ANATOMY OF REPRODUCTIVE SYSTEM

UTERUS
It situated between the urinary bladder and the rectum. The site of implantation of fertilized ovum. Development of the fetus during pregnancy and labor.

OVARIES
The female gonads are paired glands that resemble unshelled almonds in size and shape. Produce secondary oocytes and hormones, including progesterone and estrogens, inhibin and relaxin.

UTERINE TUBES
Two uterine tubes that extends laterally from the uterus. Provide a route for sperm to reach an ovum. Sites where fertilization occurs.

WHAT IS HYSTEROSALPINGOGRAPHY?
An x-ray procedure performed to determine whether the

fallopian tubes are patent (open) and to see if the shape of the uterine cavity is normal. Usually done after the menstrual period has ended, but before ovulation to prevent interference with an early pregnancy.

PURPOSE
The radiographic demonstration of the female

reproductive tract with a contrast medium. To diagnose any functional or structural defects. Best demonstrates the uterine cavity and the patency (degree of openness) of the uterine tubes.

INDICATIONS

CONTRAINDICATIONS

Infertility. Recurrent miscarriage. Confirm tubal and uterine abnormalities Follow-up to some surgical procedures.

Pregnancy

Active uterine bleeding Pelvic Inflammatory disease (PID) Recent curettage or active genital tract infection.

PATIENT PREPARATION
Patient need to take laxative to empty their bowels. (the uterus surrounding structures can see clearly.)
Inform if have any allergic to iodinated contrast medium.

Empty the bladder before the examination.

 A vaginal speculum (they come in two sizes: large 35cm /

ACCESSORY AND OPTIONAL EQUIPMENT

medium 20cm Tenaculum Basin Cotton balls Medicine cup Sterile gauze Sterile drapes Sponge-holding forceps

In addition to the HSG tray: 10 ml syringes (usually use two pieces) Sterilized pair of gloves An antiseptic solution, a cannula or balloon catheter

PROCEDURE
Patient in lithotomy position

A vaginal speculum will inserted into the vagina

Then the cannula will inserted and the speculum will removed

Patient moved up the table (supine position)

Contrast medium will injected while screening

Films are taken at the most opportune time

Radiograph taken until fallopian tubes fill and contrast injected spillage is seen at peritoneum

PATIENT DETAILS

Name MRN Age Sex Exam no Race Religion Language spoken Occupation Marital status Consultant Dr / Clinic Date of examination Types of examinations Reason for x-ray

: Kim Sun (pseudo name) : 64952 : 30 : Female : 4236 : Chinese : Buddha : Malay and Chinese. :: Married : Kedah Medical Centre : 9.April.2012 : HSG : Primary Infertility

TECHNIQUE
IR :-

AP scout image (10 x 12 inches).

Central ray :-

5 cm superior to the symphysis pubis.

Additional images may be required :-

RPO or LPO

SUMMARY (FILM SEQUENCE)

From the radiologist report, the entire right fallopian tube is opacified with free peritoneal spillage demonstrated at distal end but the left fallopian tube is not visualized. Impression of doctor, the left fallopian tube of patient is blocked.

RADIOGRAPHIC CRITERIA (from picture analysis)

The pelvic ring is seen and centered at collimated field. The cannula is visualized within the cervix.

Contrast medium is present within the peritoneum.

Patient ID and anatomical marker is seen at the

radiograph.

EXAMPLE OF REPORTS
NAME : KIM SUN (PSEUDO NAME) MRN : 64952

EXAMINATION NO
REFERRAL DR / CLINIC

: XR 4236
: KEDAH MEDICAL CENTRE

DATE

: 9/4/12

HYSTEROSALPINGOGRAPHY The uterine os is cannulated. Water soluble contrast is then injected. FINDINGS: Normal uterine cavity. Round lucent shadows within the uterine cavity and appears mobile, most likely to be air bubble. The entire right fallopian tube is opacified with free peritoneal spillage demonstrated at distal end. The left fallopian tube is not visualized. IMPRESSION: The left fallopian tube is blocked.

REFERENCE
SOURCE FROM TEXTBOOK: Principles of Anatomy and Physiology, Maintenance and Continuity of the Human Body, Twelfth Edition, Volume 2, Gerard J. Tottora, Bryan H. Derrickson

SOURCE FROM INTERNET: http://infertility.about.com/od/causesofinfertility/a/blocked_tubes.htm http://www.womenshealth.gov/publications/our-publications/factsheet/infertility.cfm http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002173/ https://docs.google.com/viewer?a=v&q=cache:BQaHAiaa1wJ:www.geosalud.com/embarazo/hsg.pdf+hysterosalpingogram&hl= en&gl=my&pid=bl&srcid=ADGEESidgaev8WnMbeZ9NUuLcyZ_Pns3ye_YDy2UMMkyQop4oZufv_fOFNPzhzQl9Q8eKteF0U9dLpyPL rtDnifpIg0zpPt1_GDTvjVLYIaHlxaP6QuawvWS9vvjV_pwtFthM8et7g&sig=AHIEtbTyGEhPp 7CsKIu7gOIf-NM6F9STHQ