Hysterosalpingography ppt aimed for knowledge of UG Ayurveda students

1. Hysterosalpingography
Dr Rupali Mahadik
Principal/Prof
PAMCHRC Lucknow

2.  It is radiological visualization of the uterus
and fallopian tubes after introducing radio
opaque dye through the cervix.
 Time of Procedure-
Post-menstrual phase-between 4th and 7th
day after the last day of the period.
If done in the premenstral phase chances of-
a.Disturbing the conception
b. False +ve results
Risk of endometriosis if done during bleeding

3. Contraindications
 Vaginal bleeding
 Vaginal or cervical infection
 Genital tuberculosis
 Pelvic(adnexal) mass
 Pelvic infection
 Pregnancy(suspected)

4. Preparation-
 An enema to expel out gases from the colon to
get a clear picture
 Inj. Atropine to avoid cornual spasm
Anaesthesia-
no anaesthesia is required.
Instruments-
 Instruments for visualising the cervix
 Tenaculum forceps
 Uterine sound
 Rubin’s/Wilkinson’s cannula
 Luer Lock syringe 20 ml

6. Steps-
This procedure is done on X-ray table.
 Cervix is visualised.
 Both the anterior and posterior lips of cervix are caught
by two tenaculum forceps.
 Uterine sound is passed to assess the direction and the
size of the uterus.
 After confirming that the cannula can pass through the
os, the syringe is filled with the dye.
 The cannula is fitted to the syringe and all the air in the
syringe and the cannula is expelled out.
 The cannula with the syringe attached is introduced
through the cervix into the uterine cavity. The cork of
the cannula should be adjusted to fit snugly on external
os.
 Slight pull is given on tenaculum forceps, while the
cannula is gently pushed in, to avoid leakage of the dye
from he cervix in the vagina.
 The dye is slowly instilled into the uerus.
 Radiological pictures are taken thereafter.

7. Interpretation-
 Peritoneal spill on both the sides indicates the tubal
patency
 Any abnormality in the uterine cavity or the tubal
lumen can be visualized.
Complications-
Occasional patient may develop anaphylactic shock
due to the sensitivity to the dye.
Advantages-
 Simple, short procedure not requiring anaesthesia
 Exact location and the nature of the block can be
known thus further surgical treatment can be
planned.
 Uterine abnormalities like bicornuate uterus,septate
uterus,submucous fibroid etc can be diagnosed
 Uterine synechia can be diagnosed by honey-comb
appearance.
 Unsuspected tubal tuberculosis can be diagnosed-

8. Following are radiological H.S.G. features vary
typical of genital tuberculosis-
1. Rigid pipe-stem tubes
2. Vascular or lymphatic intravasation of contrast.
3. Small shrunken uterine cavity with filling defects.
4. Bilateral Cornual block
5. Cervical incompetence can be diagnosed
6. Internal os wider than 8 mm (funneling)
 May act therapeutically by breaking flimsy tubal
adhesions.
1. Disadvantages-
2. Cannot diagnose extra-tubal,extra uterine
pathologies, nor pelvic adhesions.

9. Normal look of tubes at H.S.G
Pl.note wavy outline of tubes spill on both side

10. Bilateral cornual block & Intravasation.

11. Bil hydrosalpingx.

12. Bil. T.O.masses

13. Bil. Cornual block,cervical dilatation

14. Deformed Ut..

15. Rigid pipe line tubes of proved kochs