Febrile morbidity following hysterosalpingography: identification of risk factors and recommendations for prophylaxis

Although previous large series have reported that from 0.3% to 1.3% of patients undergoing hysterosalpingography (HSG) develop infectious morbidity, our impression was that the incidence was higher among our patients. Therefore the records of 448 consecutive healthy women who underwent HSG were examined. Within 24 hours after the HSG, 14 of these 448 patients (3.1%) developed fever and pelvic peritonitis requiring hospitalization and treatment with parenteral antibiotics, a significantly greater frequency than reported elsewhere (P less than 0.01). Traditional laboratory tests failed to predict patients at risk, and prophylactic antibiotics effective against aerobic organisms could not protect against this complication. However, it was possible to design a scoring system based on specific findings in the history and previous physical examinations that was capable of identifying patients who would subsequently become infected. The clinical sensitivity of this scoring technique is 57%, clinical specificity 99%, and test efficiency 97%. It is suggested that in view of the major risk of post-HSG infection in certain identifiable women and because of the impact of this complication on their future fertility, hysterosalpingography should not be performed in those patients determined to be at high risk. In women at lowest risk, the procedure is safe. Finally, in patients assigned an intermediate risk-score, the risk-benefit ratio must be carefully weighed and discussed with the patient, and prophylactic antibiotics with anaerobic coverage should be considered.