the exam; 4) disrobe from the waist down; 5) RF room ready; 6) aseptic technique; 7) involves introduction of iodinated radiopaque contrast into the uterus;