Definition
Hysterosalpingography (HSG), also known as uterosalpingography is a radiologic procedure to investigate the shape of the uterine cavity and the shape and consistency of the fallopian tubes.
Purposes
- To detect tubal patency.
- To detect conditions, such as polyps, submucosal leiomyomas, synechiae, hydrosalpinx, Müllerian anomalies, and peritoneal adhesion.
Indications
- Infertility.
- Chronic pelvic pain.
- Congenital anomalies and/or anatomic variants.
- Prior to treatment with assisted reproductive technologies.
- Thickened, irregular endometrium.
- Previous ectopic pregnancy.
- Irregular vaginal bleeding.
Contraindications
- Pregnancy.
- Ongoing pelvic infection.
- Active vaginal bleeding.
- Allergy to iodinated contrast medium.
Articles
- Two pairs of gloves.
- Betadine solution 10%.
- Kidney tray.
Sterile items:
- Drapes.
- Sponge holding forceps.
- Cusco’s speculum.
- Vulsellum forceps.
- 10 mL syringe and extension tubing.
- Contrast medium.
- Cotton swabs and gauze squares.
Procedure
| Nursing action | Rationale | |
| Before procedure | ||
| 1. | Explain to patient the need for HSG and how she needs to cooperate. | Relieves anxiety and enhances cooperation. |
| 2. | Assist her to lie down on the examination table with buttocks at the edge of table and knees flexed on thighs and feet held up with stirrups. | For proper visualization and performance of procedure. |
| During procedure | ||
| 3. | Clean the perineal area with betadine solution. | To avoid chance of infection. |
| 4. | Drape the perineal area. | To avoid contamination. |
| 5. | Cusco vaginal speculum is inserted into vaginal canal. | To visualize cervix. |
| 6. | Cervix is cleaned with betadine swabs. | To prevent transfer of germs. |
| 7. | Extension tubing attached to syringe is inserted into the uterine cavity after assessing the endometrial cavity and priming the tube to remove air from it. | For deciding on the instillation of contrast medium. |
| 8. | Approximately 10-30 mL contrast medium is instilled taking care not to over distend the fallopian tubes. | To visualize the anatomical structures. |
| 9. | Observe patient while slowly administering the contrast fluid. | To prevent discomfort and spasm. |
| 10. | Obtain images after administering contrast medium. | To assess the endometrial cavity and tube patency. |
| 11. | After obtaining images, take out the tube and speculum. | Completes the procedure. |
| 12. | Clean and dry the perineal area and place perineal pad. | Promotes patient hygiene. |
| After procedure | ||
| 13. | Remove draping sheet and help patient wear undergarments. | Promotes comfort. |
| 14. | Clean all articles, keep drying. | For autoclaving and next use. |
| 15. | Wash and dry hands. | Infection control measure to prevent cross contamination. |
| 16. | Carry out essential recording. | For communication among staff members. |
Postprocedural instructions
- The discomfort and cramping experienced due to instillation of contrast medium would not last long.
- Discomforts, such as generalized abdominal pain and vaginal spotting are normal for few days.
- To contact the physician if she develops fever, persistent pain or unusual bleeding per vagina.
Special Consideration
- Assist the patient into the dorsal lithotomy position (lying on their back with feet in stirrups).
- Ensure proper draping to maintain the patient’s dignity.
- Observe the patient’s comfort level and provide reassurance throughout the procedure.
- Hand instruments to the physician as needed and ensure proper handling of the contrast medium.
- Ensure the contrast medium is administered slowly to minimize discomfort.
- Monitor for any adverse reactions, such as allergic responses to the contrast dye.
- Inform the patient that mild spotting or cramping is normal and typically resolves quickly.
- Advise the patient to avoid tampons, douching, or sexual activity for 24–48 hours to reduce infection risk.
- Observe for immediate complications, such as excessive bleeding or signs of infection.
- Encourage the patient to report symptoms like fever or severe abdominal pain.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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