Hysterosalpingography (HSG) of the fallopian tubes, manual. Hysterosalpingography procedure Brown discharge after HSG

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Reasons why some women for a long time doesn't work out to get pregnant, they find a lot. One of them is obstruction fallopian tubes. To identify such a pathology, special studies are prescribed. Find out how to check the patency of the fallopian tubes. Understand this diagnostic procedure, preparation and consequences.

What is hysterosalpingography

This difficult-to-pronounce concept means a special medical procedure or x-ray. It is carried out to check the condition of the uterus and fallopian tubes, as well as assess their patency. Indications for hysterosalpingography are cases when women cannot conceive a child for a long time or they have already had several miscarriages.

Checking the patency of the fallopian tubes

There are 3 methods used to check the patency of the fallopian tubes. The main one is hysterosalpingography. The procedure involves an x-ray of the fallopian tubes. First, a rubber tip is inserted into the cervix, and through it a thin tube called a cannula is inserted. Through the latter, a coloring substance, often blue, enters inside. Then, using the rays of an X-ray machine, a picture is taken. It shows the structure of the uterine cavity and the tubes extending from it. Other methods for studying these organs include:

Echohysterosalpingography

Assessment of the condition of the fallopian tubes and uterus using ultrasound is carried out using a monitor, and not from an image, as with HSG. Its advantage is the absence of radiation exposure. In addition, echography is also carried out without hospitalization of the patient. The recommended time for the procedure is the day before ovulation. The advantage of this valuable period is that the cervix is ​​relaxed. To prepare for an ultrasound scan, a woman only needs to not eat for 2-3 hours before the procedure. In case of increased gas formation, the gynecologist may prescribe Espumisan, which is taken for 2 days before the test.

To conduct an echography, a woman must pass the following tests: for hepatitis, HIV, syphilis and vaginal microflora. This is necessary to exclude the presence of viruses in the body. During the procedure, patency is indicated by the fact that the contrast medium freely passes through the fallopian tubes and enters the abdominal cavity. Based on reviews from women, we can conclude that after ECHO-HSG there is slight pain that goes away during the day.

X-ray for tubal patency

X-rays or HSG examine the fallopian tubes only in non-pregnant women, because radiation is harmful to the embryo. In such cases, use the previous method, i.e. echography. X-rays are more informative and it is easier to assess the condition of the abdominal organs. The procedure has some disadvantages. Among them are:

1. exposure to radiation, albeit in a small dose;
2. possible allergic reactions to the contrast agent;
3. mechanical damage to the epithelium with subsequent bleeding.

Price of hysterosalpingography

Regarding the cost HSG uterine pipes, it depends on the chosen method. IN state clinic any such procedure will be free. In private institutions, the price for x-rays varies from 1500 to 5000 rubles, and for ECHO-HSG - from 5000 to 8000 rubles. There is variation due to the variety of procedures. The upper bar also includes other services:

• consultation with a gynecologist;
• conducting an examination under anesthesia;
• husband's presence at the event.

How to check the patency of pipes

With any method of studying the patency of the fallopian tubes, everything begins with an examination by a gynecologist and the appointment of a test. necessary tests. In addition, the doctor must choose the time when it is best for the patient to undergo the procedure. To avoid inaccurate results, the specialist must be sure that on the day of the examination the woman’s uterus will be in a relaxed state, then the risk of spasms is much less. After passing mandatory tests And proper preparation The procedure itself is carried out to determine the patency of the fallopian tubes.

What tests are needed for HSG

The first on the list of necessary tests are general studies urine, blood and its biochemistry. Tests for syphilis, HIV, and hepatitis are mandatory. You also need to take a vaginal smear to study its microflora. When ordering an x-ray of the fallopian tubes, be sure to do a pregnancy test or take a blood test for hCG. This study is a difference between the preparation process for HSG and ECHO-HSG, because the latter can be used for pregnant women.

Preparation for HSG tubes

This procedure requires special behavior from the woman in the several days before the test date. The latter occurs exclusively on days 5-9 menstrual cycle. The preparation for tubal HSG includes the following rules:

1. 1-2 days before HSG you need to stop having sexual intercourse.
2. During the week before the examination, douching procedures and the use of special means personal hygiene, i.e. tampons.
3. Use should be stopped one week before the examination. vaginal suppositories, sprays or tablets unless approved by a doctor.
4. On the day of the examination, it is better to remove excess hair on the external genitalia.
5. Be sure to empty before HSG bladder and intestines. If there was no stool, then you need to perform a cleansing enema.

