Indications Diagnostic role 1- Infertility 2- Habitual spontaneous abortion 3- Abnormal uterine bleeding 4- Pelvic pain. 5- Pelvic mass or fistula 6- Congenital defects 7- Evaluation of uterine tube after tubal ligation.
Indications Theraputic role:- Narrowed tortuous or occluded tubes
Contraindications 1- Suspected Pregnancy. 2- Acute pelvic inflammatory disease. 3- Uterine bleeding. 4- Recent dilatation and curettage or abortion. 5-Contrast sensetivity. 6- Immediate pre and post menstrual phase.
Patient preparation 1- Mild laxative or cleanising enema 2- Mild pain relevier 3- Adequte reassurance and explanation of the procedure. 4- General anathesia is rarely needed. 5- Empty the bladder immediately before the procedure Why ?
Compications 1- Pain :- from Vulsellum forceps Passage of speculum and injection cannula Distension of the uterus with tubal spasm Pain on peritoneal spillage on use of water soluble contrast media and presist for 24 hours 2- Allergic phenomena, include urticaria. Asthma and laryngeal oedema
Compications 3- pelvic infecton :- 4- Haemorrhage 5- Venousintravasation :- Delineation by contrast medium of the uterine venous network and the pelvic veins resulting in a fine lace like pattern within the uterin wall.
Compications The factors leads to intravasation:- Direct trauma to the endometrium. Timing of the procedure near to the menstruation orwithin a few days after curettage. A high intraluminal pressure during the injection of contrast medium with tubal occlusion. Uterine abnormalities, e.g uterine T.B, carcinoma and fibroid.
Compications 6- Perforation of the uterus (v.rare). 7- Infection (rare).
After care The patient should take antibiotic and pain reliever.