GHA tubal x-ray: pros and cons
HSG X-ray (X-ray hysterosalpingography, RG-HSG) is a diagnostic technique designed to assess the condition of the female genital organs. The essence of the study is that a catheter is inserted into the uterine cavity through which a contrast agent is supplied. It is this that will be seen during the execution of a series of X-ray images. After it is evenly distributed over the uterus and appendages, the doctor "shines through" the organs using an X-ray machine. The images will clearly show the fallopian tubes and uterus.
With the help of this procedure, it is possible to detect such pathologies of the genital organs as obstruction of the fallopian tubes, endometriotic growths in the uterus, structural anomalies, etc. This method is often recommended for women who suffer from infertility, since these factors most often lead to the fact that patients get pregnant.
It is possible to perform the procedure both in an outpatient clinic and in hospitals of gynecological departments. The main condition for its implementation is the presence of an X-ray apparatus and a specialist who can work on it.
Content:
- GHA and ultrasound are the same thing?
- Which is better: X-ray or GHA?
- Indications for the GHA
- Contraindications to the GHA
- Preparation for the procedure
- How is the GHA carried out?
- What contrast agent is used for the GHA?
- Consequences and complications of the GHA
- Assessment of results
- GHA cons
- GHA advantages
During hysterosalpingography, the woman is in the gynecological chair. After the doctor injects a contrast agent into the uterine cavity, it is necessary to withstand for some time. This will allow the fluid to be evenly distributed throughout the internal genitals. After that, one or more photographs are taken to assess the result.
If a woman does not have any pathologies, then the uterus looks like a triangle of regular shape, and the tubes have an arched shape. In the presence of diseases, the picture changes: it is possible to detect neoplasms (polyps, fibroids), septa, adhesions, etc. If a woman has obstruction of the fallopian tubes, the contrast agent will be unevenly distributed, and obstacles in its path will be clearly visualized.
The procedure does not require the introduction of anesthesia, as it does not cause pain. However, if a woman has a high threshold for pain sensitivity, then local anesthesia is indicated for her.
GHA and ultrasound are the same thing?
GHA and ultrasound are two different procedures. Ultrasound examination involves a review of the patient's internal organs and the detection of possible pathology by changing their structure and density. The picture is displayed on the monitor. To carry out an ultrasound scan, there is no need to perform any additional procedures. It is enough just to lubricate the viewed surface with a special gel.
GHA involves the introduction of a contrast fluid into the uterus. After its distribution, the doctor takes a series of images using an X-ray machine (but it is possible to examine the internal organs on an ultrasound machine). The introduction of a contrast agent makes the study more informative. In addition, the doctor can diagnose obstruction of the fallopian tubes, which cannot be done during a routine ultrasound examination.
Since two devices can be used for the GHA: X-ray and ultrasound, there is a difference in the course of diagnostics. If the pictures are taken with X-ray equipment, the procedure is called X-ray hysterosalpingography. When an ultrasound machine is used to perform the study, the technique is called "echohysterosalpingography". Due to the similarity in the name, many people believe that these procedures are identical, in fact, their essence and diagnostic value differ.
Which is better: X-ray or GHA?
A standard X-ray examination will not reveal obstruction of the fallopian tubes or other pathologies of the pelvic organs, therefore it is never used for this purpose. GHA, on the contrary, is the method of choice for suspected obstruction of the fallopian tubes, endometrial polyps, uterine fibroids, endometriosis and other pathologies of the female reproductive system. Therefore, the GHA is definitely better than X-ray.
However, it should be understood that the GHA is performed either with the help of an X-ray apparatus, or with the help of an ultrasound diagnostic apparatus. The internal genital organs of a woman become visible on them after the introduction of a special contrast agent into the uterus and fallopian tubes. Many experts use the term "X-ray" to denote the procedure for examining the fallopian tubes on an X-ray machine, and the term "GHA" - to conduct a study on an ultrasound machine. If we consider the issue from this point of view, then the GHA will be better than X-ray.
The fact is that Echo-GHA has the following advantages over the GHA:
- A woman will not have to use contraceptive methods that protect her from pregnancy if she was prescribed an ultrasound GHA.
- There are no contraindications for conceiving a child in the month when the Echo-GHA was performed.
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During and after the procedure, there is no risk of an allergic reaction to a contrast agent that contains iodine.
- The patient's body will not be irradiated by the X-ray machine. Moreover, this negatively affects the number of eggs that are in the ovarian follicles (ovarian reserve).
Indications for the GHA
GHA of the fallopian tubes is carried out by gynecologists and gynecologists-oncologists.
