1. HSG, or hysterosalpingography, is a radiographic procedure used to evaluate the uterus and fallopian tubes. It requires proper technique and positioning of the uterus using a vulsellum for optimal evaluation of the uterine cavity. 2. Precautions should be taken during an HSG if intravasation is seen, such as slight withdrawal of the cannula and treatment for pelvic inflammatory disease if pain and vomiting occur post-procedure. 3. Cornual blockages seen on HSG may be due to spasm or plugging and can sometimes be treated with a flexible tip guidewire or Buscopan injection under expert guidance.

1. HSG
Department of reproductive medicine
Bansal hospital
Dr Pallavi Agrawal / Dr Jayant Yadav

2. case 1
• 24 years female married for 3 years
- HSG – reported as small uterus
- advised against pregnancy

6. • HSG – has a role in uterine cavity evaluation
• Improper centralization of uterus will not allow us cavity evaluation
• So proper traction is required with vulsellum

7. Case – 2
• 26 years female k/c/o PCOS
• Has been given 3 cycles of ovulation induction
• HSG – reported as B/L free spill
• Further planned for 3 cycles of OI

10. • Prevalence – 0.4- 6.9%
• Level – 0 - no
- 1- up to myometrium
- 2 – parametrial vessel
- 3 – pelvic vessels
• Fat embolism In oil based contrast
• More common during preovulatory phase

11. case – 3
• Para 3001 with secondary infertility of 2 years
• Previous 3 vaginal delivery
• HSG – B/L fimbrial block

15. • Proper size of leech Wilkinson cannula
• Keep extra dye in hand

16. Case 4
• 26 years married for 1 year
• After HSG having pain and vomiting
• HSG – B/L cornual block
• Treated for PID
what precautionary measures should be taken here

19. Slightly withdrawal of cannula should be done - if intravasation is seen
along with pain

20. Case 5
• HSG – reported as B/L cornual block
• Someone suggested repeat HSG after few days
• Do you agree with repeat HSG idea or something else

24. • Upto 2/3rd of cornual blocks are either due to spasm or plugging
• Flexible tip guidewire is an option in experts hand
• Buscopan injection
• Rotation of patient to 45 degree

25. Case - 6
• HSG – showing filling defect
• What are the differential diagnosis

31. • Air bubble – moves
• Synechiae – irregular edges
• Polyp – regular edges
• Submucosal fibroid
Clinical history of patient along with sonographic details can help in
correct interpretation

32. Case - 7
- P0010 – HSG reported as bicornuate uterus
- advised for fertile period

35. • Septate uterus is more common anomaly than bicornuate uterus
• HSG has accuracy of 75%
• 3 D sonography has accuracy of 98%

36. Case - 8
• 30 years female with BMI 21
• Complains of decreased blood flow during periods
• HSG – B/L distal tubal block
• Please comment upon HSG films

40. • Right tubal involvement more than left
• Cornual block is uncommon
• Midtubal block is more common
• Loculated spill is also seen

41. Case 9
• Para 0100 – underwent HSG
• Reported as normal

43. • There is little evidence of importance of dilated internal os in HSG and
pregnancy outcome
• History in these cases is helpful

44. Case 10
• P0010 – has history of menorrhagia
• HSG – attached

48. • Whenever one cavity is shown only we have to look for another
• Incidence of unicornuate uterus is 0.3%

49. CASE-11
• 23 years lean PCOS patient was given clomiphene citrate 150 mg
• HSG was planned on day 10 of period

52. 13 -
• What is the choice of pain relief for HSG

53. Case - 14
• 30 years P0030 underwent USG
• s/o – right ovarian cyst
• HSG – was ordered after 3 months of OCS

56. Case -15
• P1001 with prolonged heavy bleeding during periods

59. Case 16
• Again pain during HSG , but post procedure pain decreased
significantly