Synonym/Acronym
Hysterogram, uterography, uterosalpingography.
Rationale
To visualize and assess the uterus and fallopian tubes for obstruction, adhesions, malformations, or injuries that may be related to infertility.
Patient Preparation
There are no food, fluid, or activity restrictions unless by medical direction. Instruct the patient to take a laxative or a cathartic, as ordered, on the evening before the examination.
Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.
Normal Findings
- Contrast medium flowing freely into the fallopian tubes and from the uterus into the peritoneal cavity
- Normal position, shape, and size of the uterine cavity.
Study type: X-ray, special/contrast; related body system: Reproductive system.
Hysterosalpingography (HSG) is performed as part of an infertility study to identify anatomical abnormalities of the uterus or occlusion of the fallopian tubes. The procedure allows visualization by fluoroscopy of the uterine cavity, fallopian tubes, and peritubal area after the injection of iodinated contrast medium into the cervix. The contrast medium should flow through the uterine cavity, through the fallopian tubes, and into the peritoneal cavity, where it is absorbed if no obstruction exists. The procedure has therapeutic indications in that passage of the contrast medium through the tubes may clear mucous plugs, straighten kinked tubes, or break up adhesions, thus restoring fertility. This procedure is also used to evaluate the fallopian tubes after tubal ligation and to evaluate the results of reconstructive surgery.
Contraindications
Pregnancy is an absolute contraindication to hysterosalpingography.
Patients with conditions associated with adverse reactions to contrast medium (e.g., asthma, food allergies, or allergy to contrast medium). Patients with a known hypersensitivity to the medium may benefit from premedication with corticosteroids and diphenhydramine; the use of nonionic contrast or an alternative noncontrast imaging study, if available, may be considered for patients who have severe asthma or who have experienced moderate to severe reactions to ionic contrast medium.
Patients with bleeding disorders, because the puncture site may not stop bleeding.
Patients with menses, undiagnosed vaginal bleeding, or pelvic inflammatory disease.
Factors That May Alter the Results of the Study
- Gas or feces in the gastrointestinal tract resulting from inadequate cleansing or failure to restrict food intake before the study.
- Retained barium from a previous radiological procedure.
- Insufficient injection of contrast medium.
- Excessive traction during the test or tubal spasm, which may cause the appearance of a stricture in an otherwise normal fallopian tube.
- Excessive traction during the test may displace adhesions, making the fallopian tubes appear normal.
- Metallic objects (e.g., jewelry, body rings) within the examination field, which may inhibit organ visualization and cause unclear images.
- Inability of the patient to cooperate or remain still during the procedure, because movement can produce blurred or otherwise unclear images.
Abnormal Findings Related to
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Discuss how this procedure can assist in assessing the uterus and fallopian tubes.
- Explain that the procedure takes about 30 to 60 min and is performed in a radiology department.
- Explain that pregnancy testing may be required.
- Discuss that there may be temporary sensations of nausea, dizziness, slow heartbeat, and menstrual-like cramping during the procedure and shoulder pain from subphrenic irritation related to the contrast medium as it spills into the peritoneal cavity.
- Review the procedure with the patient.
Procedural Information
- Baseline vital signs are recorded and monitored throughout the procedure
- Positioning for the procedure is in the lithotomy position on the fluoroscopy table.
- A KUB film is taken to ensure that no stool, gas, or barium will obscure visualization of the uterus and fallopian tubes.
- A speculum is inserted into the vagina, and contrast medium is introduced into the uterus through the cervix via a cannula or catheter, after which both fluoroscopic and radiographic images are taken.
Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
Safety Considerations
- Anticoagulants, aspirin, and other salicylates should be discontinued by medical direction for the appropriate number of days prior to a procedure where bleeding is a potential complication.
After the Study: Implementation & Evaluation Potential Nursing Actions
Avoiding Complications
- Monitor the patient for complications related to the procedure.
- Complications are rare but include risk for severe abdominal pain or cramping, allergic reaction (related to contrast reaction), heavy vaginal bleeding, infection (pelvic—uterine or of the fallopian tubes) (related to use of a cannula or catheter), pulmonary embolism, and uterine perforation.
- Explain the importance of immediately reporting symptoms such as difficulty breathing, chest pain, fever, hyperpnea, hypertension, nausea, palpitations, pruritus, rash, tachycardia, urticaria, or vomiting.
- Administer ordered antihistamines or prophylactic steroids if the patient has an allergic reaction.
- Observe/assess the cannula or catheter insertion site for bleeding, inflammation, or hematoma formation.
Treatment Considerations
- Follow post-procedure vital sign and assessment protocol.
- Resume the usual medications and activity, as directed by the HCP.
- Explain that vaginal discharge is common and that it may be bloody, lasting 1 to 2 days after the test.
- Explain that dizziness and cramping may follow this procedure, and analgesia may be given if there is persistent cramping. Severe cramping or profuse bleeding should be reported.
Clinical Judgement
- Consider how to provide emotional support regarding fear of infertility.
Follow-Up and Desired Outcomes
- Recognizes the importance of immediately reporting symptoms such as fast heart rate, difficulty breathing, skin rash, itching, chest pain, or abdominal pain to HCP.
- Understands that additional testing may be necessary to evaluate or monitor disease progression and determine the need for a change in therapy.