Hysterosalpingography

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Hysterosalpingography

Definition

Hysterosalpingography is a procedure where x rays are taken of a woman's reproductive anatomy after a contrast dye is injected into the cervix. Hystero means uterus and salpingo means tubes, so hysterosalpingography literally means to take pictures of the uterus and fallopian tubes. This procedure may also be called HSG or hysterography.

Purpose

Hysterosalpingography is used to determine if the fallopian tubes are open, or if there are any apparent abnormalities or defects in the uterus. It can be used to detect tumors, scar tissue, or tears in the lining of the uterus. This procedure is often used to help in diagnosing any physical abnormalities causing infertility in women. The fallopian tubes are the location where an egg from the ovary joins with sperm to produce a fertilized ovum. If the fallopian tubes are blocked or deformed, the egg may not be able to descend or the sperm may be blocked from moving up to meet the egg. Up to 30% of all cases of infertility are due to damaged or blocked fallopian tubes.

Precautions

This procedure should not be done on women who suspect they might be pregnant or who may have a pelvic infection . The exam is usually timed within a few days after a period to minimize the chance of performing the procedure while the patient is pregnant. If a woman has a history of heart abnormalities, she should consult with her doctor prior to the exam. Women who have had an allergic reaction to the contrast dye used in previous xray procedures should inform their doctor.

Description

As with other types of pelvic examinations, the woman will lie on her back on an examination table with her legs sometimes raised in stirrups. The x-ray equipment is placed above the abdomen.

A speculum is inserted into the vagina by the radiologist. The cervix is numbed with a local anesthetic such as Xylocaine 1%, and sometimes an instrument called a tenaculum, is gently clamped onto the cervix to hold it steady. This is mostly painless, although the patient will feel some pressure from the clamp. A catheter (a thin tube) is inserted into the uterus through the cervix (the opening to the uterus). A tiny balloon in the catheter is

inflated to hold it in place. A liquid water-based or oilbased dye is then injected through the catheter into the uterus. As the contrast spills into and out of the fallopian tubes, some cramping, pain , and spasms usually occur. The patient might also feel a burning sensation in her pelvic cavity.

As the contract spreads through the reproductive tract, the doctor will watch for blockages or abnormalities on an x-ray monitor. Several x rays will also be taken. The procedure takes approximately 15–30 minutes. The x rays will be developed while the patient waits, but the final reading and interpretation of the x rays by a radiologist (a doctor who specializes in x rays) may not be available for a few days. Typically, the radiologist can give the patient their impression, as they watch the progress of the contrast.

Interestingly, sometimes the hysterosalpingography procedure itself can be considered a treatment. The contrast used can sometimes open up small blockages in the fallopian tubes. This happens due to the pressure created in the injection of the contrast, and it is not uncommon for the patient to become pregnant in the month or two after the exam. The need for additional test procedures or surgical treatments to deal with infertility should be discussed with the doctor.

KEY TERMS

Catheter —A thin tube, usually made of plastic, that is inserted into the body to allow the passage of fluid into or out of a site.

Fallopian tubes —The narrow ducts leading from a woman's ovaries to the uterus. After an egg is released from the ovary during ovulation, fertilization (the union of sperm and egg) normally occurs in the fallopian tubes.

Hysterography —Another term for the x-ray procedure of the uterus and fallopian tubes.

Hysterosalpingogram —The term for the x ray taken during a hysterosalpingography procedure.

Speculum —A plastic or stainless steel instrument that is inserted into the opening of the vagina so the cervix (the opening of the uterus) and interior of the vagina can be examined.

Tenaculum —An instrument used to hold onto the cervix to render it immobile.

Preparation

This procedure is generally done in the x-ray department of a hospital or large clinic. General anesthesia is not needed. A non-aspirin based pain reliever may be taken prior to the procedure to lessen the severity of cramping.

Aftercare

No special aftercare is required after a hysterosalpingography. There may be a small amount of spotty bleeding for a few hours after the procedure, as well as some contrast that may flow out of the vaginal opening therefore a sanitary napkin may be worn after the procedure. If a blockage is seen in a tube, the patient may be given an antibiotic. A woman should notify her doctor if she experiences excessive bleeding, extensive pelvic pain, fever , or an unpleasant vaginal odor after the procedure. These symptoms may indicate a pelvic infection. Counseling may be necessary to interpret the results of the x rays, and to discuss any additional procedures to treat tubal blockages or uterine abnormalities found.

Complications

Cramps during the procedure are common. It is important that the radiologist inject the contrast very slowly as a blockage might cause extensive pain if the blockage doesn't resolve from the force of the injection. The radiologist can observe this on the x-ray monitor, and adjust their technique accordingly. Rare complications associated with hysterosalpingography include pelvic infection and allergic reactions. If a patient notices a vaginal odor or unusual discharge, she should contact her own physician for treatment immediately. Although this test is relatively accurate, in some circumstances, abnormalities will not be seen on the films.

Results

A normal hysterosalpingography will show a normally shaped uterus and unblocked fallopian tubes.

Blockage of one or both of the fallopian tubes or abnormalities of the uterus may be detected. In addition, any pelvic scaring might also be observed.

Health care team roles

The technologist plays a large role in the comfort and cooperation of the patient in this exam. Being prepared with all equipment and supplies is very critical as well. It is important that the technologist be informative, gentle, and calm, as most women having this exam are stressed as a result of their infertility. The technologist can share any unusual concerns regarding the patient, with the radiologist prior to the beginning of the exam.

Training

The technologist doing the HSG is highly trained in this procedure, and must be organized and confident in his or her abilities. The technologist has often observed and assisted in numerous HSG exams, both as a student radiographer and a technologist, prior to performing them with only the physician present.

Resources

BOOKS

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. "Infertility: Hysterosalpingogram." In The Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 1996, 326-327.

Faculty Members at The Yale University School of Medicine. "Hysterosalpingogram." In The Patient's Guide to Medical Tests, edited by Barry L. Zaret, et al. Boston, MA: Houghton Mifflin Company, 1997, 263-265.