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Sonosalpingography. Dr. Sharda Jain, Dr. Jyoti Agarwal

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Evaluation of fallopian tubes forms an essential part of evaluation
Tubal pathology is a cause of infertility in 30- 35% of infertile patients
Tubal Assessment
Fallopian tubes can be assessed by:
Hysterosalpingography
Hysterosalpingo-contrast-sonography (HycoSy)
Sonosalpingography

Laparoscopy & CHROMOTUBATION

Published in: Health & Medicine
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Sonosalpingography. Dr. Sharda Jain, Dr. Jyoti Agarwal

  1. 1. SonosalpingographySonosalpingography Dr JYOTI AGARWALDr JYOTI AGARWAL Dr. sharda jainDr. sharda jain
  2. 2. Evaluation of fallopian tubes forms an essential part of evaluation Tubal pathology is a cause of infertility in 30- 35% of infertile patients
  3. 3. Tubal Assessment Fallopian tubes can be assessed by: 1. Hysterosalpingography 2. Hysterosalpingo-contrast- sonography (HycoSy) 3.3. SonosalpingographySonosalpingography 4. Laparoscopy & CHROMOTUBATION
  4. 4. SONO-HYSTERO SALPINGO-GRAPHY • It is a procedure for testing tubal patency similar to HSG HyCoSy done under transvaginal ultrasound guidance using sterile saline. It can also be used to investigate endometrial and the endometrial cavity.
  5. 5. Indications • Infertility • Prior to assisted conception • Abnormal uterine bleeding. • Recurrent pregnancy loss to assess the cavity. • Amenorrhea or oligomenorrhoea
  6. 6. CONTRAINDICATIONS Infection Pregnancy
  7. 7. The normal and healthy fallopianThe normal and healthy fallopian tubes are usually not seen bytubes are usually not seen by transvaginal sonography unlesstransvaginal sonography unless they contain fluid within theirthey contain fluid within their lumen or are surrounded by fluid.lumen or are surrounded by fluid. Tubes not visualized because :Tubes not visualized because : 1.Small diameter < 4 mm 2.Serpinginous course
  8. 8. SONOSALPINGOGRAPHY (SION TEST) Sonosalpingography (SSG) uses transvaginal sonography to confirm tubal patency by visualizing turbulence near the fimbrial end when a mixture of air and saline is injected through a Foley’s catheter placed within the uterus.
  9. 9. Concept of SSG
  10. 10. Sonosalpingography Negative contrast Sonosalpingography ( Saline & Air mixture ) Positive contrast Sonosalpingography ( Echovist )
  11. 11. ‘Sion test’ using sterile saline solution as a negative contrast medium alongwith with transvaginal ultrasound one canone can evaluate the tubal patency, image theevaluate the tubal patency, image the uterine cavity and assess the pelvisuterine cavity and assess the pelvis
  12. 12. Instrumentation
  13. 13. Procedure Post menstrual Informed consent Premedication (30 minutes prior to procedure) . Inj.Diclofenac 1 amp x i.m. Or . Inj.Buscopan 1 amp x i.m.
  14. 14. Timing: Best done is the proliferative phase.
  15. 15. Preparation onlypreparation necessary for the patient is to empty the bladder.
  16. 16. sonohysterography, allows identification of intracavitary lesions and helps determine whetheran abnormality is endometrial or subendometrial.
  17. 17. The Thickened endometrium may be a polyp catheter
  18. 18. broad-based, hypoechoic, With myomas the endometrial- myometrial interface is distorted The Thickened endometrium may be a Submucosal leiomyomas
  19. 19. BenefitsBenefits Office procedure Low technology / Low cost Better resolution Better tolerability No radiation exposure Each tube can be assessed separately Provides an accurate and more complete assessment of uterine anatomy
  20. 20. LimitationsLimitations Site of the tubal block not identified Intra tubal mucosal pathology not identified Mobility of tube not assessed There is risk of infection and pain.
  21. 21. Adverse Events Pain & cramps in lower abdomen – 20% Severe pain – 4% Refered shoulder pain Bleeding 3 % Infection – 0 -1%
  22. 22. 85100502000Dijkhuizen 85100391998Williams 91871041998Schwarzler 76991091997Bernard 100100341997Keltz 10096471996Wolman 100961301995Widrich 94100581993Parsons 100100141993Syrop 9796961992Bonilla-Musoles Specificity %Sensitivity %nYearAuthor
  23. 23. HSGHSG SSGSSG Sensitivity Specificity Sensitivity Specificity Randolf et al (1986) 97 93 99 95 Sharma R.P. (1989) ------------------- 98 96 Tufekci et al (1992) ------------------- 90 96 Allahabadia et al (1992) 88 80 98 91
  24. 24. USP of SonosalpingographySonosalpingography • The accuracy of saline SSG is comparable to office hysteroscopy in detecting polyps, fibroids and focal endometrial thickening. It is better than HCG and transvaginal sonography in detecting abnormalities of uterine cavity and cause less pain than hysteroscopy and concurrent assessment of uterine cavity and tubal patency is possible a now it is to foured in all infertility guidelines.
  25. 25. Sensitivity Specificity SSG 98% 94% Our Experience 5000 plus cases We are very happy with test
  26. 26. CONCLUSION Sonosalpingography (Sion test) is an inexpensive , noninvasive , simple screening test that can be done in the gynecologist's office at the same time with endometrial sampling in infertility evaluation. Our experience of 5000 plus cases speaks volume about it.
  27. 27. Sonohysterosalpingography • It is a procedure for testing tubal patency similar to HSG HyCoSy done under transvaginal ultrasound guidance using sterile saline. It can also be used to investigate endometrial and the endometrial cavity.
  28. 28. ISO 14001:2004 (EMS) …..Caring hearts, healing hands ISO 9001:2008 HELPLINE-9650588339/22414049 HELPLINE-9599044257 HELPLINE-991008148 ISO 9001:2008 HELPLINE 9599044357

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