SIS procedure

SIS : What we need to know?? SIS : The Methodology:--The special catheter is placed well into the cervix or completely into the uterine cavity. So SIS cant image any Cx lesions as the SIS catheter is placed beyond a cervical polyp or fibroid. However, once the uterine cavity has been completely assessed with ultrasound during SIS, if no abnormality is identified the catheter should ideally be slowly removed while continuing to inject slightly warm saline and continuing to visualize the ultrasound image.

Even if the catheter is placed below the defect and saline infused, the limited distensibility of the cervix may limit visualization of every details of cervical lesion.

Limitations of SIS(or say HSG):-If no abnormality has been identified by ultrasound or SIS in a woman with a suspected anatomic etiology, the differential diagnosis should still include a cervical abnormality such as a polyp, cervicitis, or dys­plasia or carcinoma, or a uterine abnormality including adenomyosis or endometritis.

CAUTION

Limitations and contraindications:- SIS though useful for endometrial anatomic lesions & abnormalities A) it is not an accurate test to identify intracervical abnormalities. B) Not during periods or just soon after :-Since a catheter is introduced into the uterine cavity, saline infusion sonohysterography (SIS) should never be performed when pregnancy is suspected. SIS should be performed early in the menstrual cycle, after bleeding stops and before ovulation. C) After ovulation, the endometrium is irregular and endometrial fragments may be dislodged by the catheter, giving a false-positive result by showing irregular tissue in the uterine cavity. D) Caution at ameno phase??When to ascertain appropriate time in sec ameno cases?? If timing is uncertain due to irregular bleed­ing, a serum progesterone level and preg­nancy test can be performed on the day of or the day before the procedure. A progesterone level less than 2ng/mL indicates a preovula­tory state, and SIS can be performed without risk to an early pregnancy as progesterone is too low .Is endometrium is highly echogenic?? If Pre SIS a USG is contemplated and sonography does not reveal any echogenic endometrium thereby excluding pregnancy then too, SIS can be done in sec ameno phase. Alternatively. SIS can be performed at any time except during withdrawal bleeding for a woman using hormonal contraception. E) PID-No SIS:-- SIS should never be performed when a pelvic infection is suspected, since the procedure may exacerbate the infection. Antibiotic prophylaxis is not indicated for SIS, but if a hydrosalpinx is identified, broad- spectrum antibiotics, such a doxycycline 100 mg twice daily for 10 days, should be prescribed to prevent “reactivation” of the infection.

F) SIS can also be performed after suppression with a gonadotropin-releasing hormone agonist.