A saline infusion sonogram (SIS), also known as a sonohysterogram, is a specialized ultrasound procedure used to evaluate the uterus and endometrial cavity. This procedure involves the injection of sterile saline into the uterus to enhance ultrasound images and provide better visualization of the uterine lining.  The procedure:

1. A small, sterile catheter is inserted into the uterus through the cervix.
2. Sterile saline is gently introduced into the uterine cavity.
3. A transvaginal ultrasound is performed to assess the uterine lining and structure.
4. The procedure typically takes 10-15 minutes.

Possible Risks and Discomforts: SIS is a safe procedure; however, as with any medical procedure, there are potential risks, including:

• Mild cramping or discomfort.
• Light spotting after the procedure.
• Minimal risk of infection (rare).
• Rare allergic reaction to latex (please inform us if you have a latex allergy).

Contraindications: SIS should not be performed if:

• You are pregnant or suspect you may be pregnant
• You have an active pelvic infection
• You are currently experiencing heavy menstrual bleeding

Post-Procedure Care:

• Mild cramping may occur but usually subsides within a few hours.
• Over-the-counter pain relievers (e.g., ibuprofen) may be taken if needed.
• Avoid tampon use or sexual intercourse for 24-48 hours to reduce the risk of infection.
• Contact your doctor if you experience severe pain, fever, or heavy bleeding.

WAIVER & CONSENT

I acknowledge that I have been informed about the purpose, benefits, and risks of the saline infusion sonogram procedure and I voluntarily consent to undergo the Saline Infusion Sonogram (SIS). I understand that:

• The procedure involves the use of sterile saline to evaluate my uterus.
• There may be minor risks, including cramping, spotting, and a rare risk of infection.
• This procedure is not a treatment but a diagnostic test.
• I am not pregnant and have disclosed all relevant medical history.

Witness Confirmation

By clicking the "Confirm" button, you acknowledge that Apex Radiology has electronically witnessed this consent form. The date and time of submission are recorded and securely stored as part of your medical record.