Consequences

Even the safety of the HSG procedure does not guarantee the absence of negative consequences. First on the list is an allergic reaction to the contrast agent. This phenomenon is typical for women who have previously had such “answers” ​​during other examinations. Allergies can also occur in patients suffering from bronchial asthma. Even less common are bleeding, infection, or perforation of the uterus.

X-ray radiation does not pose any danger to a woman at all, because its dose of 0.4-5.5 mGy is much lower than that which could lead to tissue damage. In most cases there is pain and minor bleeding go away on their own within a few days. The main thing is to limit yourself from tampons, douching, and visits to the bath, sauna or bathhouse. If the blood does not go away within a couple of days, it is also accompanied by unpleasant smell, then consult your doctor.

Pregnancy after having your tubes checked

Doctors do not have an exact scientific basis for why pregnancy develops after HSG. Statistics indicate that this procedure actually increases the percentage of a woman’s ability to conceive a child. This happens especially often when testing for tubal patency is carried out using oil contrast agents. For this reason, some delay in menstruation after HSG may indicate not only stress experienced by the woman, but also possible pregnancy, which is definitely worth checking out.

Hysterosalpingography (another name for metrosalpingography) is an examination method that allows you to see the internal outlines and. There are two types of this procedure: using x-rays or using ultrasound. Classic hysterosalpingography is a radiological examination, that is, it takes a series of x-rays.

Which is better: ultrasound or x-ray?

As mentioned above, there are two types of hysterosalpingography: using ultrasound (another name for sonohysterography) and using x-rays. When comparing these examination methods, it is impossible to select the best one, since each is designed for a specific purpose.

Sonohysterography (HSG with ultrasound) is used mainly to examine the uterine cavity. Using this examination, abnormalities in the development of the uterus, deformation of the uterine cavity, and others can be detected. possible reasons infertility. But an ultrasound examination cannot reliably determine whether the fallopian tubes are passable.

Hysterosalpingography with x-ray is the main method for assessing tubal patency. Most experts believe that x-ray method indispensable if you need to check the fallopian tubes.

In what cases is hysterosalpingography prescribed?

Hysterosalpingography is widely used in the diagnosis of infertility, as it allows you to determine the shape of the uterine cavity and determine whether the fallopian tubes are passable. This type of examination can be prescribed:

• If you suspect obstruction of the fallopian tubes (for example, as a result of adhesions due to and other diseases)
• If there is a suspicion of abnormalities in the structure of the uterus (bicornuate uterus, underdeveloped uterus, septum in the uterus, etc.)
• If you suspect or
• Before ovulation stimulation (for example, with)
• If you suspect

In what cases should hysterosalpingography not be performed?

Contraindications to this procedure are:

• Pregnancy or suspected pregnancy
• Inflammatory diseases of the vagina or uterus
• Severe uterine bleeding

How should you prepare for hysterosalpingography?

Some time before the procedure, you should visit a gynecologist and take a test. This examination will ensure that there is no inflammation in the vagina and cervix that could penetrate the uterus during hysterosalpingography. If inflammation is detected, hysterosalpingography cannot be performed until complete cure. Also, before the examination, you may be prescribed tests for HIV infection, viral hepatitis etc.

Ask the doctor who will perform the procedure whether there is a need for prophylactic intake antibiotic before hysterosalpingography.

On what day of the menstrual cycle can hysterosalpingography be done?

If you use protection during sex and pregnancy is excluded, then hysterosalpingography can be performed on any day of the cycle, except for the days of menstruation.

If you are not using protection, then it is better to carry out the procedure in the first half of the cycle (immediately after the end of your period), since on these days the probability of pregnancy is the lowest.

Is hysterosalpingography painful?

This procedure is painless, but may seem somewhat uncomfortable or unpleasant. Anesthesia is not required for hysterosalpingography. In order to reduce discomfort During the procedure, the gynecologist may apply a local anesthetic to the cervix.

How is hysterosalpingography performed?

So, you will be asked to sit in a gynecological chair with your legs spread, as during a simple examination. The gynecologist will insert a speculum into the vagina, which will help him see the cervix. After treating the cervix with an antiseptic (so as not to introduce infection into the uterus) and local anesthetic(to reduce discomfort), the gynecologist will insert a special catheter into the canal (through which a contrast agent will be injected into the uterus) and remove the speculum from the vagina. You will be asked to position yourself under the X-ray machine. After this, a contrast agent will be injected into the uterus through a catheter. During the administration of the substance, a series of x-rays are taken. At the end of the procedure, the catheter will be removed.