The indications for the appointment of the procedure are as follows:
- Tubal infertility;
- Adhesions of the pelvic organs;
- Anomalies in the development of the reproductive organs;
- Sexual infantilism;
- Fibroma of the uterus, located in its submucosal layer;
- Endometrial cancer;
- Endometriotic growths in the uterine cavity;
- Polyps;
- Endometrial hyperplasia.
Hysterosalpingography is the method that will confirm that a woman has a pathology of the fallopian tubes or uterus, but does not always make it possible to assess the severity of the disease and its nature. If you turn to the statistics, then in 98% of cases it is possible to identify the existing violation, but the correct diagnosis is obtained only in 35% of cases.
Contraindications to the GHA
X-ray hysterosalpingography may not always be performed.
There are certain contraindications to the procedure, including:
- Intolerance to iodine preparations. This contraindication is due to the fact that the composition of the contrast agent, which is injected into the uterine cavity, contains iodine.
- Inflammation of the ovaries, uterus, appendages.
- Colpitis, cervicitis, bartholinitis.
- Acute infectious diseases of the body, for example, acute respiratory infections, ARVI, influenza, tonsillitis, sinusitis, etc.
- Blood clotting disorder.
- Heart disease.
- Renal failure
- Severe violations in the liver.
- Thyroid pathology.
- Pregnancy. A pregnancy test is mandatory before undergoing the procedure.
- Menstrual bleeding.
- Lactation.
- Increased ESR and leukocytosis.
Preparation for the procedure
Preparation for the procedure is simple, but the implementation of the recommendations given by the doctor is a prerequisite. Otherwise, you can harm your own body.
So, a woman should observe the following rules in order to properly prepare for hysterosalpingography:
- 1-2 days before the proposed study, you need to give up intimacy.
- 7 days before the procedure, do not douche or use intimate hygiene products inserted into the vagina.
- 7 days before the study, it is forbidden to use vaginal tablets, suppositories and ointments for treatment.
- 2-3 days before the study, you need to change your diet, giving up eating foods that provoke excessive gas formation. This applies to cabbage, legumes, bread, dairy drinks, soda water.
- You should stop using tampons 7 days before the procedure.
- After another period ends, partners should use a condom to avoid conception.
It is equally important to undergo a high-quality examination before conducting the GGS. It necessarily includes the delivery of the following tests:
- UAC.
- OAM.
- TANK.
- Blood test for syphilis, HIV, hepatitis.
- A smear from the vagina and from the cervix.
Before going to the procedure, you need to remove all hair from the external genital organs, wash them thoroughly. The bladder and intestines should be empty. If it was not possible to go to the toilet, then an enema should be done. The procedure should be performed on an empty stomach.
As for the self-administration of painkillers, it is prohibited to use medicines without consulting a doctor. As prescribed by the doctor, it will be possible to drink an antispasmodic, for example, No-shpu, 30 minutes before the GHA.
What is the time frame for the GHA?
Most often, hysterosalpingography is performed within 2 weeks after the next menstruation. This is due to the fact that during this period the mucous membrane of the uterus has a small thickness, which means that it does not block the entrance to the fallopian tubes.
Although, depending on the purpose of the study being carried out, it can be appointed at other times. To assess the patency of the fallopian tubes, it is carried out in the second half of the menstrual cycle. If there is a suspicion of internal endometriosis, it is recommended to perform HGS on days 7-8 of the cycle. Fibroids in the submucous layer of the uterus can be detected at any time, but only if the woman is not menstruating.
How is the GHA carried out?
If the doctor's office is equipped with a special X-ray chair, then the woman is seated on it. If there is no such chair, then the patient will sit on an ordinary gynecological chair, and an X-ray machine will be brought to her.
After treating the external genital organs with an antiseptic composition, the doctor inserts mirrors into the vagina and wipes the vaginal walls, first with dry cotton wool, and then moistened with an alcohol solution. The next step is to place the tube with fixation in the cervical canal. The tube is secured with bullet pliers. When this manipulation is done, the mirrors are removed. A contrast agent is supplied through the tube with a syringe, which must first be warmed up to approximately the woman's body temperature (up to 37 ° C).
When the contrast agent is evenly distributed throughout the uterine cavity and fallopian tubes, the doctor begins to take pictures. As a rule, the doctor takes from 4 to 6 pictures during the procedure. To begin with, the state of the uterus is recorded (its relief). Then another 4 ml of contrast agent is fed into the cavity, which makes it possible to more clearly visualize the appendages. If this volume of liquid is not enough, then inject as much as necessary.
