BMeieene: _ Hysterosalpingogr ‘aphy It is a radiographic examination of the uterus and the fallopian ibe post commonly used in the investigation of infertility and recurrent abortion. The test is performed by the gynecologist in the supervision of the radiologist in the radiology department. QQ Anatomy- The ovaries are the female reproductive organs produce the ova and sex hormones. Ovaries are located on both sides of the uterus. The ovaries connected to the fallopian tube by infundibulopelvic ligament and with the uterus by an ovarian ligament. The uterus is a pear-shaped organ located in the female pelvis. The uterus is divided into 3 main parts: the fundus, body, and cervix, The cervix Opens into the vagina, and fundus is connected to the fallopian tubes. In the fallopian tubes the egg is fertilized then the fertilized egg moves into the uterus and attached to a wall of the uterus. The fertilized egg becomes an embryo and develops into a fetus. J Indication- © Infertility- to evaluate fallopian tube blockage and infection ¢ Continental uterus abnormalities e Suspected genital tuberculosis e Uterine fibroids, malignancy, and polyps e Postoperative evolutionPregnancy Hypersensitive to Todine Recent surgery Severe renal and cardiac disease Cervicitis (inflammation of cervix) Vaginal discharge Equipment- e Fluoroscopy unit with spot film device and cassettes Speculum Vulsellum or tenaculum forceps Cannula or Foleys catheter lodinated contrast media ionic or non-ionic Syringe Antiseptic solution Sterile towel Gauze Patient preparation- No special preparation is required for the examination Patient empties the bladder prior to the procedure HSG is done in first half of menstrual cycle in proliferative phase between 8 to 12 days. An antispasmodic is given before the examination. Procedure- On the day of examination describe the whole procedure to the patient. Technologist should obtain consent from the patient for permission of procedure,Ask the patient to remove clothing and wear a Hospital gown ‘An intravenous line is inserted into the patient arm and sedative medication is given through line to make patient relax. Place the patient in supine position on the fluoroscopic table. © If the patient is very anxious, intravenous diazepam is injected before the procedure to prevent anxiety. Two methods are common for H; 1. Using a cannula 2. Using Foley’s catheter Cannula method- The patient is placed in the lithotomic position at the edge of the X-Ray table. The vagina is cleaned with antiseptic solution and draped with the sterile towel then the gynecologist inserts the speculum to widen the vagina and holds the cervix with the help of tenaculum then intrauterine cannula inserted in the cervical canal. After placing the cannula speculum is removed and the patient is placed in Trendelenburg position (head down feet up). Under the fluoroscopic control, 5-6 ml contrast is injected to fill the uterine cavity and fallopian tube. The contrast is slowly administrated under fluoroscopic guidance till the fallopian tube filled and contrast spill in the intraperitoneal cavity. Foley’s catheter method- The patient is placed in the lithotomic position at the edge of the X-Ray table The vagina is cleaned with antiseptic solution and draped with a sterile towel then the gynecologist inserts the speculum to widen the vagina and holds the cervix with the help of cervical forceps then 8 f Foley’s catheter is inserted in the cervical canal. After placing the Foley’s catheter speculum is removed and the patient is placed in Trendelenburg position (head down and feet up).Underterosalpingogr, ENG the fluoroscopic contro}, 5. fallopian tube The contras till the fallopian tube fille, ~6 ml contrast is injected to fill the went : is slowly administrated under fluoroscopic. BF d and contrast spill in the intraperitoneal cavity 4 spot films are taken into both 1, Early filling phase 2. Uterus fully filled, 3. Fallopian tube filling phase and 4. Peritoneal spillage phase procedures in yarious phases ~ After completion of the procedure, the intrauterine cannula is removed and antibiotics are given to the patient and informed about vaginal spotting for one or two days Complication- © Pain in uterus e Infection ¢ Bleeding e Uterine perforation Fig: Hysterosalpingogram