Dilatation and insufflation (D&I), also known as Rubin's test, is performed to assess the patency of fallopian tubes, typically for fertility investigations or following tuboplasty. The procedure involves several steps including cervical dilation, air insufflation into the uterus, and monitoring for audible sounds to confirm results. Complications can arise immediately or remotely, including injury to the cervix or gut, infection, and the potential for pelvic endometriosis.

1. Dilatation and Insufflation
Dr. Yashika

2. Dilatation and Insufflation
(D&I)
• AlsoknownasRubin’s test.
• Operation for dilatation of cervix and insufflation of
air(CO2) in totheuterine cavity toknowthepatency
offallopiantubes.

3. Indications of D&I
• Investigationforfertility.
• Followingtuboplasty.
Contraindication:Pelvicinfections.

4. Steps of operation
1. The patient is asked to remain empty bladder.
2. Operation is done under general anaesthesia.
3. The patient is placed in lithotomic position
4. Local antiseptic cleaning is done.
5. Posterior vaginal speculum is introduced.
6. Anterior lip of cervix is grasped with Allis tissue forceps.

5. 7. Uterine sound is introduced to confirm the position and
to note the length of cervical canal.
8. Cervical canal is dilated with graduated dilators.
9. After the desired dilatation, the insufflation cannula is
introduced into the cervical canal.
10. Air is introduced in the uterus and the hissing sound is
auscultated over the flanks.

6. Test
• PositiveTest:
1. Anaudiblehissingsoundontheflanksduetoexitofair.
2. Patientcomplainsofshoulderpainonsitting.
• NegativeTest:
1. Nohissingsoundovertheflanks.

7. Complications
Immediate
• Injury to Cervix
• Injury to gut
• Uterine perforation
• Infection
Remote
• Cervical incompetence
• Uterine synechiae

8. Complications
Immediate
• Air embolism
• Rupture of tubes
• Flaring up of pre existing
pelvic infection.
Remote
• Pelvic endometriosis.

9. Thank You