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Re: Hysterosonography ProtocolFrom: DuboseTerryJ@uams.eduMon Mar 26 08:02:29 2001
Sharon, thanks for giving us a framework to begin writing a protocol for Hysterosonography at OBGYN.net. Because I do not participate in these procedures I will wait for others to comment. My only question is, should we advise only using sterile saline and not other contrast agents. I realize that most have moved from the more expensive commercial contrast agents to sterile saline, but is there never an advantage to the contrasts? I remember seeing Doppler images of contrast moving through the fallopian tubes, would this "not replace the HSG"? I ask this primarily to stimulate discussion, and not to be argumentative. Once we have had some comment about this topic, I am going to recommend to the Ultrasound Section Editorial Advisory Board that we post it as a "recommended hysterosonography protocol". Thanks again for stepping up to bat. Terry J. DuBose, M.S., RDMS, Assistant Professor Director, Diagnostic Medical Sonography Program CHRP, University of Arkansas for Medical Sciences Little Rock, Arkansas, USA 501-686-6510 http://www.io.com/~dubose/ http://www.uams.edu/CHRP/dmshome.htm http://www.obgyn.net/us/panel/panel.htm -----Original Message----- From: charter.net [mailto:hap@charter.net] Sent: Sunday, March 25, 2001 5:22 PM To: Multiple recipients of list ULTRASOUND Subject: Re: Hysterosonography Protocol Greetings, I will give it a shot, by enumerating the steps we use in doing the procedure. I hope it is helpful. Sharon Durbin RDMS SONOHYSTEROGRAM POLICY Physician to be assisted with procedure by sonographer DEFINITION Instillation of sterile saline through a catheter into the uterus under real-time vaginal transducer observation for enhancement and assessment of endometrial cavity. This procedure is done on day 3 - day 7, near end of menstrual bleeding, when endometrium is thin (Day 6 is generally the "ideal day.") EQUIPMENT 1. Tray with barrier drape (approx. 16"x29") 2. Sterile container (i.e. sterile urine specimen container). 3. Hibiclens in specimen container 4. 60 cc syringe 5. Sterile saline solution (100 cc bag) 6. Three OB/GYN swabs 7. Open-sided speculum 8. KDF 2.3 intrauterine cannula 9. Ring forceps 10. Tennaculum 11. Portable light source 12. Stool (for physician) 13. Catch basin positioned in leg rest on exam table. PROCEDURE 1. Set out sterile gloves for physician. Have flashlight or another light source available for use during procedure. 2. Arrange blue Chux (tripads) on both exam table and step. 3. Explain procedure to patient to allay any anxiety. Have patient void to assure an empty bladder. Be sure patient has taken Ibuprofen before coming to appointment. 4. Assist patient in assuming lithotomy position and follow procedure as described under endovaginal scans, obtaining views of cervix. Uterus, both ovaries and cul-de-sac. This is the baseline study ---an unenhanced pre-instillation pre-evaluation. 5. Once physician is gloved, he/she draws the sterile saline solution into the 60 cc syringe, attaches the catheter and flushes saline solution through catheter. Syringe and catheter are set on sterile field. 6. Physician is ready to begin sonohysterogram: Open-sided speculum is inserted. 7. Cervix is cleansed with a betadine solution (HIBICLENS) 8. An intrauterine catheter is then threaded into the endometrium 9. Speculum is removed carefully so as not to dislodge the intrauterine catheter. 10. Vaginal transducer is re-inserted. 11. Using a 60 cc syringe, saline solution is instilled under direct real-time observation. (One should have had flushed the catheter prior to using it, to get rid of echogenic artifact.) 12. Obtain hard copy views from cornua to cornua, coronal plane; cervix to fundus. Continue obtaining views to reconstruct a 3-dimensional anatomy of the intrauterine cavity. COMMENTS: This procedure is useful in any case where better endometrial detail will be helpful. For example, to distinguish dysfunctional uterine bleeding from patients with myomas or polyps, thus dismissing or allowing appropriate surgical intervention. Infertility patients' endometrium can be evaluated for the presence of polyps. It does not replace the HSG, but the presence of free fluid in the cul-de-sac proves, at least, unilateral tubal patency. Sonohysterography is also useful in women on Tamoxifen therapy, especially if they have a history of vaginal bleeding. (Tamoxifen is used extensively in women with breast cancer, with reports of it causing hyperplasia or even adenocarcinoma of the endometrium).
>----- Original Message -----
> Hi Ann, glad the African educational trip it going well. To my knowledge
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