544 Obstetrics and Gynecology Board Review •••
❍ How is the uterine cavity evaluated?
(1) Hysterosalpingogram (HSG)—Also identifies tubal pathology
(2) TVUS or saline sonohysterography—Also recommended in cases of menorrhagia or intermenstrual spotting
(3) Hysteroscopy—Reserved for treatment
❍ How do abnormalities appear on HSG?
Developmental uterine anomalies have characteristic filling patterns, myomas or large polyps produce curvilinear
filling defects, and intrauterine adhesions produce grossly irregular contours and filling defects.
❍ TVUS may be helpful to diagnose?
- Narrowed discontinuous stripe may represent intrauterine adhesions.
- Overall or focal increase in endometrial stripe may represent polyp or myoma.
- (Use sonohysterography to further delineate)
- Differentiate between septate and bicornuate uteri by evaluation of fundus.
- Endometrial stripe trilaminar pattern poor predictor of receptivity.
- Proliferative phase, described as hypoechoic.
- Secretory phase, has increased echodensity.
❍ What is the treatment of intrauterine adhesions?
Hysteroscopic lysis of the adhesions.
❍ The overall pregnancy rate following treatment of intrauterine adhesions is?
60% to 75%.
❍ After lysis of adhesions, what medical therapy is initiated to inhibit further development of adhesions?
Placement of IUD, pediatric Foley, and/or post procedure hormone therapy which assists the endometrium in
re-epithelializing.
❍ What patient history is concerning for tubal pathology?
(1) Pelvic inflammatory disease (PID): risk of tubal infertility after first episode 10%, second episode 25% to
35%, and third episode 50% to 75%.
(2) Septic abortion.
(3) Ruptured appendix.
(4) Tubal surgery.
(5) Ectopic pregnancy.
(6) Endometriosis.
(7) Inflammatory bowel disease (IBD)
❍ When should HSG be completed?
Immediately after end of menses, recommend prophylactic antibiotic: doxycycline 100 mg bid starting 2 days
before procedure.