Saline Infusion Sonography
Also known as sonohysterogram
This technique is used to detect abnormalities of the uterine cavity and the endometrium. Essentially a small amount of fluid is injected into the uterus through a fine tube to outline the uterine cavity.
What are the common reasons for having this examination?
- Suspected abnormalities of the uterus - either ones you were born with or new ones. eg. fibroids.
- Further evaluation of abnormalities seen on transvaginal scan. eg. in women with suspected polyps of thickening of the endometrium beyond the menopause.
- Investigation of sub-fertility and recurrent miscarriage.
- If the lining of the uterus was not able to be seen clearly on routine scanning
You should not have the procedure if you are pregnant or may be pregnant at the time of the examination or you have acute pelvic infection or unexplained pelvic tenderness which may be due to pelvic inflammatory disease. Saline infusion is not done with an intra-uterine device (IUD) in place.
How is the procedure performed?
On the day of the procedure a transabdominal and/or transvaginal ultrasound of the pelvis may be performed immediately prior to the procedure. Before the procedure commences your bladder will need to be emptied completely. For the procedure itself you will be undressed from the waist down and covered with a sheet. Your legs will be placed in stirrups (the lithotomy position) and the external genitalia cleansed with Betadine (or an alternative) antiseptic solution. A speculum will be placed in the vagina and the cervix will also be cleansed with antiseptic. A fine (2 mm) plastic tube is passed through the cervix into the uterus. The speculum is removed and a vaginal ultrasound scan is then performed as the saline (sterile salt water) is injected. You will be advised of the findings as the procedure is performed.
Will I need an anaesthetic?
Whilst you may experience some mild discomfort, this is not usually a painful procedure and therefore no anaesthesia is required. However, we strongly encourage you to take 2 tablets of an anti-inflammatory medication (such as nurofen, naprogesic or advil) an hour before the procedure. This not only helps to minimise crampy discomfort, but also helps the procedure to be performed with greater ease, due to the uterine relaxation produced. If you cannot tolerate anti-inflammatories (eg. due to asthma or stomach ulcers) a simple analgesic (such as panadeine or panadol) may be substituted.
Are there any risks?
The most common ill-effect is the discomfort involved. For most women, use of an anti-inflammatory beforehand will make the procedure quite acceptable.
There is a small risk of introducing infection into the uterus and pelvis. If you develop symptoms of fevers, loss of appetite, pelvic pain or unusual discharge in the days following the procedure, please see your referring doctor or your local GP for further assessment.
Very occasionally, handling of the cervix results in a reflex fall in blood pressure, and a fainting episode (cervical shock). If you are feeling faint or experiencing loss of vision or hearing during the procedure, please alert the staff.
How will I feel after the procedure?
You may have some period-like cramps. Most women are comfortable enough to drive home and continue with usual daily activities, but if you are concerned about pain it may be worthwhile having someone available to drive you home. Local heat (hot water bottle or wheat bag) applied to the lower abdomen may be helpful to manage pain.
Some dark discharge from the vagina may be expected due to the Betadine antiseptic solution, so you may like to bring a panty-liner with you to the appointment.
If you develop symptoms of infection in the days after the procedure (eg. fever, loss or appetite, pelvic pain, unusual vaginal discharge) see your doctor as early as possible.
What preparation is required for these procedures?
In general it is not necessary to take antibiotics before the procedure but if you have a history of pelvic or uterine infections, a dose of antibiotics taken 2-3 hours before the proedure may be appropriate. Discuss this with your referring doctor, who will be the one to provide a prescription if required. You do not need to drink fluid to fill your bladder before the procedure.
How are bookings made?
The procedure is performed in the interval between the end of menstrual bleeding and ovulation (usually no later than Day 11 in a typical cycle). To help us determine an appropriate time for your procedure, you are asked to complete the attached form and forward/fax to us together with your referral. You will then need to contact us on Day 1 of your next menstrual period so that the appointment can be scheduled in the correct window of opportunity, based on the information you have given us. We will contact you if we need to discuss any of the details you have provided about your medical history and cycle.
There may be circumstances where the procedure is not necessary or feasible and if this is suspected we may recommend that you be booked first for a routine pelvic scan for further evaluation first.