How much do you know about hysterosalpingography? What should you pay attention to before and after the examination?

Author: Miao Jie, deputy chief physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Reviewer: Liang Yuting, Chief Physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Among the causes of female infertility, fallopian tube factors account for approximately 30%-40%.

Clinically, hysterosalpingography under X-ray, also known as HSG, is the most commonly used method to check the patency of the fallopian tubes. It is simple to operate and can understand the patency of the fallopian tubes by observing whether the contrast agent can smoothly pass through the uterine cavity and fallopian tubes into the pelvic cavity.

Figure 1 Original copyright image, no permission to reprint

After contrast agent is injected into the uterine cavity, if the fallopian tubes can be observed to develop quickly under X-ray, and the position, course and shape of the fallopian tubes are normal, and the contrast agent can smoothly enter the pelvic cavity through the fallopian tubes, it means that the fallopian tubes are unobstructed. Observe again after an interval of 20 minutes. If the contrast agent can be evenly applied in the pelvic cavity with intestinal peristalsis, it indicates that there is no obvious adhesion around the fallopian tubes, and infertility caused by fallopian tube problems can be basically ruled out; if the above manifestations cannot be observed, it is necessary to consider that fallopian tube factors may be one of the causes of infertility.

The most commonly used contrast agent for salpingography is iodine-containing contrast agent. A few people are allergic to iodine. Since the contrast agent is not injected into the blood vessels, the allergic reaction is generally mild. For patients with allergies, B-ultrasound hysterosalpingography can be selected, but because it is not as accurate as HSG or hysteroscopic tubal insufflation, and the operation is relatively complicated, it is not commonly used in clinical practice.

Some patients may worry that salpingography will cause harm to the body, but this is unnecessary. Although there is some ionizing radiation during the hysterosalpingography examination, the dose is very low. The X-ray dose currently used for medical diagnosis is within the safe range and generally does not cause harm to the body. However, the injection of drugs during the hysterosalpingography process will increase the pressure in the uterine cavity, and some patients will feel a little uncomfortable, but generally they can tolerate it.

There are regulations in the industry regarding the timing of hysterosalpingography. If the menstruation is regular, the examination is generally required to be done three to seven days after the menstruation ends. Patients with irregular menstruation need to follow the doctor's arrangement to choose a suitable time, and they should not have sex during the month of the examination.

Figure 2 Original copyright image, no permission to reprint

Because there will be some pre-examination tests before the angiography, do not wait until the seventh day. You should come to the hospital as soon as possible after your menstruation is completely over. At this time, the doctor will conduct pre-examination tests on the patient, such as vaginal secretion examination, including fungus, bacteria, Trichomonas, cleanliness, and pregnancy test, blood test, etc. Only after the test is qualified can the fallopian tube angiography be arranged.

If the test is unqualified, you can come back for a reexamination after treatment, and arrange for angiography after the reexamination is qualified. Therefore, for some particularly anxious patients, it is better to see a doctor as soon as possible so that the examination can be completed within a menstrual cycle. If you are not in a hurry, you can take medicine first and then do angiography three to seven days after the next menstrual period.

The process of contrast examination is actually not complicated. After all the preparations are done, the patient is asked to lie on the examination bed, and then routine disinfection, towel laying, cervix exposure, and the examination tube is inserted and fixed before the injection of medicine. Fluoroscopy and filming are intermittent during the injection of medicine. If everything goes well, the examination can be completed in a few minutes.

Sometimes the patient is nervous or feels pain and needs to calm down. Sometimes the uterus is stimulated and the fallopian tube is spasmodic, so it is necessary to wait a while. During the examination, the doctor will chat with the patient to distract the patient and let the patient relax. It usually takes more than ten minutes to complete. After the examination, the patient can get out of bed and move around for a while, and come back after 20 minutes to take a delayed film to observe the application of contrast agent in the pelvic cavity.

After the examination, please note: no tub bathing and no sexual intercourse during the month.

In addition, the doctor will give advice on whether antibiotics are needed based on the situation at the time. The patient should observe whether there is vaginal bleeding. Generally speaking, a small amount of bleeding is normal. If the amount of bleeding is more than the menstrual volume, you should seek medical attention in time.

Some patients will experience lower abdominal pain and discomfort after the examination, which will usually be relieved slowly after a few hours. If it does not relieve or even the symptoms worsen, you should see a doctor promptly.

Finally, I would like to remind you again that some patients may experience an allergic reaction to contrast agents. Allergic reactions can be immediate or delayed. If it is an immediate type, symptoms will appear during the examination, and the doctor will promptly treat it after discovering it. If it is a delayed type, symptoms will appear one day or even a week after the examination. Delayed allergic reactions are generally not particularly serious, and are mainly manifested by symptoms such as rash, itchy skin, or dizziness. After the examination, remember to drink plenty of water to speed up the excretion of contrast agents.