|[Frontiers in Bioscience 1, f1-5, January 1, 1996]|
SONOHYSTEROGRAPHIC IMAGING OF THE ENDOMETRIAL CAVITYA Parsons, A. Hill, and D. Spicer
University of South Florida, 4 Columbia Drive, Tampa, FL 33606
Catheters: For patulous cervices or enlarged uteri, the 2 mm H/S catheter with a 3cc balloon (Ackrad Co., Cranford, New Jersey) was used. This is a standard hysterosalpingogram catheter. For distension of normal sized uteri a straight 2.3 mm catheter such as the Soules intrauterine insemination (IUI) catheter (Cook company, Spencer, Indiana) was used (1). In some occasions, a 38 cm, 1.6 mm in diameter, premature infant feeding tube (# 3640, Davol Cranston, RI) was also used (2). These fine straight catheters allowed almost painless uterine distention because they permited leakage of saline from the cervix. The vaginal probe which was used was the C9-5, Ultramark 9, HDI, Advanced Technology Laboratories, Bothell, Washington
All vaginal scans were performed with the patient in stirrups on a gynecological exam table with a pull-out basin. The bladder was empty. Patients in whom PID was suspected were treated before this procedure. For obtaining the baseline scan the vaginal probe was protected with a condom and inserted into the anterior fornix of the vagina as depicted in Fig 1. First the uterus was imaged. Then, the mid-sagittal plane was identified by imaging the endometrial cavity and the entire length of the cervical canal. The ultrasound probe was perpendicular to the uterine axis for the best resolution of the endometrium. In order to examine the endometrium for asymmetry and abnormal contours, the uterus was scanned from cornu to cornu. The transducer was then rotated 45 degrees and the uterus was scanned from the external cervical os to the fundus in a transverse orientation. The thickness, hormone effect (echogenic pattern) and shape of the endometrium were noted. In order to do SIS, the cervix was cleansed through a speculum. A catheter was inserted into the cervix with packing forceps. The IUI catheter was advanced all the way to the fundus (Fig 1). When using the H/S catheter, the balloon was placed in mid cervix and gently inflated with 1 to 2cc of saline (not air). A 10 to 60cc syringe with IV injectable grade normal saline was attached to the catheter and the saline was slowly infused while scanning the uterus systematically in the sagittal and then transverse planes in order to delineate the contours of the entire cavity. Both utero-tubal ostia were identified to confirm the shape of the cavity.