Hysterosalpingography is one of the methods of gynecological examination of female reproductive health. During the procedure, the examined area is exposed to X-ray irradiation, due to which the doctor-diagnostician (in this case, the radiologist) receives information about the condition of the fallopian tubes and uterus of the woman, and can assess the patency of the fallopian tubes.
Why in general can such a question arise as the degree of patency of the fallopian tubes in the female body? The fact is that this factor directly affects the woman's ability to bear children. And the number of patients with diagnosed infertility, unfortunately, has tended to increase over the past decades.
The uterus and fallopian tubes: what are responsible for in the body
The uterus is an unpaired hollow internal organ, the main function of which is the development of the embryo and the bearing of the fetus. Anatomically, the organ is represented by the bottom, body and neck, and the neck is at the bottom and represents a narrowing of the organ, and the bottom is located on top. The place where the uterus passes into the cervix is called the isthmus of the uterus. The lower part of the neck passes into the vagina, and the upper lies above it. Around the opening of the organ are the front and rear lips. The body of the uterus has anterior and posterior surfaces. In front of her is the bladder, in the back is the rectum.
The size of the body and its mass change throughout the life of a woman. The length of the uterus in an adult woman reaches 7-8 centimeters. The weight of a nulliparous does not exceed 50 grams, of a woman giving birth - 80-80 grams.
Fixation in the pelvic area occurs due to the left and right wide ligaments, round ligaments and cardinal ligaments of the uterus.
The organ, which has the shape and appearance of the sac, is formed by three-layer walls. The inner layer is the mucous membrane covered with ciliary epithelium. Outside, the organ is covered by the serous membrane, and muscle tissue forms in the middle of the wall.
The fallopian tubes are not in vain received such a name - these organs look like hollow tubes. In the body of a woman there are two of them. The length of each tube ranges from 10 to 12 centimeters, the diameter of the lumen is up to 2-4 millimeters. Uterine or fallopian tubes directly participate in the reproductive process - through them the egg from the ovary passes into the uterus, in it the moment the egg is fertilized by the sperm, the embryo moves through the tubes into the uterus. The organs are located on the sides of the bottom of the uterus, their narrow end opens into its space, and the wide end into the abdominal cavity, that is, pipes connect the abdominal cavity and the uterus.
Their structure is represented by:
- uterine part.
The structure of the wall of the fallopian tube is similar to the wall of the uterus: it also contains three layers (serous, muscular, mucous).
The ability to diagnose patency of the fallopian tubes, as well as checking the condition of the uterus, gives women who cannot conceive or bear a baby a chance to get pregnant and give birth to a healthy baby.
What is hysterosalpingography?
The procedure is often prescribed specifically for diagnosing the causes of infertility. Hysterosalpingography is of two types, depending on the method of the study:
- echo hysterosalpingoscopy;
- X-ray hysterosalpingography.
Each of the methods is a method of obtaining an image of the fallopian tubes and / or uterus, their external and internal state. In the first case, the patient is examined by an ultrasound diagnostician using a special scanning device with a nozzle. Before this, a physiological saline solution is injected into the uterus. This method is more suitable for studying the functional features of the uterus. The classic type of examination is radiological with contrast. He, unlike an ultrasound examination, visualizes the patency of the fallopian tubes.
In which cases the patient is prescribed an examination
The most common indication for hysterosalpingography is non-pregnancy. If a woman who does not have previously diagnosed deviations in reproductive health, during the year, in the presence of one permanent sexual partner, without using contraception methods, cannot become pregnant, the gynecologist or reproductive specialist can refer her to this type of study.
Other indications for the procedure:
- the presence of previously diagnosed uterine pathologies;
- malformations of the uterus and fallopian tubes;
- suspicion of cancer;
- the likelihood of genital tuberculosis;
- unconfirmed isthmic-cervical insufficiency (condition during pregnancy, when the isthmus and cervix open too early, not withstanding the load of amniotic fluid and the fetus);
- the presence of previously transferred pregnancies, which ended in a miscarriage or a sinking fetus.
What contraindications does the procedure have
Due to the fact that this diagnostic method involves the introduction of a contrasting drug or physiological solution into the uterus and tubes, and the classic examination, in addition, is associated with x-ray irradiation, hysterosalpingography is not prescribed:
- at the slightest suspicion of having a pregnancy;
- with hypothyroidism;
- in the presence of a diagnosed renal or hepatic insufficiency, cirrhosis of the liver;
- in acute inflammatory processes in the genitals, inflammation of the vagina and vulva;
- with uterine bleeding;
- in the presence of an allergy to contrasting substances;
- with the general serious condition of the patient;
- with infectious diseases of the genital organs;
- with thrombophlebitis and acute heart failure.
