Hysterosalpingography is a method of examination that involves injecting contrast into the uterine cavity and fallopian tubes through a catheter and using an X-ray diagnostic device to perform X-ray fluoroscopy and film taking to find out whether the fallopian tubes are patent, the site of obstruction and the morphology of the uterine cavity based on the image of the contrast in the fallopian tubes and pelvis. It is the most commonly used test to find out whether the fallopian tubes are patent, the degree of patenting and the specific site of blockage, with the use of digital X-ray machine, which can make a correct diagnosis of the blockage and has certain therapeutic effects.
Indications
1. Infertility is used to understand the cause of primary or secondary infertility. It can not only understand the presence of congenital malformations or pathological conditions in the uterus and fallopian tubes, but also whether the tubes are patent, so as to find the cause of infertility. In some cases, after hysterosalpingography, it can promote the patency of the incompetent fallopian tubes and lead to conception. 2. Find the cause of abnormal uterine bleeding, understand the condition of uterine mucosa and uterine cavity, and determine whether the abnormal bleeding is due to endometrial polyps or submucosal fibroids. 3. Tubal recanalization To recanalize the fallopian tubes after tubal ligation, it is necessary to understand the condition of the uterine tubes to decide whether surgery can be performed. 4. Tumors Observe the effects of uterine fibroids, adnexal tumors and other pelvic organs on the uterine tubes. 5. Diagnosis of malformations Uterine malformations such as bicornuate uterus, longitudinal uterus, etc. 6. Foreign body diagnosis Metal intrauterine device ectopic. 7. Adhesion diagnosis Uterine adhesions, cervical adhesions, etc.
Contraindications
1. Acute and subacute inflammation of internal and external genitalia.
2. Severe systemic diseases that cannot tolerate surgery.
3. Pregnancy, menstruation.
4. Within 6 weeks after delivery, abortion or curettage.
5. Iodine allergy.
Pre-operative preparation and examination for tubal angiography.
1. Patients should be clean for 3-7 days after menstruation and abstain from sexual intercourse.
2. Pre-operative ultrasound examination of endometrial thickness less than 8 mm.
3. Gynecological internal examination and bacterial analysis of secretions to exclude acute and subacute reproductive tract inflammation.
4. Ask if there is a history of iodine allergy. Perform iodine allergy test before imaging.
5. Empty the patient’s bladder. In case of constipation, take oral laxative before the procedure to keep the uterus in normal position and avoid external pressure artifacts.
Procedure of trans-x-ray hysterosalpingography
(1) The patient is placed in a bladder amputation position, the vulva and vagina are routinely disinfected, sterile towels are laid, and the position and size of the uterus are examined.
(2) Dilate the vagina with a vaginal speculum to fully expose the cervix, disinfect the cervix and vaginal vault again, clamp the anterior lip of the cervix with a cervical forceps and probe the uterine cavity.
(3) If a soft catheter is applied to fill the catheter with contrast, drain the air, and then insert the catheter into the cervix, plug the external cervical opening so as not to spill the contrast, observe the flow of contrast through the uterine cavity and fallopian tubes under X-ray fluoroscopy and take pictures.
Precautions after contrast surgery
1. After the imaging, it is forbidden to take a tub bath and have sex for two weeks, and antibiotics can be given as appropriate to prevent infection.
2.Sometimes tubal spasm causes the illusion of tubal incompetence, repeat if necessary.
3. A small amount of vaginal bleeding within one week after the imaging test is normal if there is no other discomfort.
4. It is best to use contraception in the same month after the imaging examination to reduce the possible effects of X-ray exposure. However, clinically it has been observed that women who became pregnant in the same month after imaging did not have an increased risk of fetal abnormalities.
5, Chinese medicine regulation, pay more attention to the hygiene situation, to avoid inflammatory infections.