85 Safety of HSG with oil-based contrast medium 5 Figure 1. Prevalence of intravasation of oil-based contrast versus water-based contrast in HSG for subfertility. Forest plot of meta-analysis reporting on intravasation with the use of oil-based contrast compared with water-based contrast. (A) RCT. (B) Cohort studies. OR and 95% CI. OR < 1 favour oil-based contrast (fewer adverse events); OR > 1 favour water-based contrast (fewer adverse events). The risk of bias of individual studies is represented by coloured dots: green (low risk of bias) and yellow (moderate risk of bias). HSG = hysterosalpingography; OSCM = oil-based contrast media; RCT = randomized controlled trial; WSCM = water-based contrast media. In the whole group of HSGs with the use of oil-based contrast performed in RCT and cohort studies, there were 18 women with oil embolisms (18/19,339, 0.1% of HSG; 18/664, 2.7% of cases with intravasation). In six of these cases pulmonary embolisms were described, while the other 12 cases only described the contrast moving rapidly out of the pelvis. The latter were all asymptomatic and serious lasting consequences were not reported (see Figure 2). Figure 2. Intravasation and oil embolisms in HSG with oil-based contrast for subfertility in cohort studies and RCT. HSG = hysterosalpingography; RCT = randomized controlled trial.
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