Hysterosalpingography preparation requirements
The diagnostic procedure is mainly prescribed for the first half of the menstrual cycle. It is best to conduct it in the first few days after the end of menstruation, however, it is allowed to carry out hysterosalpingography within two weeks after its completion. Such requirements are due to the peculiarities of the female body structure - during this period, the uterine endometrium is the thinnest and the cervix is soft, so it takes almost no effort to insert a catheter, and the doctor has a better view. In this case, it is imperative to wait until the blood flow completely stops, since the presence of blood clots in the vagina and uterus makes diagnosis difficult.
As for determining the patency of the fallopian tubes, a procedure for this purpose is recommended to be carried out during the second phase of the cycle.
Also, in preparation, the doctor usually directs the woman to take general blood and urine tests, a smear on the flora. Before the examination, it is necessary to make sure that there is no pathogenic microflora in the vagina, since uterine catheterization in this case can “raise” the infection into its cavity.
During the procedure, the patient lies on a couch or a special gynecological chair. The x-ray apparatus is located above it, and if echogisterosalpingoscopy is planned, the doctor uses a special vaginal sensor.
Before introducing a catheter into the genitals, the doctor disinfects the cervix, vagina and external genitalia with an antiseptic solution. The catheters and devices used in the process must be strictly sterile, a condom can be put on an ultrasound probe.
Before inserting the catheter, the doctor examines the patient using a gynecological mirror. After that, a soft catheter is inserted into the cervix, through which a contrast drug is injected with a syringe. The substance enters directly into the uterine cavity, and gradually passes into the fallopian tubes. At this time, the doctor takes a series of x-rays.
Echo hysterosalpingoscopy of the uterine cavity occurs according to a similar scheme: the physician injects saline into the uterine cavity, and then gently inserts the ultrasound probe.
Usually the procedure does not cause severe pain or discomfort. The sensations during it resemble a pain syndrome in the first few days of menstruation. In this regard, most often, the use of anesthesia is not required. However, if the patient knows that the first days of her menstruation are very painful, and if there are no contraindications for using anesthesia, the doctor can do local anesthesia before starting the diagnosis. General anesthesia is not used with this procedure.
If there is a chance of spasm of the fallopian tubes or uterus, the doctor suggests taking antispasmodics, for example, the No-Shpa drug. Most often, in such cases, an injection is made so that the active substance quickly enters the bloodstream.
Diagnostic results: what to do next
The obtained X-ray images of the uterus and fallopian tubes, or images of echo hysterosalpingoscopy, are interpreted by a diagnostic doctor. The physician draws up a conclusion on them, in which he displays the most objective and reliable information.
X-rays show the filling of the uterine cavity and fallopian tubes with contrast material. If the drug passes freely through the tubes and is visualized in the abdominal cavity, then everything is in order with the patency of the fallopian tubes. If the image clearly shows that the fluid has not passed and stopped at a certain level, this confirms the presence of obstruction. The alternation in the image of dark and light sections in the pipes indicates that they have adhesions.
In addition, the features of the distribution of contrast over all the examined cavities and organs makes it possible to see neoplasms, polyps, foci of inflammation.
Also, the diagnostician, using the images or on the monitor of the ultrasound machine, draws conclusions about the size of the uterus and fallopian tubes, the features of their structure and location, the structure of the inner wall of the uterus. So, for example, its uneven relief may indicate the presence of adhesions, inflammation, polyps or fibroids.
If the results of the examination suggest that there is cancer of the uterus, the appointment of additional examinations, including taking tissue for a biopsy, is mandatory.
The conclusion of the doctor diagnostician, along with the pictures is transmitted to the attending physician, who sent the woman for examination.
After hysterosalpingography, the patient may experience mild bleeding from the vagina for several days. Pain in the lower abdomen that appears during the study usually disappears after 20-30 minutes. In the next 3-4 days you should avoid sexual intercourse, visiting a bath, sauna, bath.
Possible complications and consequences of the procedure
Any dangerous conditions and complications after hysterosalpingography are associated mainly with non-compliance with the preparation requirements, or with the fact that the doctor did not reveal any contraindications for examination on time. For example, if a patient has an allergy or individual intolerance to a contrast agent, her health may deteriorate sharply during the procedure. In this case, the examination is terminated, and the woman is provided with the necessary medical care.
In the case of a violation of the technology of hysterosalpingography, the subject may develop inflammation of the appendages.
On the other hand, the diagnostic method associated with the introduction of contrast into the uterus and fallopian tubes, in some cases, becomes a catalyst for pregnancy. This is due to a slight improvement in the patency of the fallopian tubes after examination.
A diagnostic method for the fallopian tubes and uterus using a contrast medium, as well as the properties of x-rays or ultrasound waves, is widely used to study and maintain female reproductive health. In addition to general well-being, the condition of the uterus and fallopian tubes directly affects a woman's ability to conceive and bear a fetus. The procedure is minimally invasive and safe for the patient, while it allows the doctor to evaluate the size, location, shape of the organs, as well as determine the presence or absence of pathological processes in them.