X-ray (hysterosalpingography) of the uterus and fallopian tubes

Hysterosalpingography is one of the methods of gynecological examination of female reproductive health. During the procedure, the examined area is exposed to X-rays, so that the diagnostician (in this case, the radiologist) receives information about the condition of the fallopian tubes and can assess their patency.

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 a woman’s ability to have children. And the number of patients diagnosed with infertility, unfortunately, has been on the rise over the past decades.

Uterus and fallopian tubes: what they are responsible for in the body

The uterus is an unpaired hollow internal organ one of whose main functions are the development of the embryo and the bearing of the fetus. Anatomically, the organ is represented by the bottom, body and neck, with the neck located below and representing a narrowing of the organ, and the bottom is located on top. The place where the uterus meets the cervix is ​​called the isthmus of the uterus. The lower part of the cervix passes into the vagina, and the upper lies above it. The body of the uterus has an anterior and a posterior surface. In front of it is the bladder, behind it is the rectum.

The size of the organ 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 ligament and cardinal ligaments of the uterus.

The organ, which has the shape and appearance of a sac, is formed by three-layer walls. The inner layer is a mucous membrane covered with ciliated epithelium. Outside, the organ is covered by a serous membrane, and in the middle, the wall is formed by muscle tissue.

The fallopian tubes got this name for a reason – these organs look like hollow tubes. There are two of them in a woman’s body. The length of each tube ranges from 10 to 12 centimeters, the diameter of the lumen is up to 2-4 millimeters. The uterine, or fallopian, tubes are directly involved in the reproductive process – through them the egg from the ovary passes into the uterus, the moment of fertilization of the egg by the sperm takes place in it, 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, the pipes connect the abdominal cavity and the uterus.

Their structure is shown:

• funnel;
• ampoule;
• isthmus;
• 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 the 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 become pregnant and give birth to a healthy child.

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 conducting the study:

• echohysterosalpingoscopy;
• x-ray hysterosalpingography.

Each of the techniques is a method for 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, saline is injected into the woman’s uterus. This method is more suitable for studying the functional features of the uterus. The classic type of examination is x-ray with contrast. It, unlike an ultrasound examination, visualizes the patency of the fallopian tubes.

In what cases the patient is prescribed an examination

The most common indication for hysterosalpingography is infertility. If a woman who does not have previously diagnosed reproductive health abnormalities cannot become pregnant within a year, if she has one permanent sexual partner, without using contraceptive methods, a gynecologist or reproductive specialist can refer her to this type of study.

Other indications for the procedure:

• the presence of previously diagnosed pathologies of the uterus;
• malformations of the uterus and fallopian tubes;
• suspected oncological diseases;
• the likelihood of tuberculosis of the genital organs;
• a history of pregnancies that ended in miscarriage or fetal fading.

What are the contraindications for the procedure?

Due to the fact that this diagnostic method involves the introduction of a contrast agent or saline solution into the uterus and tubes, and the classical examination, moreover, is associated with X-ray exposure, hysterosalpingography is not prescribed:

• at the slightest suspicion of pregnancy;
• with hypothyroidism;
• in the presence of diagnosed renal or hepatic insufficiency, cirrhosis of the liver;
• with acute inflammatory processes in the genital organs, inflammation of the vagina and vulva;
• with uterine bleeding;
• if you are allergic to contrast agents;
• with a general serious condition of the patient;
• with infectious diseases of the genital organs;
• with thrombophlebitis and acute heart failure.

Preparation requirements for hysterosalpingography

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, hysterosalpingography is allowed within two weeks after its completion. These requirements are due to structure the female body – during this period, the endometrium of the uterus is the thinnest, and the cervix is ​​​​soft, so almost no effort is required to insert the catheter, and the doctor has a better view. In this case, it is imperative to wait for the moment when the selection menstrual blood will stop completely, since the presence of blood clots in the vagina and uterus greatly complicates the diagnosis.

With regard to determining the patency of the fallopian tubes, the 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 conducting the examination, it is necessary to make sure that there are no pathogenic microflora in the vagina, since catheterization of the uterus in this case may lead to hit infections in her cavity.

Survey technique

During the procedure, the patient lies on a couch or a special gynecological chair. The radiographic apparatus is located above it, and if echohysterosalpingoscopy is planned, the doctor uses a special vaginal sensor.

Before inserting 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; specially a condom.

Before inserting the catheter inside, the doctor examines the patient using a gynecological mirror. After that, a soft catheter is inserted into the cervix, through which a contrast agent 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.

Echohysterosalpingoscopy of the uterine cavity occurs according to a similar pattern: doctor injects saline into the uterine cavity, after which the probe of the ultrasound machine is carefully inserted.

Usually, the procedure does not cause severe pain or discomfort. Feelings during it resemble pain 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 for her, and if there are no contraindications to the use of anesthesia, the doctor can give local anesthesia before starting the diagnosis. General anesthesia is not used for this procedure.

If there is a possibility of spasm of the fallopian tubes or uterus, the doctor suggests taking antispasmodics, for example, No-shpa. Most often, in such cases, an injection is given so that the active substance enters the bloodstream faster.

Diagnostic results: what to do next

The resulting images of the uterus and fallopian tubes, or echohysterosalpingoscopy images, are interpreted by the diagnostician. He draws up a conclusion on them, in which it displays the most objective and reliable information.

X-rays show the filling of the uterine cavity and fallopian tubes with a contrast medium. 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 has stopped at a certain level, this confirms the presence of obstruction. The alternation in the image of dark and light areas in the pipes indicates that they have adhesions.

In addition, the features of the contrast distribution in all examined cavities and organs make it possible to see neoplasms, polyps, and foci of inflammation.

The diagnostician also 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 from the pictures or on the monitor of the ultrasound machine. So, for example, its uneven relief may indicate the presence of adhesions, inflammation, polyps or fibroids.

If the results of the examination give reason to assume the presence of uterine cancer, it is imperative to prescribe additional examinations, including taking tissues for a biopsy.

The conclusion of the doctor diagnostician, along with the pictures, is transferred to the attending physician, who sent the woman for examination.

After a hysterosalpingogram, 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, sexual intercourse, visiting the bath, sauna, taking a bath should be avoided.

Possible complications and consequences of the procedure

Any dangerous conditions and complications after hysterosalpingography are mainly associated with non-compliance with the requirements of preparation, or with the fact that the doctor did not reveal in time the presence of contraindications for the examination. For example, if the patient has an allergy or individual intolerance to the contrast agent, her well-being may deteriorate sharply during the procedure. In this case, the examination is terminated, and the woman is provided with the necessary medical care.

In case of 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 the examination.

The method of diagnosing the fallopian tubes and uterus using a contrast agent, as well as the properties of x-rays or ultrasonic 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 assess the size, location, shape of the organs, as well as determine the presence or absence of pathological processes in them.