Sensitivity of hysterosalpingography after tubal surgery

Summary Hysterosalpingography (HSG) to assess tubal patency in the post-operative evaluation of the infertile patient has been well described. However, the sensitivity and specificity of HSG after tubal surgery has not been reported. We correlated HSG and laparoscopic findings in 25 patients who had tubal surgery (microsurgical tubal reanastomoses [11] and distal salpingostomies [14]). HSG provided a more reliable means of assessing tubal patency (sensitivity and specificity of 96% and 61% respectively) than in detecting pelvic adhesive disease (PAD) (sensitivity and specificity of 12% and 75% respectively) regardless of tubal surgical procedure. HSG was associated with a high false negative rate (60%) due primarily to the inability to detect PAD. Complete agreement between HSG and laparoscopy was noted in only 15% of cases. These data suggest that HSG is a sensitive means to determine tubal patency, but was not sufficiently sensitive or specific to detect PAD after tubal surgery. These limitations should be noted in the interpretation of HSG in any infertile patient with a history of tubal surgery, and severely limits the application of HSG to the management of the post-operative infertile patient.     

Fertility after the demonstration of intravasation during hysterosalpingography

Intravasation of contrast medium was found in 28 women out of 450 women (6.25%) who underwent hysterosalpingography (HSG). Ten of these women had an otherwise normal uterine cavity and patent tubes. In six patients (66%) out of nine who underwent a repeated HSG within 2 months no intravasation was demonstrated. Seven of the 28 patients with intravasation (25%) of whom four were among the 10 patients with normal uterine cavity and patent tubes (40%) conceived and delivered later.It is concluded that in cases in which no other uterine pathology is demonstrated on HSG intravasation is not a persistent occurrence, and by itself does not affect the prognosis of fertility.     

Thyroid function after hysterosalpingography using an oil-soluble iodinated contrast medium

Background. The objective of the present study was to evaluate the effect of an oil-soluble iodinated contrast medium (lipiodol) for hysterosalpingography (HSG) on thyroid function.

Methods. In 214 of 528 women with infertility examined by HSG using lipiodol between 1996 and 2006 at our institution, serum free thyroxine (FT4) and thyrotropin-stimulating hormone (TSH) were measured before and several months after HSG.

Results. The average age of the women was 34.5 ± 4.6 years and their average infertility period was 2.9 ± 2.5 years (mean±standard deviation). The 214 patients were divided into three groups based on the results of thyroid function before HSG: 180 in euthyroid, 28 in subclinical hypothyroidism and 13 in subclinical hyperthyroidism. The number of patients in the subclinical hypothyroidism group who developed hypothyroidism after HSG (ten of 28) was significantly higher than that of the euthyroid group (four of 180). Thyroid hormone replacement was required in three patients from the subclinical hypothyroidism group 1, 2 and 5 months after HSG.

Conclusions. We conclude that thyroid function should be monitored closely after HSG using lipiodol to detect the development of hypothyroidism, particularly in patients with subclinical hypothyroidism, and TSH and FT4 measurements should be performed before HSG to identify patients at risk for hypothyroidism.     

Pregnancy rates after hysterosalpingography with oil- and water-soluble contrast media

Hysterosalpingography can be accomplished with either oil or water-soluble contrast medium. This randomized prospective study compared pregnancy rates in women who had hysterosalpingography with either water- or oil-soluble contrast material and were followed for six months. Fifteen of 60 (25%) patients who received water-soluble dye conceived compared with 14 of 46 (30%) patients in the oil-soluble group, a statistically insignificant difference. Furthermore, no difference in pregnancy rates within each subgroup of fertility diagnosis was detected. Intravasation was more common in patients administered oil-based contrast materials (six of 46 versus one of 60 patients, P = .02), although no serious consequences occurred. No difference in the amount of pain as assessed by pain scoring was experienced by patients in each group. The authors conclude that pregnancy rates are similar after hysterosalpingography with oil- and water-soluble contrast material, during at least the first six months after the procedure.     

Cerebral embolization and coma after hysterosalpingography with oil-soluble contrast medium

A case of coma due to embolization after HSG, using oil-soluble contrast medium is presented. The patient was in a comatose state 11 days and then spontaneously regained full consciousness. The safety of oil-contrast medium for HSG is questionable.     

The use of a continuous infusion of epinephrine for anaphylactic shock during labor

BACKGROUND: Anaphylaxis is a potentially life threatening, acute, and severe systemic reaction that occurs after the reexposure to a specific antigen. This immunoglobulin E-mediated process is the result of the action of basophils and mast cell mediators, causing severe brochospasm, laringospasm, angioedema, urticaria, and cardiovascular collapse. CASE: We present a case of anaphylactic shock during labor secondary to administration of ampicillin for group B streptococcus prophylaxis. Generalized itching and hives were soon followed by severe maternal hypotension and tachycardia and prolonged fetal bradycardia. These symptoms responded partially to the administration of fluids and parenteral epinephrine. A continuous infusion of epinephrine was required for persistent maternal symptoms. The infusion did not result in further fetal compromise. The patient delivered a healthy fetus 4 hours after the start of the epinephrine infusion. CONCLUSION: This case supports the use of parenteral (intravenous) epinephrine for the treatment of anaphylactic reactions during pregnancy.     

Unusual synechia at hysterosalpingography: intrauterine fallopian tube after surgical abortion

We report a patient who had uterine perforation with incarceration of the fallopian tube after surgical abortion. The diagnosis was made during hysteroscopy, realized after hysterosalpingography, and treated by laparoscopy.