Influencing Factors For Contrast Agent Reflux In Transvaginal Four-dimensional Hysterosalpingo-contrast Sonography: A Logistic Regression Analysis

Objective To observe the images of reflux in the process of transvaginal four-dimensional hysterosalpingo-contrast sonography,to explore the influencing factors of reflux and reduce the incidence of reflux.Methods Take the 235 cases of female infertility patients(aged from 22 to 47 with infertility duration of 1 to 13 years)as samples,who undertook transvaginal fourdimensional hysterosalpingo-contrast sonography treatment in our hospital from January,2017 to December,2018.Carefully observe the sonographic images of the presence of reflux of ultrasound contrast agent,and group them into groups according to whether reflux exists or not.101 patients in the reflux group and 134 patients in the non-reflux group were included,and analyze and compare the clinical and imaging data of all patients.From the age,infertility time,tube patency,pain degree,uterine position,endometrial thickness,menstruation examination time,infertility type,abortion history,uterine malformation,ectopic pregnancy history,gynecological inflammation,Uterine Space-occupying Lesions,pelvic surgery history,and intrauterine adhesion these 15 factors to explore the causes of reflux.Results The incidence of contrast reflux was 42.9%,Univariate analyses showed that endometrial thickness,history of abortion,menstruation examination time,intrauterine adhesion,type of infertility and tubal patency can all be possibly related with the reflux(P<0.05).Multivariate logistic regression analyses showed that endometrial thickness,menstruation examination time,type of infertility and tube patency are closely linked to the reflux(P=0.036?0.045?0.025?0.004).Endometrial thickness and menstruation examination time have negative correlation with the reflux(B=-0.834?-0.802).Type of infertility and positive group of Fallopian tubes are positively correlated with the reflux(B=1.122?0.898).According to the results of Logistic regression analyses,the ROC curve was constructed.The area under the curve of multi-factor joint prediction model(AUC=0.798)was larger than the single factor,and the prediction value was preferred.Conclusion Endometrial thickness <6mm,examination 3-4 days after the menstruation,secondary infertility and tubal occlusion are the main causes of reflux.Therefore,it is advisable to have the examination when the endometrial thickness is ?6mm and the menstruation is over for 5 to 7 days.Meanwhile,the endometrial damage should be avoided as much as possible,and the uterine cavity pressure be reduced,which is beneficial to keep incidence of reflux low and improve the diagnosis rate of fallopian tube patency.