How to do hysterosalpingography

Hysterosalpingography is a common gynecological examination method. Through this radiographic examination, we can understand some symptoms of the fallopian tubes and uterus, and whether the fallopian tubes are unobstructed or blocked. Generally, this examination is relatively safe, without obvious pain, and patients can basically accept it. Of course, before the operation, the patient must make some preparations and prevent infection after the operation.

Surgical procedures

1. When doing angiography, the patient lies supine on the X-ray machine operating platform and takes the lithotomy position. Routinely disinfect the vulva and vagina, lay sterile towels, and check the position and size of the uterus again.

2. Observe the flow of contrast agent through the uterine cavity and fallopian tubes under X-ray fluoroscopy and take X-rays. Under fluoroscopy, iodized oil was slowly injected. The first injection volume is 3~5ml. Observe its entry into the uterus and flow through the fallopian tubes, and take a film at this time. Continue to push in 3 to 5 ml of iodized oil and take an X-ray after 5 to 10 minutes.

3. Use a speculum to dilate the vagina, expose the cervix, disinfect the cervix and fornix with iodine, fix the anterior lip of the cervix with a cervical clamp, and explore the uterine cavity. Fill the cervical catheter with iodized oil and remove the air in the tube, then insert it into the cervical canal along the direction of the uterine cavity. Tighten the cervical clamp so that the conical rubber head of the catheter fits tightly against the cervix to prevent leakage during injection.

4. In case of contraction or spasm of fallopian tube, acupuncture can be performed on the Hegu and Neiguan points or intramuscular injection of drugs. Take a third film at the same location 24 hours later to observe whether there is free iodized oil in the abdominal cavity. If a clear-boundary iodine mass is seen, tubal adhesions may be considered. If both sides of the fallopian tubes are blocked, there will be no diffuse iodized oil image in the pelvic cavity. If there is a small amount of iodized oil image and residual fallopian tube images, the fallopian tubes may be obstructed.

Preoperative preparation

1. The imaging time is selected from 3 days after the end of menstruation to before ovulation, that is, between the 7th day and the 4th day of the menstrual cycle. If you want to understand the condition of the internal cervical os, you should have angiography after ovulation.

2. No acute or subacute pelvic inflammatory disease, such as no inflammatory masses or tenderness in the adnexa on both sides, and body temperature below 37.5℃.

3. Examination of leucorrhea suspension showed no Trichomonas or fungal infection in the vagina.

4. Avoid sexual intercourse and deep water baths 3 days before and 2 weeks after angiography to prevent infection.

Postoperative precautions

1. Do not take a bath or have sexual intercourse for two weeks after angiography. Antibiotics may be given as appropriate to prevent infection.

2. Sometimes tubal spasm may cause the illusion of tubal obstruction. Repeat if necessary.

3. A small amount of vaginal bleeding within one week after the angiography is normal if there is no other discomfort.

4. It is best to practice contraception for three months after the contrast examination to reduce the possible effects of X-ray exposure. However, clinical observations have found that women who become pregnant in the same month after angiography do not have an increased risk of fetal abnormalities.