Evaluation of the uterine cavity: HSG, SHG, hysteroscopy: similar acronyms, a different approach
There are three essential components for reproduction: the ovum, sperm and an area where they will be found. The uterus and fallopian tubes are dynamic components and add concert. The fallopian tubes are quite mobile that supports the ovary during ovulation and direct the ovum towards the tube because it ovulates from the ovary itself, a bit like a vacuum. within the natural conception, the egg is fertilized on the surface of the Fallopian tube. The newly created and now expanding embryo travels through the Fallopian tube towards the doorway to the uterine body. This six-inch trip lasts approximately six days. The embryo is implanted within the cozy endometrium of the uterus and, together, the fetus and therefore the uterus will grow at a fantastic rate over the subsequent 38 weeks. So crucial are the uterus and fallopian tubes for this process, it’s imperative that they need no problems.
There are alternative ways to gauge this technique. What these diagnostic methods share, additionally to similar eponyms, is that the ability to see the structural components of reproduction. Although similar, these tests aren’t identical and each features a particular focus.
Hysterosalpingography (HSG) may be a fluoroscopy-based test performed in conjunction with a radiologist. a little balloon catheter is placed within the cervix (the lower a part of the uterus) and slowly, a dye is instilled. Very low levels of radiation are used for a brief period of your time. The dye covers the uterine walls even as milk covers the within of a glass. With continuous installation, the dye will seep into the upper portion of the uterus and eventually into the fallopian tubes. Overtime (approximately 3 minutes), the dye will cover the interior tract of the Fallopian tube then spill into the abdomen. Essentially, the dye will make the reverse trip experienced by the primary egg then the resulting embryo.
The HSG provides information on the contour of the endometrial cavity and therefore the contour of the Fallopian tube tract. The presence or absence of dye spillage from the ends of the tubes provides information on the power of the egg to pass during ovulation. This test also can define structural abnormalities like hydrosalpinx pins (swollen tubes) and polyps, fibroids and connective tissue inside the uterus then repair them surgically. The HSG provides little information about the contour of the outside of the uterus and therefore the actual mobility of the tubes themselves. Although it’s an honest test of the cavity, it’s not the foremost sensitive test for all uterine abnormalities.
His cousin is that the sonohysterogram (SHG) and is an office-based test. A catheter is placed within the cervix just like that of the HSG. Unlike HSG, during a sonohysterogram, a little amount of saline is instilled within the uterus that separates the betting layers. A transvaginal ultrasound is employed for visualization and no radiation is required. Actually, the uterus may be a virtual cavity, very similar to an empty plastic lunch bag. The pressure of the instilled saline separates the uterine walls, allowing excellent visualization of the contour of the endometrial cavity. The literature clearly demonstrates that polyps, fibroids or connective tissue within the cavity can decrease embryo implantation rates by up to 40%. it’s for this reason that we must make certain that the endometrial cavity is right and receptive to the embryo. The SHG provides information on the contour of the outside of the uterus (as against HSG) but provides less precision when evaluating the permeability of the fallopian tubes.
Hysteroscopy is that the third thanks to evaluating the cavity. Diagnostic hysteroscopy is that the only thanks to directly visualize the endometrial cavity. It is often done during a visit to the office or within the OR, counting on the expected result. Briefly, a little and versatile hysteroscope is placed within the canalis cervicis uteri using saline to dilate the endometrial cavity. Under direct visualization, the hysteroscope is advanced and therefore the entire cavity is often evaluated, also because of the Ostia (the opening of the fallopian tubes into the uterus). The OR set is reserved for patients who have demonstrated pathology in other evaluations, or if the hysteroscopy within the office isn’t clear.
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