What substance is injected into the uterus during hysterosalpingography?

Since the uterus and fallopian tubes are not visible on a simple x-ray, special substances that do not transmit x-rays are used to detect them. These substances are called contrast agents.

For hysterosalpingography, contrast agents Verografin, Urografin, Triombrast, Ultravist and others are used. All these substances contain iodine. These drugs are sterile, so if the procedure is performed correctly, there is a risk of infection of the uterus or other internal organs minimal.

How will you feel after hysterosalpingography?

Discharge: After a hysterosalpingogram, you may have a thick, dark brown discharge that resembles blood. This is where the remains of the contrast agent come out, and possibly pieces of the endometrium (the inner lining of the uterus). Use if discharge occurs.

Pain: Minor painful sensations in the lower abdomen after hysterosalpingography are also possible. They are associated with contractions of the uterus, which may be “irritated” by the procedure. To eliminate pain, you can take a No-shpa tablet.

What complications are possible with hysterosalpingography?

Complications of hysterosalpingography are very rare if the procedure is performed correctly. There is some risk of the following complications:

• An infection that enters the uterus from the vagina or cervix can lead to the development of inflammation of the uterine mucosa (acute or).
• Allergy to contrast agent. If you are allergic to iodine or other substances, be sure to inform your gynecologist.

The risk of damage to the uterus or fallopian tubes is very small, especially if the hysterosalpingography is performed by an experienced gynecologist.

Be sure to contact your doctor if:

• Vaginal discharge does not stop within 2-3 days after the procedure, or has acquired an unpleasant odor
• Body temperature after the procedure increased to 37.5C ​​or higher
• You severe pain lower abdomen
• You severe weakness, nausea, vomiting after hysterosalpingography

What are the normal results of hysterosalpingography?

Normally, the images show the uterus triangular shape, from which two fallopian tubes depart, looking like winding “strings”. There may be spots at the ends of these “strings” indeterminate form, which indicate that the contrast agent has passed through the fallopian tube and “poured out” into abdominal cavity. This is a sign that the fallopian tubes are patent.

If only one thread extends from the triangle, then only one fallopian tube is passable; if there are no threads at all, then both tubes are impassable.

When can you plan a pregnancy after hysterosalpingography?

Since during X-ray hysterosalpingography a contrast agent is injected into the uterus, it is not recommended to plan a pregnancy in the same cycle. You will be able to start conceiving a child in the next menstrual cycle (after the end of your regular period).

It is one of the most informative in diagnosing diseases of the pelvic organs. HSG, or hysterosalpingography, is another additional imaging modality that can provide a more complete picture of the anatomy and functional state uterine cavity and fallopian tubes. It is especially widely used to diagnose the causes of infertility.

Preparation for hysterosalpingography

Timing of the procedure depend on the presumptive diagnosis and purpose of the study. To assess the patency of the fallopian tubes, as well as to clarify the presence or absence of internal endometriosis and adenomyosis, HSG is performed on days 5-8 of the menstrual cycle, if cervical insufficiency is suspected - in its second phase (on days 18-20). Diagnosis of the volume and boundaries of the submucosal (under the mucous membrane) myomatous node is carried out on any day of the menstrual cycle, provided there is no heavy discharge blood from the genital tract.

Indications and contraindications

Indication to hysterosalpingography is the assumption of the presence of:

1. Isthmic cervical insufficiency- expansion of the cervical canal and its internal pharynx up to 5-7 mm.
2. Anomalies of the development of the uterus and appendages.
3. Submucosal fibroids or synechiae (adhesions in the uterine cavity).
4. Adenomyosis, endometrioid cancer, polyps, genital tuberculosis.

One of the stages of preparation is examination of the patient by a gynecologist and preliminary studies in order to determine not only indications, but also contraindications for HSG.

Contraindications:

1. Assumption about the possibility of pregnancy.
2. Pregnancy and breastfeeding.
3. Bloody issues from the genital tract.
4. Acute infectious diseases.
5. The degree of vaginal cleanliness is below grade II and acute inflammatory processes of the genital organs or urinary tract- bartholinitis, vaginitis, cervicitis, salpingoophoritis, urethritis, cystitis, pyelonephritis.
6. Severe chronic somatic diseases.

