Hysterosalpingogram

A Hysterosalpingogram or hsg is a diagnostic x-ray of the uterus and fallopian tubes. This test allows the gynecologist to observe the inside of the uterus and fallopian tubes for any problems such as blockage of fallopian tubes, endometrial polyps, fibroids, genital tuberculosis or abnormalities in the uterine cavity. Hysterosalpingogram is also done to find problems in the uterus, such as abnormal shape and structure, an injury, adhesions or a foreign body in the uterus. HSG is often used in cases where a sterilization reversal is sought.

Hysterosalpingogram procedure

A woman must inform the radiologist if she is allergic to iodine dye, suffer pelvic or sexually transmitted disease. Women with bleeding problems such as hemophilia or those on blood thinning medicines such as aspirin must keep the doctor appraised. The gynecologist or radiologist uses a cannula to fill the uterus with iodine. The dye will flow into the fallopian tubes as the uterus is hooked with these tubes, and the pictures are taken using high steady beam fluoroscopy, as the dye passes through. In case of injury or an abnormal structure, the picture can throw up the problems. The pictures are shown on a TV monitor during the test. If another view is needs, the examination table is tilted or the patient may be asked to change positions. A blockage can prevent sperm from moving into the fallopian tube and joining an egg for fertilization to occur.

A HSG can catch if there is any problem inside her uterus that possibly prevents a fertilized egg from implanting to the uterine wall. This helps in outlining the fallopian tubes so that any abnormalities in the tubes or uterine cavity is observed. In cases of infertility due to tubal blockage, HSG is used to evaluate the location and extent of blockage. The Hysterosalpingogram procedure takes a few minutes and can be moderately uncomfortable for the woman, with possibility of cramps. Women who have tubal disease may develop pelvic infection. In rare cases, the woman develops iodine allergy. Some women notice spotting for a couple of days after the HSG.

Risks of Hysterosalpingogram

In less than 1 in 100, there may be a chance of a pelvic infection after the test. The chances are higher in those who have had pelvic infections before. Antibiotics A negligible chance of damaging or puncturing the uterus or fallopian tubes during the test does exist during the test. There could be some allergic reaction to the iodine x ray dye. If oil based dye is used, the oil can leak into the blood. This can cause blockage of blood flow to a section of the lung. But most HSG tests are water based. A woman may feel some cramping similar to menstrual cramps during the procedure and the amount of pain may depend upon the problems that the doctor finds and treats during the test. There could be some vaginal bleeding for several days after the test.

The test result is considered normal if the injected dye spills freely out from the ends of the fallopian tube and the x ray shows normal uterine shape. However, if further tests do not reveal the cause of infertility or recurrent pregnancy loss, the doctor could order for a hysteroscopy. There are chances that while a HSG could show a normal uterine shape, a hysteroscopy show abnormalities.

Gynecologist

Gynecologists are doctors who specialize in women's health. They primarily deal with diseases relating to the female reproductive organs. Obstetricians are doctors who also specialize in women's health and focus more on management of pregnancy and childbirth. It is pretty common to see that gynecologists are obstetricians and vice-versa. Gynecologists have to complete medical school and then further specialize in the field of gynecology and obstetrics. Modern days have seen both these services clubbed together and practiced together. Gynecologists/obstetricians carry out the following tasks:

• Examine pregnant women and ensure their pregnancy is proceeding well. They advice women on the various conditions they face during the pregnancy phase.
  
• They give specialized treatments for the patients as recommended by their general physicians and perform surgeries in the required patients.
  
• They advice the patients on the various contraception methods available and suggest the on best suitable for them.
  
• Give specialized treatment for infertility either through medications or surgical processes.
  
• Deliver babies either through normal deliveries or caesarean sections.
  
• Check on the health of the mother and the infant during and after the delivery.
  
• They treat conditions like amenorrhoea (absence of menstrual periods) and dysmenorrhea (agonizing menstrual periods).
  
• Treat cancer in the reproductive organs such as uterus, fallopian tubes, ovaries, vagina etc.

Latest techniques employed in gynecology

The use of latest technology in the field of gynecology/obstetrics has made it easier for the diagnosis and treatment of gynecological disorders

• Vaginal scans have paved way to study the cervix ovaries, uterus and its contents in a detailed manner.
  
• Pap smear helps check for any abnormal changes in the cervix cells called dysplasia.
  
• Laparoscopy is another advancement that helps in processes like hysterectomy.
  
• MRI and CAT scans are used to study uterine malformation etc.
  
• Vaginal swabs are used to study bacterial growth.
  

Leopold Maneuver

Named after gynecologist Christian Gerhard Leopold, Leopold maneuver is used to determine the position, presentation and engagement of the fetus within the mother's womb. This technique may be used to determine the fetal weight too. It is usually performed by a qualified doctor. The maneuvers include four different moves or actions that are very important and critical as each of them helps determine the position of the fetus. Leopold maneuver is preferably performed after 24 weeks of gestation when the fetal line can be palpitated. Though this maneuver cannot be equated to an ultrasound, it can be useful if the person performing the technique is competent enough to make the right assessment.

Leopold's maneuver helps determine

• What is in the fundus
  
• Determination of the direction and degree of flexion of the head
  
• Evaluation of fetal back and extremities
  
• Palpation of the presenting part above the symphysis.
  

The mother is placed in the dorsal recumbent position, wherein the supine with the knees is flexed to relax the abdomen. The hands are usually rubbed together so that they don't get cold, as cold hands may lead to uterine contractions. Finger should not be used for palpation. Palms are used for palpation.

The four maneuvers

First maneuver fundal grip: Helps in determining the presentation and to understand the fetal part that is lying in the fundus. Both the hands are used to find the fetal part that is lying in the fundus.

• If a firm hard, round object that moves independently is felt, then it is the head.
  
• A soft, irregular shape that is more difficult to move means that the buttock is in the fundus and this means breech position.
  

Second maneuver Umbilical grip: Helps determine the spine of the fetus and helps determine the position of the baby. One hand is placed to steady the uterus while the other is moved slightly in circular motion from the top to the lower segment of the uterus to feel the back of the baby. Gentle yet deep pressure is used.

• Fetal spine is felt.
  
• Knees and elbows (small extremities) are felt like small protrusions.
  

Third maneuver Pawlik's grip: Determines the engagement of the presenting body. The thumb and finger is used to grasp the lower portion of the abdomen and slight movements are made from side to side by pressing lightly.

• Presenting part is engaged if it is not movable.
  
• Presenting part is not engaged if it is movable.
  

Fourth maneuver Pelvic grip: Determines the degree of flexion of the fetal head. Using both hands, palpate fetal head pressing downward about 2 inches above the inguinal ligament.

• If the cephalic prominence is felt on the same side as the small parts it indicates that the fetus is in vertex presentation.
  
• If the cephalic prominence is on the same side as the back it indicates that the head is extended and the fetus is in face presentation.