Pain And Complications Related Factors Analysis Of Transvaginal Four-dimensional Hysterosalpingo-contrast-sonography

Objective To investigate the occurrence of pain and related complications in patients during transvaginal four-dimensional hysterosalpingo-contrast-sonography（TV 4D-Hy Co Sy）examination and to analyze the main influencing factors.Methods From March 2020 to March 2022,patients diagnosed with infertility who undergo TV 4D-Hy Co Sy in the department of ultrasound in the second affiliated hospital of the air force medical university were selected,and general clinical data were collected.Data were collected including the occurrence of pain,pain degree and possible related factors at six different time point from intrauterine catheterization,water sac adjustment,during Hy Co Sy,30 minutes after Hy Co Sy,1 hour after Hy Co Sy and 24 hours after Hy Co Sy.Possible complications of patients were followed up including vaginal bleeding 24 hours after Hy Co Sy and menstrual changes 1～2 months after Hy Co Sy.Univariate and logistic multifactorial analyses were performed to determine the factors associated with pain and other complications in patients undergoing TV 4D-Hy Co Sy.Results Among 963 patients who underwent TV 4D-Hy Co Sy examination,78.6%of patients had different degrees of pain symptoms after intrauterine catheterization.The main correlate of patients’pain was the size of the water sac,and for every 0.1 ml increase in the size of the water sac,the patients’risk of pain increased 1.27 times.After adjustment of the water sac,the percentage of pain decreased to 57.9%,and the degree of pain decreased significantly.The number of patients with pain grade 2 decreased from 333 to 195;the number of patients with pain grade 3 decreased from 231 to 30.The proportion of patients with pain during the Hy Co Sy,30 min after the Hy Co Sy and 1 h after the Hy Co Sy was 75.8%,48.6%and 31.5%,respectively,and the proportion of patients with pain was 13.7%among the 626 patients for whom follow-up data were obtained up to 24 h after the Hy Co Sy,and the proportion of patients with pain gradually decreased over time.After intrauterine catheterization,intraoperative patient pain was mainly associated with the degree of tubal patency（OR=3.051,95%CI:2.563-3.632）,followed by pressure of contrast agent injection（OR=2.552,95%CI:1.830-3.560）,contrast agent countercurrent（OR=2.089,95%CI:1.189-3.671）,uterine bleeding flush solution（OR=2.097,95%CI:1.397-3.147）,previous history of dysmenorrhea（OR=1.722,95%CI:1.154-2.570）and water sac size（OR=1.058,95%CI:1.013-1.105）.The main factors influencing pain in patients 30 min and 1 h after Hy Co Sy were the degree of tubal patency(OR_30min=1.438,OR_1h=1.302)and the pressure of contrast agent injection at the time of Hy Co Sy(OR_30min=1.217,OR_1h=1.228),while other influencing factors,such as the contrast agent countercurrent and the color of the uterine flush solution at 30 min after the Hy Co Sy were risk factors for pain,with ORs of 1.412 and1.337,respectively,and by 1h post-imaging,the effect of both on pain disappeared,while previous history of dysmenorrhea became a significant influence on post-imaging pain perception（OR=1.423,95%CI:1.067-1.897）.At 24h after Hy Co Sy,a total of 626 patients were collected from questionnaire survey for the occurrence of irregular vaginal bleeding,of whom 306 had irregular vaginal bleeding（48.9%）.Multifactorial analysis showed that endometrial thickness at the day of Hy Co Sy（OR=3.833,95%CI:1.270-11.563）,pain degree（OR=2.998,95%CI:1.948-4.615）,the degree of tubal patency（OR=2.489,95%CI:2.104-2.944）,high pressure of contrast agent injection（OR=2.478,95%CI:1.139-5.391）and water sac size（OR=1.127,95%CI:1.073-1.184）were risk factors for irregular vaginal bleeding.,There were 156 patients had menstrual changes（58.2%）within 1 to 2 months after Hy Co Sy.Multivariate analysis showed that the degree of pain（OR=1.426,95%CI:1.066-1.906）at the time of angiography was a high risk factor for menstrual changes,while patients with previous abnormal menstrual volume（OR=0.409,95%CI:0.242-0.691）had a reduced risk of menstrual changes after angiographyConclusion Before Hy Co Sy,the adjustment of the water sac size can effectively correct the pain level of patients,so as to truly reflect the pain level of patients during the Hy Co Sy.In the examination of TV 4D-Hy Co Sy,poor patency of fallopian tube,high pressure of contrast agent injection,large water sac,countercurrent of contrast agent and bleeding uterine flushing fluid were high risk factors for pain in patients.Among them,the degree of tubal patency and contrast agent injection pressure were the main influencing factors of pain,pain severity and irregular vaginal bleeding in patients both during Hy Co Sy and after Hy Co Sy.In addition,patients with increased pain had a higher risk of menstrual changes within 1 to2 months after Hy Co Sy.According to the above research,the occurrence of complications in patients underwent TV 4D-Hy Co Sy can be predicted according to the clinical manifestation improving the quality of doctor-patient communication and humanistic care.