HSG / hysterosalpingography in radiology

HSG / hysterosalpingography

HSG is a special type of X-ray procedure of fallopian tubes and uterus. This procedure is about 45 minutes.

Indication

• Infertility - Infertility is the main reason for this procedure. 
• Recurrent miscarriages - recurrent miscarriages 
• Following tubal surgery - To check the tube opening after fallopian tube surgery. 
• Assessment of the integrity of a caesarean uterine scar - to check for cesarean scar. 
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• Contraindications

  • Pregnancy- Ten Day's Rule is followed. 
  • If during the inspection of the vulva or cervix of the patient, there is no purulent discharge or if the patient has PID for the last 6 months, then this procedure is not done. 
  • This procedure is not done even if the patient is sensitive to iodinated contrast media.

  • Equipmen

    • Fluoroscopy unit with spot film device .
    • Vaginal speculum

    

    • Vaginal speculum

    
    
    • Vulsellum forceps

    

    • Vulsellum forceps

    
    
    
    
    
    
    • Uterine cannula, Leech-Wilkinson cannula, Olive of 8-F pediatric foley catheter.

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      foley catheter

      
      
      

    Patient preparation

    •  Patient should stay away from sexual intercourse during appointment and examination. Or it should use reliable contraceptive method. 
    • If a woman's menstrual cycle is regular, that is, for 28 days, then she can be given an appointment from 4th to 10th day for the procedure. 

    Preliminary Film

    • A collimated view of the pelvic cavity can be taken. 

    Technique

    •  Let the patient put supine on the examination table. The knees of the patient are flexed and the legs are abducted , and the heels are kept close to each other. 
    • Using aseptic technique, the operator inserts the speculum into the vagina and the vagina and cervix are cleaned clean with chlorhexidine . 
    • The cannula is inserted inside the cervix's anterior lip with vulsellum forceps . 
    • The contrast media is inserted into the catheter with the help of a syringe. It is taken care that there is no air bubble in the syringe and the cannula. 

    Films

    As the contrast media starts filling in the fallopian tube, the undercouch takes the image from the x-ray tube. At least 4 spot films are taken.
    
    • Early filling phase
    • Uterus fully distended
    • Tubal filling phase-
    • Peritoneal spillage takes the next film as soon as it appears.

    Aftercare

    It is ensured that the patient is in a very comfortable state before discharge and there is not much bleeding.
    The patient is advised that he may have bleeding from the vagina for the next 2 -3 days, which can last up to 2 weeks.
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