• stopping the use of vaginal medicinal products and douching 7 days before the test, unless prescribed by a doctor, and within 3 days after the procedure;
• refusal of sexual intercourse or use of contraception during the menstrual cycle during which the examination is planned;
• no sexual intercourse for 1-2 days before the procedure and 2-3 days after the study;
• exclusion from the diet of foods that promote gas formation in the intestines 3-4 days before the test, cleansing enemas the night before and in the morning on the day of the procedure.

Hysterosalpingography is normal

How the research is carried out

The method exists in the form of two options, depending on the equipment used - radiopaque (Rg-HSG) and sonographic or ultrasound (US-HSG). In any case, hysterosalpingography is performed on an empty stomach without the use of anesthesia.

The procedure may cause the patient being examined a feeling of discomfort, discomfort in the lower abdomen and minor pain. Therefore, in case of psycho-emotional instability and high excitability, fear about the procedure and at the woman’s request, it is possible to introduce sedatives or administering adequate general intravenous anesthesia.

The study is carried out on a gynecological chair. After a preliminary examination and induction of anesthesia (if necessary), a special balloon catheter with a length of about 35 cm and a lumen diameter of 0.2 cm is inserted into the cervical canal. It is equipped with a cone-shaped balloon that ensures tightness in the area of ​​the external os of the cervix.

Through the outer end of the cannula, 2.5-3 ml of a radiopaque or echo-contrast solution is injected into the cervical canal with a syringe and x-ray or examination on the screen (in the case of ultrasound-HSG) of the inner surface of the uterine cavity. Then about 4 ml of contrast solution is injected, thereby achieving tight filling of the uterine cavity and exit of the solution through the fallopian tubes into the pelvic cavity (to check the patency of the tubes). This is also recorded by photograph or inspection. If necessary, control is carried out by repeated administration of another 3-4 ml of solution. Total the latter is 10-20 ml.

In order to diagnose isthmic-cervical insufficiency and determine its cause, adrenal progesterone test . When performing HSG on the 18th day of the menstrual cycle, a sharply narrowed cervical canal and its internal os are normally detected. If they are dilated, the named test is performed.

It helps to determine whether the disorders are organic or functional. The essence of the test is the subcutaneous injection of 0.5 ml of 0.1% adrenaline. 5 minutes after this, a control HSG is performed. If narrowing cervical canal did not happen, then in the evening of the same day, oxyprogesterone capronate (0.125 g) is injected into the muscle, followed by repeating the previous procedure after 4 days.

For functional cervical insufficiency caused by insufficiency corpus luteum, after its correction with oxyprogesterone, a sharp narrowing of the channel occurs, in the case of organic cause its expansion it remains the same.

Thus, ultrasound hysterosalpingography and X-ray HSG In terms of technical performance, they are almost no different. They are also equivalent in terms of information content. The main difference between the methods is:

1. Contrast solutions used. In the case of ultrasound-HSG, an echo-contrast solution is used that does not cause allergic reactions - a 10% glucose solution or echovist, which is galactose granulate in a bottle. It is dissolved immediately before the study to a 20% suspension with a solvent added to the preparation. For X-ray HSG, iodine-containing X-ray contrast agents are used - Verografin, Triombrast, Urotrast or Cardiotrast. Their administration should be preceded by a sensitivity test, since any of these drugs can cause a severe allergic reaction.
2. Degrees of impact physical factors(radiation). US-HSG is based on the use of the effect of ultrasonic waves, which do not cause negative influence on the genitals. Despite the fact that a small dosage of X-ray radiation is used to perform Rg-HSG, nevertheless, with repeated images it has a cumulative effect. biological effect to the ovaries. Therefore, trying to become pregnant is recommended only after menstruation following the study.

Consequences of hysterosalpingography

In some women who have undergone HSG, the onset of the first menstruation after the procedure occurs at a later date than usual, followed by the restoration of the previous cycle. Such a delay after hysterosalpingography, usually not exceeding several days, is apparently associated with psycho-emotional stress and mechanical interference with the function of the genital organs.

HSG is solely a diagnostic method and not a therapeutic method. However, many patients who were examined for infertility note the onset of pregnancy in the next 3 months after the examination.

Scientific explanation no to this. Some doctors associate pregnancy after hysterosalpingography with the introduction oil solution a radiopaque substance, which supposedly improves the function of the villous epithelium of the tubal mucosa and destroys “loose adhesions,” which is unlikely.

