Safety of oil-based contrast medium for hysterosalpingography: a systematic review

  • Roest I
  • van Welie N
  • Mijatovic V
  • et al.
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Abstract

Objective: A hysterosalpingography (HSG) with oil-based contrast increases pregnancy rates in women with subfertility. However, there have been some concerns regarding complications, most importantly the risk of intravasation of the contrast resulting in oil-embolisms, pelvic infections and thyroid dysfunction. Here, we present a clear overview on the frequency of the reported complications. Design(s): A systematic review and meta-analysis. Material(s) and Method(s): We searched electronic databases up to March 2018 as well as textbooks (published before 1960) and reference lists to identify eligible studies. There were no language or publication date restrictions. We performed a systematic review and meta-analysis of relevant RCTs, cohort studies and case reports/series. We looked at women and their offspring. Result(s): We included 120 studies, published between 1928 and 2017, of which 76 case reports/series. The 44 cohort studies reported on 20.438 HSG's. Intravasation occurred in 1.9% (389/20.438), no treatment was needed in the majority of cases. Embolisation occurred in 0.1% (24/20.438). A total of four deaths have been reported in the cohort studies; three caused by peritonitis (last report in 1950) and one caused by an oil-embolism (1955), which occurred in a 45-year old woman who received an HSG for another indication than subfertility. Among the cohort studies published since 1970, 22 studies reported on 7027 HSG's, intravasation occurred in 1.5% (102/7027) and embolisation in 0.2% (13/7027), without fatal complications. The 76 case reports/series, published since 1928, reported on a total of 204 intravasations and 27 embolisations, with locations in the lungs, cerebrum and retina. There have been seven deaths described in the case reports/series; one caused by an anaphylactic shock and one caused by an oil-embolism in a women of 60 years who received an HSG for a different indication than subfertility. The other five deaths were caused by infection after the HSG and/or a subsequent laparotomy. The latest fatal infection occurred in 1950. Conclusion(s): HSG with oil-based contrast for tubal testing is a safe procedure, when performed in a modern setting with antibiotic prophylaxis when indicated.Copyright © 2019

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Roest, I., van Welie, N., Mijatovic, V., Dreyer, K., Koks, C. A. M., & Mol, B. W. (2019). Safety of oil-based contrast medium for hysterosalpingography: a systematic review. Fertility and Sterility, 112(3), e73. https://doi.org/10.1016/j.fertnstert.2019.07.312

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