Ultrasound-guided Lipiodol® hysterosalpingography: A prospective study on pregnancy and complication rates

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY Australian & New Zealand Journal of Obstetrics & Gynaecology Pub Date : 2024-02-01 DOI:10.1111/ajo.13794
Glen Lo, Dana Hince, Neil Johnson, Paul L. Hofman, Jasmin Sekhon, Emmeline Lee
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Abstract

Background

Fluoroscopic hysterosalpingography (HSG) with Lipiodol® is safe and has a therapeutic effect on fertility: transient in endometriosis-related infertility and sustained in unexplained infertility. Ultrasound is replacing fluoroscopy as the preferred imaging modality for HSG due to comfort and radiation safety (no ionising radiation). The safety of ultrasound-guided Lipiodol® HSG is uncertain.

Aims

Prospectively observe pregnancy and complication rates after ultrasound-guided Lipiodol® HSG.

Materials and Methods

A single-centre prospective study of women with unexplained infertility undergoing ultrasound-guided Lipiodol® uterine bathing and tubal flushing after tubal patency confirmed with ExEm® Foam HyFoSy (hysterosalpingo-foam-sonography). Pregnancy outcomes at six months and serum and urinary thyroid function at one, three and eight weeks were recorded. Pain scores were recorded during and immediately after HSG. Descriptive statistics are reported.

Results

Fifty-two participants were enrolled between July 2019 and April 2021, median age 33 years (range 21–45). Only 45 (87%, 45/52) completed the Lipiodol® HSG; 5/7 experienced intravasation during initial HyFoSy. Of 30 women at follow-up, 57% had biochemical (17/30, 95% CI 37%–75%), 53% clinical (16/30 95% CI 34%–72%) and 35% ongoing pregnancies (11/30, 95% CI 20%–56%). The rate of subclinical hypothyroidism (SCH) at two months was 41% (7/17). One intravasation event occurred during Lipiodol® HSG (2%, 1/45). Median pain score was 5/10 (range 0–9, interquartile range 2.5–7). No anaphylaxis, infection or oil embolism was observed.

Conclusion

Outpatient ultrasound-guided Lipiodol® HSG was safe, with pregnancy rates comparable to previous studies of fluoroscopic guidance. Rates of intravasation and SCH were also similar, confirming the need to monitor thyroid function.

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超声引导下 Lipiodol® 子宫输卵管造影术:关于妊娠和并发症发生率的前瞻性研究。
背景:使用 Lipiodol® 进行透视子宫输卵管造影(HSG)是安全的,对生育有治疗作用:对子宫内膜异位症相关不孕症有短暂疗效,对不明原因不孕症有持续疗效。由于舒适和辐射安全(无电离辐射),超声波正取代透视成为 HSG 的首选成像方式。目的:前瞻性观察超声引导下利必多®HSG术后的妊娠率和并发症发生率:单中心前瞻性研究:对不明原因不孕的妇女进行超声引导下 Lipiodol® 宫腔冲洗和输卵管冲洗,然后用 ExEm® 泡沫 HyFoSy(子宫输卵管造影)确认输卵管通畅。记录了六个月的妊娠结果以及一周、三周和八周的血清和尿甲状腺功能。记录了 HSG 期间和之后的疼痛评分。报告了描述性统计结果:52 名参与者于 2019 年 7 月至 2021 年 4 月间入组,中位年龄为 33 岁(21-45 岁不等)。只有 45 人(87%,45/52)完成了 Lipiodol® HSG;5/7 在最初的 HyFoSy 过程中出现了内侵。在随访的 30 名妇女中,57% 有生化指标(17/30,95% CI 37%-75%),53% 有临床指标(16/30 95% CI 34%-72%),35% 正在怀孕(11/30,95% CI 20%-56%)。两个月后出现亚临床甲状腺功能减退症(SCH)的比例为 41%(7/17)。在 Lipiodol® HSG 过程中发生了一起浸润事件(2%,1/45)。疼痛评分中位数为 5/10(范围 0-9,四分位间范围 2.5-7)。未观察到过敏性休克、感染或油栓塞:结论:门诊超声引导下的 Lipiodol® HSG 是安全的,妊娠率与之前的透视引导研究相当。浸润率和SCH的发生率也相似,这也证实了监测甲状腺功能的必要性。
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来源期刊
CiteScore
3.40
自引率
11.80%
发文量
165
审稿时长
4-8 weeks
期刊介绍: The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.
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