SIS : i.,.e tip on on Saline infusion sonography (akin to hystero salpingography or diag hysteroscopy)

 Tips in SIS ?? Tips on SIS(Saline infusion sonography) : Ans 1) Exclude pregancy:-Since a catheter is introduced into the uterine cavity, saline infusion sonohysterography (SIS) should never be performed when pregnancy is suspected. 2) On which day of Cycle?? Ans: SIS should be performed early in the menstrual cycle, after bleeding stops and before ovulation. 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. 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 2 ng/mL indicates a preovula­tory state, and SIS can be performed without risk to an early pregnancy. 3) Not on PID :-SIS should never be performed when a pelvic infection is suspected, since the procedure may exacerbate the infection. Should we use antibiotics post procedure I,e after SIS(Saline infusion sonography) ?? Ans: 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. 5) Paon management : Ans: cramping is usually minimal and well tolerated, use of ibuprofen 600 mg orally approximately 30-60 minutes before the procedure will make some patients more comfortable.

6) What kind of USG machine is ideal for SIS?? Ans,Three- and four-dimensional sonography is helpful in providing information to reconstruct an image of a solid-fluid interface, but adds little to the diagnosis beyond the two-dimensional assessment of the uterus and SIS imaging of the endometrium. One exception to this is a woman who has several intrauterine abnormalities identified during SIS, since three-dimensional imaging provides a more complete image of the endometrial cavity than single-plane imaging. In practice, however, this advantage in providing slightly more insight into an endometrium with multiple defects is essentially negated during treatments such as hysteroscopy since all endometrial lesions should be identified and removed. A second circumstance in which three-dimensional SIS is helpful is for a patient who has rapid leakage of fluid and loss of uterine distention. The three-dimensional scan can capture the image before the fluid escapes the cavity, and allows for analysis.

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