Performing an Hysterosalpingogram.

The patient should go into the toilet before the HSG to empty her bladder.

There will be a HSG machine right above her head and a monitor that looks like a T.V screen.

The patient will lie on her back and open her legs apart. The doctor will then insert a metal speculum inside the patient's womb, which will make your cervix visible.

This may sting in the begging. The doctor will then clean the cervix with iodine, which will kill any germs. A tool will be attached to the top of the cervix to stop it from moving.

After the cervix is in place a cannula will be directed into the vagina to the opening of the cervix where contrast material (dye) will be injected to make the uterus and tubes evident on the x-ray monitor. Now x-ray picture can be taken and produced in a small amount of time.

Procedure in steps:

* Woman lies down on table with legs far apart

* In respect to the patients dignity, the patient doesn't need to fully unclothe and is given a blanket to cover parts that don't need to be examined

* The doctor wipes the cervix with an antiseptic, and sterilises his equipment.

* The doctor places a speculum inside the vagina and pictures the cervix.

* The doctor can now either use a catheter or a tenaculum through the cervical opening into the uterine cavity.

* For example sake a tenaculum is placed on the cervix, after that a narrow metal cannula is inserted through the cervical opening.

* Contrast is then injected through the cannula.

* If the dye doesn't flow through the fallopian tubes, more pressure is needed to check if the tubes are blocked.

* This can cause further anxiety.

* While the uterine cavity is filling up, an automated X-ray machine will take images.

* More dye will then be injected so that the dye should finally fill the fallopian tubes and spill into the abdominal cavity.

* More X-rays are taken

* When there are signs of blockage in both tubes then the patient will be asked to roll over to one side, this is to give a slanted image. This might help to explain her anatomy.

After the test

After the examination she will be given a hand by female staff when making her way to the bathroom and if she is experiencing light bleeding then she will be given a sanitary pad.

Some side effects may occur like cramping, dizziness or nausea but these should disappear in about 30 minutes. If the patient develops a worsening pain, fever, colds or bleeding lasting more than two das then she should contact her gynaecologist.

The x-ray that I have with me shows that the right side of the fallopian tube is not visible which means its blocked and that looks like the problem because her uterus doesn't look abnormal.

The minimum amount of x radiation was applied by the way and doesn't effect the inside the inside of the reproductive organs too much. So it doesn't cause foetal malformation.

Advantages

* It's comparatively non-invasive.

* Highly reliable like for example negative results that show the fallopian tubes to be open.

* Its shows the inside and structure of the fallopian tube clearly while ultrasound doesn't.

* The test may in fact unblock small clogs.

Disadvantages

* It might produce false-positive results, which means if the fallopian tube isn't visible it doesn't necessarily mean that it's a blockage it might only be a spasm. (A sudden tightening in the muscles.)

After the results are gained there are two options the patient may either stop testing if the test is negative and the patient has nothing wrong with her fallopian tube. If the test proves to be negative then the patient can take further tests like hysteroscopy or laparoscopy, which are other forms of imaging.

If it's clear what the problem is then surgery might be necessary.

Complications related with a Hysterosalpingogram consist of the risk of an allergic effect to the dye, which is rare. This typically shows as a rash, but seldom be more severe.

Pelvic infection or uterine perforations are also probable complications. Both of these possibilities are very uncommon.

Evaluation

This way of imaging is the best way to examine my patients blocked fallopian tubes. If the usual x-ray was used it wouldn't have produced an image of the part of the body we wanted clearly.

We needed to use the HSG because it's the best imaging technique for the reproductive system. It gives us a clear inside image of what is going on inside the reproductive system, which an x-ray would have given us less detailed imaging.

The image produced shows us where the problem was occurring in detail.

If we used ultrasound it would have showed us a very bad detailed image that requires a lot of experience to interpret.

The type of treatments it's used to image is pregnancies and blood flow. You couldn't use ultrasound for this treatment.

The HSG is very reliable but it can produce undependable results in the case it detects a spasm instead of a blockage.

It's a sensitive test and doesn't use a lot of x-ray radiation to perform.

In the usual x-ray image more radiation is used to produce a clear image, as for HSG's a little amount of radiation is used and a little amount of dye.

There weren't any serious health hazards. Like in a typical x-ray the member of staff hides behind lead wall that the rays can't penetrate.

To the patient the risks are very mild, normally fever, cramping or colds in rare cases some patients might be allergic to the dye.