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