After all the pictures have been taken, the patient is placed on a couch and left in a horizontal position for another hour. The fluid that was introduced during the procedure is absorbed into the bloodstream and excreted from the body by the liver and kidneys.
What contrast agent is used for the GHA?
For the procedure, the introduction of a contrast fluid is shown, which has the ability to delay X-ray rays. These are drugs such as:
- Cardiotrust. It is a contrast agent that can contain 50% and 30% iodine.
- Urotrast, Triombrast and Verografin. These are three analogs belonging to the group of radio-opaque substances, which can contain 60% and 76% iodine.
Interestingly, for the first time, hysterosalpingography was attempted with Lugol's solution in 1909. But because of the irritation of the peritoneal cavity and uterus, this attempt was unsuccessful. A year later, the Lugol solution was replaced with bismuth paste, and then with argyrol and collargol. However, it was not possible to achieve the desired effect using these substances. In addition, they all entailed inflammatory processes of the peritoneum.
Only in 1925, the scientist Heuser first used Lipiodol (a preparation containing iodine) for hysterosalpingography. This substance made it possible to visualize well the state of the uterus and fallopian tubes, and also did not harm the woman's health. It was since then that the procedure was introduced into medical practice.
Consequences and complications of the GHA
A woman should use sanitary napkins for 2-3 days after the procedure. This need is due to the fact that residues of the contrast agent can flow out of the vagina. If a small amount of blood is found in the discharge, then you should not worry about this, since such a phenomenon is a variant of the norm.
Mild painful sensations, reminiscent of those that occur during the next menstrual cycle, should not frighten a woman. After the GHA, such discomfort does not indicate any complications.
Also, the patient should be prepared for the fact that during or several hours after the HSG, a metallic taste in the mouth, dizziness, and increased heart rate may occur. This is a normal reaction of the body to the administration of a contrast agent.
A woman should not visit a sauna or a bathhouse, as well as take a hot bath for 3-4 days after passing the GHA.
If your body temperature rises, bleeding profusely, or severe pain in the lower abdomen, you should be concerned and seek immediate medical attention.
Extensive blood loss, infection, perforation of the uterus and fallopian tubes during the GHA procedure are extremely rare in modern gynecological practice, as an exception.
A woman should refrain from becoming pregnant for the next 3 months. For protection, use a condom.
As a rule, the procedure is well tolerated, but only on condition that the preparation for it was carried out with high quality: inflammatory processes were detected on time, there are no other contraindications to the GHA.
Assessment of results
The doctor should interpret the results based on the images obtained.
The signs of various diseases on the X-ray picture are as follows:
- Noticeable asymmetry of the uterus - the diagnosis is "one-horned uterus"
- An elongated cervix and a pronounced decrease in the volume of its cavity is the diagnosis of "infantile uterus".
- Short, long, or asymmetric fallopian tubes - the diagnosis is "congenital obstruction of the fallopian tubes."
- The presence of flask-like expansion in the tubes is a possible diagnosis of "adhesions of the fallopian tubes", or "saktosalpinx", or a combination of these two diagnoses.
- The presence of light areas in the tubes - "adhesions of the fallopian tubes."
- The shape of the fallopian tubes, reminiscent of the shape of smoking pipes, the presence in them of extensions in the form of a bulb, a decrease in the volume of the uterine cavity - the diagnosis of "genital tuberculosis".
- The uneven contours of the uterus, the identification of defects of an oval or other shape - the diagnosis is "uterine polyps" or "endometrial hyperplasia".
Of course, only the most obvious and common signs of certain diseases were listed. Only the attending physician can make a final diagnosis, evaluating the whole complex of results obtained in the course of various studies.
GHA cons
The disadvantages of the procedure include the following points:
- A woman's dose of radiation, albeit a small one.
- The likelihood of an allergic reaction to the contrast medium being administered. Women with a history of bronchial asthma, as well as allergic patients, should be especially careful.
- There is a risk of mechanical damage to the epithelial layer of the uterus, which leads to the appearance of bloody discharge.
GHA advantages
In addition to the fact that the X-ray GHA is highly informative, it has another important advantage. The fact is that hysterosalpingography is not only a diagnostic, but also a therapeutic method of influencing the female body. It has been established that approximately 20% of women suffering from infertility, after passing the GHA, successfully become pregnant.
Doctors explain this fact by the fact that during the procedure it is possible to improve the patency of the fallopian tubes, since the injected substances "wash" them, eliminating small adhesions.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
