![]() VanBogaert 6 has reported a 23.8% prevalence of polyps in patients with menometrorrhagia. ![]() Endometrial PolypsĮndometrial polyps are a common cause of menometrorrhagia. If the endometrial cavity must be assessed in a patient with hydrosalpinges, prophylactic antibiotics are also recommended 4. I, therefore, utilize prophylactic antibiotics in these cases. The utilization of a balloon tipped catheter to evaluate the fallopian tubes has a theoretically higher potential of tubal infection. The limited amount of fluid utilized to evaluate the endometrial cavity and low intrauterine pressures achieved when a non-occluding catheter is used minimizes the risk of infection. The administration of prophylactic antibiotics is controversial 3,4.īonnamy et al 5 has recommended prophylactic antibiotics for all patients with infertility. Infection is an acknowledged, but rare, complication of sonohysterography 3. Patients may occasionally become dizzy or nauseous during, or immediately after, the procedure. While minimal discomfort when the catheter reaches the uterine fundus or with saline instillation can occur, severe pelvic pain should not be experienced. In patients with significant uterine retroversion, partially filling the bladder or manipulating the uterus with the transvaginal transducer may straighten the uterus enough to permit catheter placement. The procedure cannot be performed in the presence of true cervical stenosis. When visualization is still sub-optimal, the pediatric feeding tube should be removed and a balloon tipped catheter used in its place.Įxtreme obesity and impaired flexibility of the hips are factors that may prohibit a sonohysterogram 2 . The latter modifications to the technique will usually permit adequate visualization of the endometrial cavity. In addition, the transvaginal transducer should be used to manipulate the uterus in an attempt to reduce the egress of fluid. If the endometrial canal collapses immediately upon instillation of normal saline then a larger bolus of fluid is required. When the endometrial cavity remains filled with fluid, additional injections of sterile saline are not required (Fig. Instillation of the sterile normal saline is begun slowly under direct sonographic visualization. A 20 ml syringe containing sterile normal saline is attached to the catheter. Once the catheter is in place, the speculum is removed and the transvaginal transducer is inserted. For infertility studies in which tubal patency must also be evaluated, a balloon tipped catheter is required. The insertion of additional catheter will interfere with endometrial cavity visualization and may result in kinking of the catheter that obstructs flow. By measuring uterine length before the procedure, the examiner will know how far the catheter should be inserted to reach the fundus. Characteristically, the patient will note a slight cramping when the pediatric feeding tube reaches the uterine fundus. A 5.0 French pediatric feeding tube will provide an adequate bolus of saline to evaluate the endometrial cavity. The introduction of the end of a sterile Q-tip into the cervical canal will break up any adhesions and also determine the appropriate angle for catheter placement. Occasionally, cervical adhesions or the direction of the endocervical canal will prevent the insertion of the catheter. The catheter is threaded into the endometrial canal. This reduces the amount of air introduced into the endometrial cavity when the saline is instilled. A sonohysterographic catheter is filled with sterile normal saline prior to insertion into the endometrial cavity. In women with short or highly irregular cycles, it is best to use a form of birth control prior to the procedure in order to ensure that an early intrauterine pregnancy is not interrupted.Ī speculum is inserted into the vagina and the cervix prepped with betadine or hibicleans in the iodine sensitive patient. At the beginning of the menstrual cycle the endometrium has not grown sufficiently to have an irregular appearance that might result in a false positive diagnosis of endometrial pathology. In premenopausal patients, saline infusion sonohysterography should be performed after menstrual bleeding, but before day 8 of the menstrual cycle.
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