hsg catheter surgery is an examination method which injects contrast medium into the uterine cavity and fallopian tube through a catheter, and then performs X-ray fluoroscopy and radiography with an X-ray diagnostic apparatus to know whether the fallopian tube is open, the site of obstruction and the shape of the uterine cavity according to the development of the contrast medium in the fallopian tube and pelvic cavity.

contraindication
1. Acute and subacute inflammation of the internal and external genitalia.
2. Severe systemic diseases that cannot tolerate surgery.
3) Pregnancy, menstrual period.
4) Postpartum, miscarriage, within 6 weeks after curettage.

5) Those who are allergic to iodine.
6) Iodine allergy.

Indications
1. infertility To understand the cause of primary or secondary infertility, it is useful not only to understand the presence of congenital malformations or pathological conditions in the uterus and fallopian tubes but also to understand the patency of the fallopian tubes and thus to find the cause of infertility. In some cases, hysterosalpingogram can help to make the fallopian tubes clear for conception.

2) Abnormal uterine bleeding To find out the cause of abnormal uterine bleeding, to understand the condition of the uterine mucosa and uterine cavity, and to determine whether the abnormal bleeding is due to endometrial polyps or submucosal fibroids. 3) Revascularization of the fallopian tube.

3) Fallopian tube revascularization To revascularize the fallopian tube after ligation, it is necessary to know the condition of the uterine fallopian tube to decide whether it can be operated.

4) Tumor Observation of the effects of uterine fibroids, adnexal tumors, and other pelvic organs on the uterine fallopian tubes.

5.Diagnosis of malformations Uterine malformations such as the bicornuate uterus, mediastinal uterus, etc.

6.Foreign Body Diagnosis Metal IUD ectopic.

7. Diagnosis of adhesions uterine adhesions, cervical adhesions, etc.

Contraindicated groups
1. Acute and subacute inflammation of the reproductive tract. Such as vaginal cleanliness II-III.
2. severe systemic disease, such as heart and lung disease.
3.Normal delivery, miscarriage, curettage, or within 6 weeks after delivery; endometrial curettage within 4 weeks.
4. menstrual, uterine, or cervical bleeding.
5. iodine allergy.
6. fever.
7. menopause before pregnancy is ruled out.

Best time
The timing of the tubal imaging is usually best done within 3 to 7 days after a clean period. However, if your menstrual cycle is not very regular and you have post-menstrual errors, you can delay it until 10 days after menstrual cleanliness; for those patients whose menstrual cycle is quite disordered, or even have amenorrhea, you can have the test at any time, but the premise is to exclude the possibility of pregnancy.

Testing methods
Disinfect the vulva, vagina, and cervix before imaging. Insert a metal catheter or a double-lumen catheter into the uterine cervix and tighten it. Drain the air bubbles from the catheter to prevent misdiagnosis of polyps or fibroids. Inject under fluoroscopy while observing, until the uterus and fallopian tubes are full, then make a film; or inject slowly without fluoroscopy, until the patient’s lower abdomen is distended, then make a film. If there is obvious resistance to injection or the patient is in pain, the injection should be stopped and the total injection volume should be about 5-10mi, if iodine is injected, take 2 tablets in a row, separated by lO~15min, if iodine is injected, take the second tablet after the first tablet is washed out for observation, after 24 hours, scrub the vagina to remove any iodine that may remain in the vagina, then take a pelvic flat film. one image. If the fallopian tubes are clear, there is no oil residue in the tubes, oil entering the pelvic and abdominal cavity is a smear image, residue in the uterus is a longitudinal strip image, residue in the vagina is a transverse strip image, and residue in the umbilicus of the fallopian tubes is a sausage image.

Examination procedure
(1) The patient is placed in the bladder amputation position, the vulva and vagina are routinely disinfected, sterile towels are laid, and the position and size of the uterus are examined.
(2) Dilate the vagina with a vaginal speculum to fully expose the cervix, disinfect the cervix and vaginal vault again, clamp the anterior lip of the cervix with cervical forceps and explore the uterine cavity.
(3) If a metal catheter is used, fill the catheter with contrast medium, drain all the air, and then insert the catheter into the cervix, blocking the outer opening of the cervix to prevent the contrast medium from overflowing, then observe the flow of contrast medium through the uterine cavity and fallopian tube under X-ray fluoroscopy and take a film. The first film should be taken when the contrast agent fills the uterus and fallopian tube, and the second film should be taken when the contrast agent enters the pelvic cavity through the fallopian tube to a small extent. If the contrast agent enters the pelvic cavity and diffuses too much, the accurate observation of the fallopian tube will be affected by the diffusion of the contrast agent into the pelvic cavity. The last delayed film is taken when the contrast agent is sufficiently diffused in the pelvic cavity, after 20 minutes of appropriate walking. If the balloon catheter is used for imaging, the procedure is almost the same as that of metal catheter imaging. It should be noted that the timing of the film taking during the hysterosalpingogram process must be grasped when the contrast agent flows through the fallopian tube and a certain pressure is maintained during the flow of the contrast agent to take the film, to clearly understand the specific flow of the lumen.

