A sonohysterogram involves the administration of sterile saline into the endometrial cavity under ultrasound guidance. The saline distends the cavity, separating the walls of endometrium. The most common indication for sonohysterography is abnormal uterine bleeding in both premenopausal and postmenopausal women. Other indications include evaluation of endometrial abnormalities detected by transvaginal sonography or a suboptimally visualized endometrium by transvaginal ultrasound, infertile women, and suspected congenital uterine malformations.

The procedure is explained to the patient and verbal consent is obtained. A sterile speculum is inserted into the vagina and the cervix cleansed with an antiseptic solution. A special very thin catheter is inserted into the uterine cavity. The speculum is then removed and sterile saline is inserted via the catheter into the endometrial cavity and images are obtained.

Sonohysterograms should be performed as follows :

1.) Premenopausal women : Day 4-7 of the menstrual cycle as the endometrium is thin and avoids the possibility of disrupting an early pregnancy.

2.) Postmenopausal women on HRT : performed shortly after the monthly bleeding period

3.) Postmenopausal women not on HRT : procedure can be performed at any time

SHG should not be performed in patients who may be pregnant or have acute PID


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