HYSTEROSALPINGOGRAPHY (HYSTEROSALPINGOGRAM) – Purposes, Abnormal Findings, Client Preparation, Procedure, Factors Affecting Diagnostic Results and Health Teaching (MATERNAL AND CHILD HEALTH NURSING)
Hysterosalpingography is a fluoroscopic examination and X-ray examination of the uterus and fallopian tubes. A contrast substance, either oil-base ethiodol or lipiodol or water soluble salpix is injected into the cervical canal. It flows through the ureter and in to the fallopian tubes and spills into the abdominal area, allowing visualization of the uterus, the fallopian tubes, and the body of the uterus. Usually the procedure is performed by the radiologist and the health care worker
The hysterosalpinogram should be done on the seventh to ninth day after the menstrual cycle. The client should not be pregnant or have active bleeding. Or an acute infection; if any of these conditions exits, the test should be canceled. There may be some abdominal cramping, and sometimes there are chills and transient dizziness as the contrast substance spills into abdominal area. Normally, the spillage is not harmful and is expected. The amount of radiation exposure is high because of the fluoroscopic examination. Today ultrasonography is replacing hysterosalpinogography; expect that the latter test is more effective in determining tubal potency
PURPOSES
- To identify uterine fibroids, tumor or fistula
- To identify fallopian occlusion
- To evaluate repeated fetal losses
ABNORMAL FINDINGS
- Uterine masses (i.e. fibroids, tumor)
- Uterine fistulas
- Fallopian tubal occlusion (i.e. adhesions, stricture)
- Extrauterine pregnancy
- Evaluation of repeated fetal losses
CLIENT PREPARATION
- Explain to the client that the purpose of the test is to visualize the uterus and tubes for any abnormalities or to determine the patency of the fallopian tubes
- Explain the procedure to the client. The procedure may slightly differ in your institution, so check before explaining to the client
- Check to see that the consent form is signed. Ask the client when she had her last menstrual period. Record the information. If pregnancy is suspected, the procedure should not be done
- Administer pre-testy orders-enema, douche or sedative. If the clients come from home, check that she has prepared herself as ordered
- Inform the client that the test takes about 15-30 minutes
- Encourage the client to ask questions and to express concerns. Be a good listener. Refer questions and concerns you cannot handle adequately to other appropriate health professionals
- Check for signs and symptoms of infection following the test such as fever, increased pulse rate and pain
PROCEDURE
- A consent form for hysterosalpingography should be signed by the client
- Food and fluids are not restricted
- A cleansing enema and douche may be ordered prior to the test
- A mild sedative (e.g. diazepam (valium)) may be ordered prior to the test
- The client lies on the examining table in the lithotomy position. The gynecological and the contrast substance are injected into the cervix under fluoroscopic control. X-ray is taken throughout the 15-30 minute procedure
FACTORS AFFECTING DIAGNOSTIC RESULTS
Tubal spasm may causes tubal stricture, which could give the appearance of a partial or complete tubal obstruction in a normal fallopian tube
HEALTH TEACHING
- Inform the client that she may experience some abdominal cramping and some dizziness. Explain that this is normal but that if there is continuous and severe cramping, she should tell the examiners
- Inform the client that there may be some bloody discharges for several days; she should notify her health care provider
- Instruct client to call the healthcare provider if a high fever is present
