Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study,

Abstract

Objectives: To determine if women with tubal patency experience more fluid loss compared to those with bilateral tubal occlusion following intrauterine instillation of fluid via a balloon catheter. Study Design:In this prospective cohort pilot study, we enrolled women with prior Essure ® procedures and healthy controls from September 2016-July 2017. We excluded women using an implant or intrauterine device, or with a prior cesarean delivery or permanent contraception procedures other than Essure ® . An infusion pump delivered saline via balloon catheter under continuous pressure monitoring. After one minute, we withdrew the fluid and recorded volumes in and out. Subjects then underwent hysterosalpingogram for evaluation of tubal patency. We conducted crude analyses with t-tests and sensitivity analyses.Results: We recruited 23 participants; ten provided analyzable data in each group. Hysterosalpingogram confirmed patency in all control and occlusion in all post-Essure ® subjects in the analysis group. We found the median volume of saline lost among control subjects [7.8 mL (7.4, 8.4)] larger than post-Essure ® participants [2.2 mL (2.0, 3.8), p<0.01]. While 50% of control subjects tolerated the full 10mL of fluid instillation, none of the post-Essure ® subjects tolerated this volume (p=0.03). A combination of saline loss ≤4mL and participant intolerance of the full 10mL volume yielded sensitivity of 0.80 (95%CI: 0.57, 1.00) and specificity of 1.00 for bilateral tubal occlusion. Conclusion:Instillation of a fixed volume into the uterus may discriminate between women with tubal patency and occlusion following permanent contraception procedures with high specificity

Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study

“…The difference in findings may be due to differences in the HSG imaging and HyCoSy procedures, including variations in the type of contrast agent, pressure injection process, and pressure measurement process ( 32 ). Moreover, Qiang et al ( 9 ) also demonstrated the association between tubal patency and the slope of the pressure curve during HyCoSy, indicating that peak injection pressure could be used as a promising supplement indicator ( 18 ).…”

“…Previous studies have shown a significant correlation between the volume of contrast agents in HSG and tubal patency in women who have undergone permanent contraceptive procedures. However, the diagnostic efficacy of peak uterine pressure is constrained ( 18 , 19 ). Theoretically, obstruction of the fallopian tubes is expected to increase injection pressure, but there is scant evidence regarding the relationship between peak injection pressure and tubal patency during 4D-HyCoSy.…”