Medication Summary
The goals of pharmacotherapy are to provide local analgesia and prevent infections.
Local Anesthetics, Amides
Class Summary
Local anesthetics are used for local pain relief.
Lidocaine (Xylocaine)
Lidocaine is an amide local anesthetic used in 1% concentration. Administration of 10 mL of 1% lidocaine injected into the uterine cavity before the contrast may reduce delayed pain. The 1% preparation contains 10 mg of lidocaine for each 1 mL of solution; Lidocaine inhibits depolarization of type-C sensory neurons by blocking sodium channels.
Tetracyclines
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. The American College of Obstetricians and Gynecologists recommends empiric treatment for women with a history of pelvic infection or when hydrosalpinx is diagnosed at the time of the study.
Doxycycline (Doryx, Adoxa, Ocudox, Vibramycin, Oraxyl)
Doxycycline is a broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. It is almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.
Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly the 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. A common and effective regimen is 100 mg orally twice daily for 5 days.
Diagnostic Imaging Agents
Class Summary
Ultrasonograph with contrast imaging may be considered to detect fallopian tube patency.
Air polymer type A (ExEm Foam)
Intrauterine foam is formed by mixing the clear (polymer type A [hydroxyethyl cellulose], glycerin, purified water) with air and sterile purified water. When mixed, an echogenic contrast agent is created, that when visualized with ultrasound, the foam appears echogenic or bright within the fallopian tubes and peritoneal cavity. It is indicated for sonohysterosalpingography to assess fallopian tube patency in women with known or suspected infertility.
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Examples of hysterosalpingogram (HSG) images showing: (A) normal tubal patency, (B) endometrial polyp, (C) submucosal leiomyomata, (D) intrauterine synechiae, (E) hydrosalpinges, and (F) salpingitis isthmica nodosum.
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Instruments required for hysterosalpingogram (HSG) include an open-sided speculum, tenaculum, sponge stick, antiseptic, contrast medium, and an acorn (Cohen) cannula (A) or a balloon-tip catheter (B).
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Positioning the uterus parallel to the x-ray beam is critical for evaluation. In panel A, the uterus is not positioned correctly, obscuring the uterine septum seen in panel B when the uterus is repositioned.
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Dramatic extravasation of contrast media is seen in the myometrial and uterine veins.
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Hysterosalpingogram Part 1
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Hysterosalpingogram Part 2
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Hysterosalpingogram Part 3
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Hysterosalpingogram Part 4
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Hysterosalpingogram Part 5
