HYSTEROSALPINGOGRAPHY study

procedure is usually done ____-____ days after the onset of mensuration

7-10

patient symptoms for intrauterine pathologic process may include

Abnormal uterine bleeding Pelvic pain Pelvic fullness

what kind of fluid may com out of the patient after the exam?

Brown liquid or blood

how is the procedure done?

Contrast is injected through the cervix

HSG can demonstrate lesions such as:

Endometrial polyps Uterine fibroids Intrauterine adhesions

what kind of pathologies can be diagnosed using HSG?

Pelvic masses Fistulas Habitual spontaneous abortions Congenital defects

patient prep may include:

Propper bowel prep to ensure visualization of the reproductive tract that may be obstructed by gas or feces Mild pain relievers before the exam to reduce discomfort Empty bladder immediately before exam to prevent displacement of uterus and tubes Physicians may perform a manual pelvic exam prior Scout x-ray of pelvis procedure explained INFORMED CONSENT

what is a hysterosalpingogram (HSG)?

Radiographic demonstration of the female reproductive tract with a contrast agent

why do we do this exam? clinical indications

assessment of female infertility diagnose any functional or s structural defects therapeutic the injection of contrast may dilate or straighten a narrowed, tortuous, or occluded tube verification of tubal ligation intrauterine pathologic processes can demonstrate lesions used to diagnose pathologies

what kid of imaging is used during HSG's?

digital fluoroscopic unit

why should a water-soluble contrast be used?

easily absorbed by the patient does not leave residue within the reproductive tract provides adequate visualization causes pain, may last for hours after the exam

what are indications of endometrial polyp

filling defects

what position does Gynecologic stirrups put the patient in?

lithotomy (legs spread out)

the procedure: Contrast continues to fill the uterine cavity allowing for the ___________ of the uterine tubes to be demonstrated as contrast material spills into the __________ cavity

patency peritoneal

what kind of table should be used?

preferably with a table that can tilt and gynecologic stirrups

The uterine cavity is outlined, demonstrating its ________ and _______ which can aide in the detection of any uterine pathologic process

shape & contour

contradictions?

should not be done if pregnant pregnancy test must be performed prior acute pelvic inflammatory disease active uterine bleeding

what position can be useful to put the patient in if the table can tilt?

trendelenburg (Facilitates the flow of contrast into the uterine cavity)

contrast media used:

water-soluble

accessory equipment:

▪HSG Tray ▪Goose neck lamp ▪Large cotton Swabs ▪Chux ▪HS Catheter ▪Speculum -Plastic with light is preferred ▪Sterile specimen cup ▪Betadine ▪Lubricant ▪Omnipaque300 ▪Pink 18 guageneedle (for contrast) ▪10 cc syringe ▪4X4 gauze pack ▪Drape sheet ▪Sterile towels (2) ▪Patient sanitary pad ▪Sterile gloves -Dr's size- for exam -Your size- for set up ▪Tenaculum- an instrument with a hooked clamp for gathering & holding tissues & structures in place ▪Uterine Sound- used to dilate or open the cervix

cannula or catheter placement and injection process:

▪Patient is supine in the lithotomy position ▪Patient is draped with sterile towels; sterile technique ▪Vaginal speculum is inserted ▪Vaginal walls and cervix is cleansed with an antiseptic solution ▪A cannula or balloon catheter is inserted into the cervical canal ▪The speculum may be removed after catheter is placed ▪Pt may be put into Trendelenburg position ▪A contrast filled syringe is attached to the catheter ▪Under fluoroscopy, contrast is slowly injected into the uterine cavity ▪After injection, additional images may be obtained to document spillage of the contrast into the peritoneum

image evaluation criteria

▪Pelvic ring should be centered within the collimation field of the AP projection ▪The cannula or balloon catheter should be visualized within the cervix ▪An opacified uterine cavity and uterine tubes are seen centered to the IR ▪Contrast is seen within the peritoneum if one or both uterine tubes are patent ▪Density and contrast is adequate to demonstrate anatomy and contrast ▪Use your markers

anatomy:

-Uterus (uterine cavity) -Uterine (fallopian) Tubes & their patency (degree of openness)