Hazards of surgery
There are some implications for a woman’s health condition with a tubal imaging test, but it does not cause any significant harm to the patient and is straightforward to ignore. As long as the precautions taken before and after the tubal test are well taken care of, it is harmless to the body, and therefore the test for tubal imaging is harmless.

Caution
Pre-operative attention
1. 3 to 7 days after the patient’s menstruation is clean, sexual intercourse is prohibited.
2. The patient should empty the bladder.
3. Atropine 0.5mg can be injected intramuscularly half an hour before surgery to reduce tubal spasm.
Constipated patients can take oral laxatives before surgery to keep the uterus in a normal position and avoid the appearance of external pressure artifacts.
Postoperative attention
1、Basin bath and sex life are prohibited for two weeks after imaging, antibiotics may be given as appropriate to prevent infection.
2、Sometimes the false impression of fallopian tube failure is caused by spasm of the fallopian tube, which may be repeated if necessary.
It is normal to have a small amount of vaginal bleeding within a week after the imaging examination if there is no other discomfort, if the bleeding amount is more than the menstrual volume or there is another discomfort, you should contact your doctor.
It is best to avoid pregnancy for three months after the imaging test to reduce the possible effects of X-ray radiation. However, it has been clinically observed that there is no increased risk of fetal abnormality in women who become pregnant in the same month after the imaging procedure.

Procedure
1. Patients lie on their backs on the operating table of the X-ray machine and take a bladder cut-off position when imaging. Routinely disinfect the vulva and vagina, lay a sterile towel, and check the position and size of the uterus again.
2. Observe the flow of contrast agent through the uterine cavity and fallopian tube under X-ray fluoroscopy and take the film. Inject iodine oil slowly under fluoroscopy. Inject 3~5ml of iodine oil for the first time and observe the flow of the contrast medium into the uterus and through the fallopian tube. Continue to inject 3~5ml of iodine oil, and take a picture after 5~10 minutes.
3. Use a speculum to dilate the vagina, expose the cervix, disinfect the cervix and fornix with iodophor, fix the anterior lip of the cervix with cervical forceps, and explore the uterine cavity. Then insert the cervical canal in the direction of the uterine cavity and tighten the cervical forceps so that the tapered rubber tip of the canal is close to the cervix to prevent leakage of the drug during the injection.
4, contraction or tubal spasm, can be acupuncture hegu, the internal barrier points or muscle injection drugs, 24 hours and then at the same site to take the third film, observe the abdominal cavity with or without free iodized oil. If you see a clear border of iodine clusters, then consider the tubal adhesions. The adhesions of the fallopian tubes can be mild or severe, and there are three degrees of adhesions: one degree for adhesions to the coercive part of the fallopian tubes, two degrees for adhesions to the union of the fallopian tubes and the uterine horn, and three degrees for adhesions to the jug of the fallopian tubes and the umbilicus.

Side effects
1. Since the main practice is to inject the contrast agent into the fallopian tubes and the uterus, the main procedure is performed under X-ray. This makes it difficult for the body to avoid absorbing some of the X-rays. However, the patient does not need to worry too much about this because the damage caused by the instantaneous exposure to the X-ray is controlled and reversible. Of course, patients should take precautions during routine X-ray examinations, but as long as basic protective measures are taken, the safety factor is quite high, so there is no cause for fear.
The reason for using high-density iodized oil is that it has an excellent developing effect, but the irritation is relatively high, and there may be greater abdominal pain after the operation, and also, it may cause chemical peritonitis. Also, the examination time is long, which may cause foreign body granuloma, slow absorption, and may lead to oil embolism if the amount of venous entry is excessive.
3. other side effects and precautions of tubal imaging
Some patients may have symptoms such as chest tightness and shortness of breath, nausea, dry heaves, coughs and stomach pains, etc. Some patients may have allergic reactions due to personal circumstances, and in severe cases, allergies may occur.

Frequently Asked Questions

What are the differences between tubal imaging and fluids?
Since the doctor does not know the condition of the lumen of the fallopian tube before the rehydration and does not know if the patient has a twisted fallopian tube, or if there are adhesions or infarcts in the lumen, tubal rehydration is not effective for most infertile women and is only useful for mild adhesions. Repeated tubal lavage will destroy the peristalsis and cilia movement of the fallopian tubes, increasing the chance of infection with each lavage, especially if the sterilization is not strict.

Is fallopian tube test painful?

According to experts from Beijing Jiayuan Hospital, the pain of tubal imaging is within the tolerable range of general people. The pain of tubal imaging also depends on the size of the patient’s uterus, the presence of lesions, and the doctor’s proficiency, whether the patient cooperates and other factors.

How long after HSG can you try to conceive?
Experts say, just after the imaging surgery, need to wait for some time because the fallopian tubes need a recovery process. Usually, it takes 3 to 6 months before you can have children.

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