The assumption of mechanical washing with a solution of a contrast agent of mucus that forms on the mucous membrane of the walls of the fallopian tubes in the presence of a sluggish inflammatory process that has not been previously diagnosed seems more convincing. As a result, the patency of the tubes and the function of the villous epithelium are restored for some time.

Another assumption is a short-term correction of the function of the corpus luteum with oxyprogesterone during an adrenal-progesterone test.

After HSG, discomfort in the lower abdomen may persist for 1-2 days, and minor bloody and/or mucous discharge may appear. If the procedure was performed against the background of a chronic inflammatory process, an exacerbation of the disease is possible.

At the same time, hysterosalpingography in most cases does not cause any serious consequences and is highly informative additional method in the diagnosis of a number of diseases and causes of infertility in women.

Hysterosalpingography (HSG, metrosalpingography) is a method of x-ray examination of the uterine cavity (hysterography) and fallopian tubes by artificially contrasting them. Hysterosalpingography is used to determine the cause of infertility, if a malformation of the internal genital organs, submucosal fibroids, endometrial cancer, fallopian tube tumors, adhesions, etc. is suspected.

HSG is preferably performed in phase II of the menstrual cycle (16-20 days). However, if internal endometriosis is suspected, it is advisable to carry out this study in phase I, the day after diagnostic curettage or at the end of menstruation. To perform HSG, the doctor uses water-soluble contrast agents (Verografin, Urografin, etc.).

Preparation for hysterosalpingography (HSG)

1. When performing hysterosalpingography, the patient should be protected from pregnancy during the menstrual cycle in which the HSG will be performed;
2. 5-7 days before the study, perform a flora test of blood, urine and discharge from the cervical canal and vagina (without the results of these tests, GHA has no right to conduct);
3. on the day of the HSG procedure, a cleansing enema is necessary, immediately before hysterosalpingography - to empty the bladder.

Hysterosalpingography is performed without anesthesia, so if you have increased pain sensitivity or are afraid that hysterosalpingography will be painful, discuss pain relief with your doctor before HSG.

Don't forget to bring sanitary pads with you. Some clinics require you to take a robe, change of shoes and bed linen with you (as a rule, according to reviews, these are government-owned medical institutions and hospitals). The cost (price of the HSG procedure) depends on the clinic, as a rule, in state hospitals referred from antenatal clinic Hysterosalpingography is performed free of charge if you have an insurance policy.

How is the HSG procedure performed?

After treatment of the vagina and cervix alcohol solution iodine, a uterine cannula is inserted into the cervical canal, through which 10-12 ml of a 60-76% solution of a water-soluble radiopaque substance, the temperature of which is 36-37°, is slowly introduced into the uterine cavity under fluoroscopy control. As the uterine cavity and fallopian tubes fill, X-rays are taken. If radiographs do not show filling of the fallopian tubes after 3-5 minutes, repeat images are taken after 20-25 minutes. Radiographs are used to assess the condition of the cervical canal, the position of the uterus, the configuration and size of its cavity, the location and patency of the fallopian tubes.

For the patient, the HSG procedure looks like this:

You come to the clinic with the results of blood, urine and smear tests, and change clothes. The nurse will take you to the office where the hysterosalpingography procedure will be performed. You need to undress and lie on the couch on your back, with a pillow placed under your back and pelvis. When treating the genitals with a disinfectant, there will be a slight tingling sensation. The cannula insertion procedure is absolutely painless. When applying a radiopaque solution, there is a feeling of filling of the uterus, distension, pressure, and at the end of the process it may be a little painful (as it is painful on the first day of menstruation). In this position, you will need to freeze for a while so that the doctor takes a couple of pictures. Next, the liquid is pumped out.

An HSG study may be accompanied by a short-term increase in body temperature, bleeding and abdominal pain (they go away on their own), allergic reactions. It is rare to experience fainting after an HSG procedure.

The nurse will take you back to the room, where you will lie down until your abdominal pain goes away (from 15 minutes to several hours, depending on individual characteristics organism).

For the next 5-7 days after the procedure, it is necessary to insert tampons with medications to prevent inflammatory processes in the pelvic organs (placed in a day hospital).

Consequences of hysterosalpingography

After HSG, you may smear blood for about a week, this is normal. If the bleeding is severe or prolonged or abdominal pain does not go away, you should consult a doctor.

Contraindications for hysterosalpingography

Metrosalpingography is contraindicated in acute or subacute inflammatory processes genitals, acute infectious diseases, thrombophlebitis.