Hysterosalpingography

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Hysterosalpingography Presented by Dr.
Narayan M. Patel M.D.,D.G.O. FICS Emeritus
Professor Muni. Medical college Postal
address-- Mahalaxmi Institute of medical
teaching, 3, Shantiniketan park,
Naranpura, Nr.Sardar Patel Colony, AHMEDABAD-
380 014 (Gujarat) INDIA T.N.[phone],
Mobile- 98252 95530 E mail- narayanpatel1932_at_yah
oo.com
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Hysterosalpingography is a dying art of
investigation, as it is being performed less and
less frequently. Availability of laparoscope
makes the gynecologist to think that it can
replaced Hysterosalpingography. There are plenty
of articles in the literature, where a fixed
number of patients were subjected to both the
investigations and their findings were compared.
Result is, in about 40 of cases there is always
added or altered information, when both
investigations are done, as compared to any
single investigation. Conclusion is that these
two investigations are complimentary to each
other and one can not replace other. Like this,
other dying arts in Ob/gyn. is mid cavity
forceps, Breech delivery, destructive obstetric
operations, Tubal microsurgery, Internal podalic
version etc.
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Hysterosalpingography

• Hysterosalpingography is a
• permanent visual record
• of the uterus and tubes
• First described by Rubin and
• Carey in 1914

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Hysterosalpingography

• 1909- Nomenov suggested
• Lugols iodine to visualize uterus.
• 1910- Rindfleish visualize the
• uterus by filling with paste like
• suspension of Bismuth

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Hysterosalpingography

• Characteristics of an ideal dye or
• contrast media--
• Non irritant to tubal mucosa, endometrium and
• peritoneum.
• God contrast means better image.
• No sensitivity reaction.
• No harm if intravasations occurs.
• It should be sterile.
• It should not any cause chemical peritonitis.

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Hysterosalpingography

• Lipiodol - the contrast media of past.
• It is 40 iodine in poppy seeds oil.
• It is thick oily solution
• Sensitivity test to be done by putting a drop
  in eye
• Contrast take 24 hours to pass from uterine
• cavity to tubes.
• First x-ray is taken to day next x-ray
  tomorrow.
• Draw back of oil granuloma.
• Picture used to be of good quality.
• As an undergraduate student, I still remember
• having crammed lipoidoal- is 40 iodine in
• Poppy seed oil.

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Hysterosalpingography

• Diaginol viscous-- was the next contrast
• media of past. It is Actrizolatein dextran
• 40 It is thick oily solution
• Conray 280 --was the next contrast used.
• It is Meglumine iothlamate 60 w/v.
• It is water soluble gives good pictures.
• Minimal sensitivity reaction.
• Safe even if intravasations occurs.
• .

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Hysterosalpingography

• Improvement in contrast media
• Media is now water soluble
• There is immediate spill.
• It is non-irritant to tubal mucous, endometrium
  
• and peritonium.
• Sensitivity reaction is rare.
• Fast absorbed
• No harm if intravasations occurs.
• In one ampoule of 20 cc of media, you can
  perform
• 2 Hysterosalpingography.

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Hysterosalpingography

• Requirements --
• Ideally H.S.G. should be done in place where
• Image intensifier facility is available.
• If image intensifier is not available than at
  least,
• X-ray with screening facility is a must.
• In that case one should do accommodation of
• eyes by wearing adaptation glasses at least
• ten minutes before staring screening.
• To wear lead apron for radiation protection.
• Ideal dye and ideal canula to be used.

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Hysterosalpingography
Following sterile instruments will be required
and the procedure has to be with strict aseptic
precaution.

• Sponge holder.
• Uterine sound.
• Tenaculum forceps.
• Rubinscanul.
• Colvins canula.
• Single bladed speculum.
• Luerlock glass or plastic
• 10 c.c.sterile syringe needles.
• Plefers probe.
• Hegargs dilatoe no 5-6-7-

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Hysterosalpingography

• Different types of canulas used for H.S.G.
• Rubuns canula
• Leach-wilkinson canula,
• also called Colvins canula.
• Pediatric foleys catheter no-8
• KIddes canula.
• Cohen edler canula.

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Hysterosalpingography

• Indications of Hysterosalpingography--
• Primary and secondary Infertility.
• Localization of fibroids.
• To detect congenital uterine anomalies.
• To know condition of tubes, its sight of
  blockage ,
• to detect condition like hydrosalpingx etc
• To localization of misplaced I.U.C.D.
• To detect condition like uterine synechia.
• In suspected cases of genital tuberculosis.
• Before and after tuboplasty operation.
• In cases of habitual abortion.

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Hysterosalpingography

• Contra indication of H.S.G.
• Recent pelvic inflammation.
• Any bedding per vagina.
• Any doubt for pregnancy.
• Known case of allergy to dye.
• It is to be performed after period and before
  ovulation.
• Pre medication of Injection of Atropine and
  analgesic.
• Post procedure antibiotics and analgesics to
  be given for 5 to 6 days.

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Hysterosalpingography
To detect congenital uterine anomalies.
Localization of fibroids.
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Hysterosalpingography
In suspected cases of genital tuberculosis

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Hysterosalpingography
To visualize tube, its potency, site of
blockage, condition like hydrosalpingx etc.
Bil.cornual block
Normal H.S.G. both Tubes patent with spill On
both sides
Hydrosalpings Both sides
Hydrosalpings On ri.side
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Hysterosalpingography
Localization of I.U.C.D.

• To visualize uterine syneche.
• Primary and secondary Infertility
• Before and after tuboplasty.
• To demonstrate Incompetent Int.os.

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Hysterosalpingography

• Complications of H.S.G.
• Flaring up of pelvic inflammation.
• Peritonial irritation and pelvic pain.
• Perforation of uterus.
• Bleeding from tenaculum bite on cervix.
• Vaso vagal attack.
• Inravasation of dye.

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Thank you