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 ).
• 10-12 cm in length and 1-4 mm in diameter.
Uterine tubes
Parts :-
• Interstitial
• Isthmus
• Ampulla
• Infundibulum ,
Hystrosalpingography
Definition :-
Indications
Diagnostic role1- 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.
Thank you
Top Related