This document discusses gynaecology and gynaecography. It begins by introducing gynaecography as a technique used since 1926 to visualize the pelvic organs by injecting gas into the peritoneal cavity. It can show the normal uterus, tubes and ovaries on x-ray and detect abnormalities. The document then discusses the abdominal route as the preferred method and indications for gynaecography such as evaluating uterine and ovarian size and structure when examination is difficult. It concludes by listing contraindications like acute infection or haemorrhage.

1. GYNAECOGRAPHY
MAAJID MOHI UD DIN MALIK
LECTURER COPMS ADESH UNIVERSITY
BATHINDA PUNJAB

2. INTRODUCTION
The introduction of gynaecography or
pelvic pneumography (Stein, 1926) i.e. the
injection of gas in the peritoneal cavity and
visualising the pelvic contents, has proved to
be of great usefulness in gynaecological
diagnosis. By this the normal uterus, tubes
and ovaries can be clearly visualised on the
roentgen films and often exploratory
surgery in cases of suspected lesions can be
avoided by obtaining such a film.

3.  In addition, any gross changes such as
alteration in size, shape and density of these
viscera such as one observes in uterine
myomas, ovarian cysts and tumor, tubal
enlargement and adhesions of the pelvic
viscera to omentum or to the intestine can
be seen by gynaecography. This type of
gynaecography utilizing only gas is referred
to as the "Single contrast" or "Simple
gynaecography".

4. Majority of the workers have used
abdominal route for pelvic pneumography
but others have used transuterine method
for the same, or some times in combination
with hysterosalpingogram to visualize the
uterotubal cavities as well. Dicker (1946)
described pervaginal method of
pneumoperitoneum by perforation of the
posterior vaginal fornix with a trochar,
keeping patients in knee chest position.

5. Trans abdominal route is the method of choice
in most of the cases due to following reasons:
1. It is generally easier and quicker.
2. It is more comfortable for the patient.
3. Little experience is required to obtain diagnostic
films.
4. It can be used even in cases of bleeding
pervaginal, absent vagina or uterus and cervical
stenosis, in which other routes can not be used.

6. Gynaecography a term introduced by Stein
involves the visualization of the uterus, tubes
and ovaries by means of pneumoperitoneum
plus Hysterosalpingography.

7. Pneumoperitoneum is gas or air trapped
within the peritoneal cavity, but outside the
lumen of the bowel. It is due to insufflations of
gas (Carbon dioxide or nitrous oxide) during
examination of organs inside the abdomen.
While Hysterosalpingography is an x-ray
examination of a woman’s uterus and
fallopian tubes that uses special form of x-ray
and contrast media.

8. Gynaecography technique permits an
accurate diagnosis of obscure pelvic pathology
and has been utilized successfully in many
thousands of patients during the past twenty -
five years by Dr. Stein and his group.

9. Gynaecography or pelvic pneumography is
comprehensively defined as the term used for
radiographic demonstration of the ovaries,
fallopian tubes, uterus and uterine supporting
ligaments by insufflations of gas (negative
contrast) into the peritoneal cavity.
Gynaecography is accepted as meaning gas –
contrast, pelvic organ examination. This
procedure outlines the uterus and ovaries in the
center of the gas filled peritoneal cavity.

10. INDICATIONS
Gynaecography is indicated in female patients of any age
in whom accurate assessment of the size of the uterus
and ovaries is required and particularly when accurate
bimanual examination is impossible such as in infants
and children, in virginal and obese women, in patients
with narrow introitus or patients who are so tense that
examination is unsatisfactory.
 Polycystic Ovarian Syndrome (PCOS)
 Endometriosis

11.  Virilism: it is a female disorder in which there is a
development of secondary male sexual characteristics
as a hirsutism (being hairy) and lowered voice (bass)
caused by various conditions affecting hormonal
regulation.
Amenorrhoea: is the condition when menstrual cycle
does not occur in women. It is of two types, primary
and secondary.
 Ovarian cyst.

12. CONTRAINDICATIONS
 Acute intraperitoneal haemorrhage.
Acute pelvic sepsis.
Shock.
The transuterine route for Gynaecography is
contraindicated in;
Cervicitis
Suspected pregnancy
Uterine bleeding
Tubal obstruction and
Intact hymen.

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