Hystrosalpingography

Anatomy of reproductive system in female Vagina Uterus Uterine tubes Ovaries

The uterus Central organ of the female pelvis. Pear shaped hollow muscular organ. size and shape of the uterus vary.

The uterus 1- Fundus. 2- Corpus (body). 3- Isthmus. 4- Cervix.

The uterus The uterus is composed of three layers. Endometrium Myometrium. Serosa.

Uterine tubes Communicate with the uterine cavity from the superio-lateral aspect between the body and the fundus (the cornu ) cm in length and 1- 4 mm in diameter.

Uterine tubes Parts :- Interstitial Isthmus Ampulla Infundibulum,

Hystrosalpingography Definition :-

Indications Diagnostic role 1- Infertility 2- Habitual spontaneous abortion 3- Abnormal uterine bleeding 4- Pelvic pain. 5- Pelvic mass or fistula 6- Congenital defects 7- Evaluation of uterine tube after tubal ligation.

Indications Theraputic role:- Narrowed tortuous or occluded tubes

Contraindications 1- Suspected Pregnancy. 2- Acute pelvic inflammatory disease. 3- Uterine bleeding. 4- Recent dilatation and curettage or abortion. 5-Contrast sensetivity. 6- Immediate pre and post menstrual phase.

Patient preparation 1- Mild laxative or cleanising enema 2- Mild pain relevier 3- Adequte reassurance and explanation of the procedure. 4- General anathesia is rarely needed. 5- Empty the bladder immediately before the procedure Why ?

Equpiments 1- Fluroscopy with spot film device. 2- Vaginal speculum. 3- Vulsellum forceps. 4- Uterine canula or 8-F paediateric foley’s catheter. 5- Syringes 50 ml. 6- Sterile gauze. 7-Lubricating gel.

Equpiments

Contrast media 1- water soluble contrast media :- Advantages:- Disadvantages:-

Contrast media 2- Oil based medium:- Advantages:- Disadvantages:-

Contrast media Amount of Contrast media

Preliminary film

Technique

Positioning Fluroscopy spot filming:-

Compications 1- Pain :- from Vulsellum forceps Passage of speculum and injection cannula Distension of the uterus with tubal spasm Pain on peritoneal spillage on use of water soluble contrast media and presist for 24 hours 2- Allergic phenomena, include urticaria. Asthma and laryngeal oedema

Compications 3- pelvic infecton :- 4- Haemorrhage 5- Venousintravasation :- Delineation by contrast medium of the uterine venous network and the pelvic veins resulting in a fine lace like pattern within the uterin wall.

Compications The factors leads to intravasation:- Direct trauma to the endometrium. Timing of the procedure near to the menstruation orwithin a few days after curettage. A high intraluminal pressure during the injection of contrast medium with tubal occlusion. Uterine abnormalities, e.g uterine T.B, carcinoma and fibroid.

Compications 6- Perforation of the uterus (v.rare). 7- Infection (rare).

After care The patient should take antibiotic and pain reliever.

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