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Leiomyomata and Reproduction
Published in John C. Petrozza, Uterine Fibroids, 2020
Hysterosalpingogram (HSG) is a common screening test for uterine cavity and tubal abnormalities. During this procedure, radiopaque contrast is injected into the uterus, and the cavity and fallopian tubes are evaluated by X-ray. However, its relatively low sensitivity (50%) to differentiate different uterine-cavity lesions limits its function as the sole screening test for those at risk for fibroids [17]. Saline-infusion sonohysterogram (SIS) is an ultrasound performed after the instillation of saline in the uterus. The positive predictive value for SIS in diagnosing uterine abnormalities is 100%, with reportedly 77% sensitivity [18]. Advances in technology allowing for three-dimensional renderings of the uterus done during SIS have improved diagnosis of submucosal fibroids, allowing for better characterization than by traditional two-dimensional SIS [19]. The hystero-contrast sonography (HyCoSy), which utilizes contrast medium or agitated saline has enhanced the positive and negative predictive values of fallopian tube evaluation [20], making the HyCoSy a promising “single comprehensive” screening tool for both uterine and tubal factor infertility[21]. Leiomyomata have a low-intensity signal compared with surrounding myometrium on both T1- and T2-weighted MRI images. Although MRIs are more sensitive than sonograms for diagnosis of fibroids, they are significantly more costly than the other modalities. MRI imaging can be useful in describing the size and location of fibroids and may be best utilized for preoperative planning and to determine the best surgical approach for the surgical removal (myomectomy) of fibroids [22].
Reproductive health in adults with congenital heart disease: a review on fertility, sexual health, assisted reproductive technology and contraception
Published in Expert Review of Cardiovascular Therapy, 2023
J.A. van der Zande, G. Wander, K.P. Ramlakhan, J.W. Roos-Hesselink, M.R. Johnson
Couples who present to a fertility clinic will undergo preliminary blood work, pelvic ultrasound, and semen analysis. Subsequently, more detailed examinations may include assessments of tubal patency, which can be achieved using a Hystero-contrast-sonography (HyCoSy) or a hysterosalpingogram. In both, a tube is passed through the cervix and fluid is injected into the cavity of the uterus, outlining its shape and showing whether the fallopian tubes are open. Since both involve cervical manipulation, a vasovagal attack may occur. This occurs in 5% of healthy women during insertion of an IUCD and usually resolves spontaneously, but in women with CHD (particularly pulmonary hypertension or a Fontan circulation), a vasovagal event can be more serious. Consequently, procedures involving instrumentation of the cervix should only be performed with cardiovascular monitoring, anesthetic support on standby, and appropriate pain relief to minimize the risk of a vagal reaction [44,45]. More invasive, laparoscopic assessments do allow diagnosis and treatment at the same time (such as for tube adhesions and endometriosis), but require increased intra-abdominal pressure, which can impact cardiac output by reducing the venous return and elevating cardiac afterload [46]. Further, the raised intra-abdominal pressure can compromise respiratory function, causing CO2 retention and increasing pulmonary vascular resistance. Positional changes can exacerbate these factors and lead to significant hypoxemia, hypotension, and hemodynamic instability, which are all poorly tolerated by those with CHD. If necessary, laparoscopic surgery can be performed with minimal abdominal inflation under regional or even local anesthesia [47]. Hysteroscopy is well tolerated, but close attention to fluid balance is essential. Prophylactic antibiotics are advised for most gynecological procedures, and in the presence of CHD, these can be adapted to cover infectious endocarditis [48].
Recurrent miscarriage and infertility: a national service evaluation
Published in Journal of Obstetrics and Gynaecology, 2023
Laura Linehan, Marita Hennessy, Keelin O’Donoghue
Six respondents would routinely perform imaging in addition to a pelvic ultrasound (6/20; 30%), 13 would do so in certain clinical circumstances (13/20; 65%) and one would never do so (1/20; 5%). Named additional imaging obtained included CT (n = 5), MRI (n = 13), HSG (n = 13) and hystero-contrast sonography (HyCoSy) (n = 2).