PECULIARITIES OF HYSTEROSALPINGOGRAPHY USAGE

Abstract

Soares and coworkers showed that hysterosalpingography (HSG)a sensitivity of 58% and a positive-predictive value of 28,6% for polypoid lesions, and a sensitivity of 0% for endometrial hyperplasia. The same study showed HSG to have a sensitivity of 44,4% for uterine malformations, and a sensitivity of 75% for the detection of intrauterine adhession.This contraindication can be avoided by performing the examination before the ovulation phase, between the 7th to 10th day of the menstrual cycle. Because of the scattering risk, the examination should be avoided when there is active intrapelvic inflammation. The procedure is performed in the first half of the menstrual cycle following cessation of bleeding. The endometrium is thin during this proliferative phase, which facilitates better image interpretation and shouldalso ensure that there is no pregnancy. Antibiotics might be required 1 day before and fora few days after the examination if previous inflammations are present in the patient’s clinical history. Antibiotics are required after the examination when the maneuvers are fairly sanguineous or if the fallopian tubes present a certain degree of dilation. The suggested antibiotic regimen is metronidazole 1 grectally at the time of the procedure, plus doxycycline 100 mg twice daily for 7 days. The cervix is localized and cleansed with iodine solution. Afterward, the uterine cervix is straightened by one (at the 12 o’clock position) or two (at the 9 and 3 o’clock positions) surgical forceps exercising a degree of pulling. Next, the outside uterine cervix ostium is catheterized. The catheterization can be performed in two ways. In the past, oil- soluble contrast media were mainly used. Today, we use all available iodinated hydrosoluble contrast media.Results Examination of different patient population has resulted in widely disparate estimates, with a reported prevalence that ranges from 0,16 to 10%. As a result of selection bias, a prevalence of 8 to 10% has been reported in women being evaluated with HSG because of recurrent pregnancy loss. The overall data suggest that the prevalence both in women with normal fertility and infertility is approximately 1%, and the prevalence repeated pregnancy loss is approximately 3%.While the majority of women with mullerian duct anomalies have little problem conceiving, they have higher associated rates of spontaneous abortion, premature delivery, and abnormal fetal position and dystocia at delivery. Most studies report an approximate frequency of 25% for reproductive problems, compared with 10% in the general population.