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Introduction ⬇

A hysterosalpingogram, also known as hysterosalpingography or uterosalpingography, involves x-ray visualization of the uterine cavity and the fallopian tubes to detect obstruction or abnormalities that may be the cause of infertility or other problems. Normally, a contrast agent introduced into the uterine cavity will travel through the fallopian tubes and “spill” into the peritoneal cavity, where it will be naturally reabsorbed.

Procedure ⬆ ⬇

  1. Have the patient remove all clothing and put on a hospital gown. Tell the patient to empty the bladder before the study begins.

  2. Have the patient lie supine on the x-ray table in a lithotomy position. Obtain preliminary pelvic x-ray images as ordered.

  3. The radiologist or gynecologist introduces a speculum into the patient’s vagina and inserts a cannula through the cervical canal. Administer the iodinated contrast agent into the uterus through this cannula.

  4. Remove the speculum (unless it is radiolucent) and perform both fluoroscopic and conventional images.

  5. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormal uterine and fallopian tube x-ray findings may include the following conditions:

  1. Bicornuate uterus or other uterine cavity anomalies

  2. Tubal tortuosity

  3. Tubal obstruction evidenced by failure of the contrast dye to spill into the peritoneal cavity on one or both sides (bilateral tubal obstruction causes infertility)

  4. Scarring and evidence of past pelvic inflammatory disease

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain test purpose and procedure. Ensure a properly signed and witnessed informed consent if required by the facility.

  2. Follow iodine contrast test precautions.

  3. Verify date of last menstrual period to ensure that the patient is not pregnant.

  4. Advise the patient that some discomfort may be experienced but subsides quickly.

  5. Provide sanitary napkins to wear because some spotting and contrast agent discharge may occur.

  6. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Clinical Alert

  1. Pregnancy, active vaginal bleeding, and active pelvic inflammatory disease are contraindications to hysterosalpingography. It is best to perform this test 7–10 days after the onset of menses.

  2. If the patient has diabetes and is taking metformin, special considerations may be necessary. Consult with the radiology department to determine whether this medication regimen must be discontinued the day of and for several days after the study.

  3. Assess whether the patient is allergic to latex and inform the radiology department of any known or suspected allergies or sensitivities before study.

  4. Assess whether the patient is allergic to iodine. If iodine contrast allergies or sensitivities are known or suspected, inform the radiology department before the study.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Monitor the patient for discomfort and administer analgesic agents as ordered.

  3. Instruct the patient to report heavy vaginal bleeding, abnormal discharge, unusual pain, or fever to the referring healthcare provider.

  4. Review test outcomes and counsel about infertility problems.

  5. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal

Normal intrauterine cavity

Patent fallopian tubes