Pertubation of Fallopian tubes - Causes, symptoms and treatment. MF.

Pertubation( Latin per- through + anatum tuba [uterina] fallopian tube, synonym for purging the fallopian tubes) is a method for studying the patency of the fallopian tubes by introducing carbon dioxide, air or oxygen into the uterus through the uterine cavity. It is used mainly to identify the cause of infertility.

Contraindications to pertubation are:

general or local infectious process;
III-IV degree of purity of the vagina;
bleeding from the cervical canal;
increased ESR and increased white blood cell count.
Pertubation is not recommended to be performed earlier than 2 months after mud treatment and 4 months after the inflammation in the genitals is exacerbated.

Before pertubation, examine the contents of the vagina( smear), conduct a bimanual( vaginal-abdominal) examination, examine the vagina and cervix using vaginal mirrors.

Pertubation is performed on an outpatient basis( in a women's clinic or polyclinic) during the first phase of the menstrual cycle.during this period the mucous membrane of the uterus and fallopian tubes is thin and does not interfere with the passage of gas. In addition, the risk of gas entering the vasculature of the uterus and fallopian tubes during this period is the smallest. For pertubation, it is preferable to use carbon dioxide, given its property of rapidly dissolving in the blood.

A woman is on a gynecological chair in a position for vaginal operations. The cervix is ​​exposed with vaginal mirrors and, after appropriate treatment, is fixed with bullet forceps, then a special tip or Schultze canula is inserted into the uterine cavity so as to close the cervical canal( do not probe the uterus before the procedure to avoid injuries and gas into the vessels).Gas into the uterine cavity is injected gradually under a pressure of no more than 200 mm Hg. Art.(exceeding this level may lead to rupture of the uterine coarse).

To assess the patency of the fallopian tubes, it is necessary to take into account the results of auscultation of the abdominal cavity and sensation of the woman during pertubation. When gas enters from the uterine coarse to the abdominal cavity, characteristic tube noise is auscultated. The subjective sign of gas entering the abdominal cavity is a frenicus-symptom - pain in the right supraclavicular area, caused by gas stimulation of the endings of the diaphragmatic nerve. If the patency of the fallopian tubes is impaired, pain occurs in the lower abdomen.

The most informative is the pertubation, at which oscillations of the gas pressure in the system, reflecting the patency and contractile activity of the fallopian tubes, are recorded with the help of special writing devices - kymographic pertubation. Given the kymografic data, several variants of the status of the fallopian tubes are distinguished:

Fallopian tubes are freely passable: the pressure at which the gas begins to enter the abdominal cavity( maximal pressure) is 60-90 mm Hg.st: peristalsis of the fallopian tubes is good;with auscultation, tube noise is determined from both sides of the abdominal cavity;The frenicus symptom appears after the administration of 70-100 ml of gas if the patient has taken a vertical position.
Spasm of fallopian tubes: the gas pressure remains on the same numbers( 100-140 mm Hg) for a long time, a sharp drop is noted after the introduction of antispasmodics;the peristalsis of the fallopian tubes and the frenicus-symptom appear after the gas pressure drop.
Atony of fallopian tubes: gas freely penetrates into the abdominal cavity, its maximum pressure is lower than normal( about 40 mm Hg);peristalsis of the fallopian tubes sluggish;The frenicus-symptom appears quickly and well expressed.
Obstructed tubal obstruction( stenosis): high maximum pressure( 160-180 mm Hg), which gradually decreases, but the minimum pressure at which the patency of the tubes remains is high( above 100 mm Hg);the peristalsis of the fallopian tubes is almost not determined;The frenicus-symptom is weakly expressed.
Obstruction of the fallopian tubes: the gas pressure continuously increases, reaching 160-200 mm Hg.p.there is no peristalsis of the fallopian tubes;with auscultation of the abdominal cavity, tube noise is not determined;in the process of pertubation, there are pains in the lower abdomen, the negative symptom is a negative frenicus.
Especially valuable information on the state of the fallopian tubes can be obtained by comparing the results of kymografic puncture and metrosalpingography.

After pertubation, the woman should be under medical supervision for 1-2 hours.

Complications( exacerbation of the inflammatory process in the pelvic organs, rupture of the fallopian tubes, air embolism) occur rarely if the conditions for carrying out the puncture and violation of its technique are not observed.