Risk of adverse pregnancy outcomes after abnormal hysterosalpingography

Objective: To investigate the association between an abnormal hysterosalpingogram (HSG) and obstetrical and neonatal outcomes. Design: A retrospective cohort study comparing outcomes between women with normal versus abnormal tubal patency and uterine cavity on HSG. Results: Among 2181 women included in the study, 494 (22.6%) had an abnormal HSG. Of these, 207 (42%) presented with uterine abnormalities, 336 (68%) with tubal abnormalities and 49 (10%) with both. The study identified 232 clinical pregnancies in the abnormal HSG group and 814 pregnancies in controls. Women with abnormal HSG showed higher rates of preterm labour (PTL) compared to controls (13.6% vs. 7.7%, p < 0.05, n = 1687). Multivariate analysis revealed that any HSG abnormality was associated with an increased risk of PTL (aOR 2.39, 1.04–5.51). When analysing by type of abnormality, uterine abnormalities increased the risk of preeclampsia (aOR 2.86, 1.06–7.7) and low birthweight (aOR 2.31, 1.0–5.35), while tubal abnormalities were specifically associated with increased risk of PTL (aOR 3.87, 1.63–9.19). Conclusion: An abnormal HSG study was associated with adverse obstetrical outcomes. Specifically, uterine abnormalities increased the risk of preeclampsia and birthweight below 10th percentile, while tubal abnormalities were associated with a heightened risk of PTL.