Health Policy and Practice / Sant´ e : politique et pratique m´ edicale Unsuspected Pregnancies in Hysterosalpingography: Implementation and Review of a Multi-Institutional Pre- Procedural Pregnancy Screening Protocol Dennis Parhar, MD 1,2 , Annemarie Budau-Bymoen, ACR 3 , Victoria Peterson, BSc 4 , Ge Shi, BSc 4 , Yogesh Thakur, PhD, FCCPM 1,3 , and Charlotte J. Yong-Hing, MD, FRCRC 1,3,5 Abstract Purpose: Owing to the increasing average age of first-time mothers, as well as advances in assistive reproductive technology, the number of hysterosalpingography (HSG) requests has continued to rise. This increases the likelihood of patients presenting with unsuspected early pregnancies prior to HSG. Currently, there is no standard of practice for the pre-procedural screening of pregnancy prior to HSG, with most institutions using patient-reported pregnancy status and unreliable menstrual cycle dating methods. We implemented a multi-institutional pre-procedural pregnancy screening protocol in order to determine the rate of unsuspected pregnancies prior to HSG and improve the quality and safety of these procedures. Methods: Following multi- institutional and multidisciplinary input, a consensus protocol was formulated and implemented across 9 institutions in the Lower Mainland of British Columbia, Canada. Subsequent tracking of pregnancy testing was then performed over a period of 3 years. Results: Pre-implementation review of protocols demonstrated large disparities between institutions. A total of 6333 HSG examinations were scheduled in the review period following implementation. Of these, 10 patients were found to have positive pregnancy tests (0.16%), despite self-reporting that they were not pregnant or had recent menstrual bleeding. Discussion: Hys- terosalpingography is contraindicated in pregnancy, yet we identified 10 unsuspected pregnancies in patients who would have otherwise undergone HSG examinations with existing guidelines. While there remains insufficient data on the deleterious effects of performing HSG on an unsuspected pregnancy, the potential physical, economical, and psychosocial consequences of performing an HSG during pregnancy are sufficient to merit consideration of relatively inexpensive routine pregnancy screening prior to HSG. R´ esum ´ e Objectif : Le nombre de demandes d’hyst´ erosalpingographies (HSG) a continu´ e d’augmenter en raison de l’´ el´ evation croissante de l’a ˆge moyen des me `res primipares et des progre `s des technologies de reproduction assist´ ee. Cela augmente la probabilit´ e que des patientes se pr´ esentent avec une grossesse non soupc ¸onn´ ee au stade pr´ ecoce avant l’HSG. Il n’existe actuellement aucune norme de r´ ef´ erence pratique pour le d´ epistage d’une grossesse avant la r´ ealisation d’une HSG, la majorit´ e des ´ etablissements se reposant sur le statut de grossesse d ´ eclar´ e par la patiente et les m´ ethodes non fiables de datation du cycle menstruel. Nous avons mis en œuvre un protocole de d´ epistage de la grossesse pr´ eproc´ edure entre plusieurs ´ etablissements afin de d´ eterminer le taux de grossesses insoupc ¸onn´ ees avant une HSG et pour am´ eliorer la qualit´ e et la s´ ecurit´ e de ces proc´ edures. M´ ethodes : Un protocole de consensus a ´ et´ e formul´ e et mis en place apre `s les apports d’information de diff´ erentes disciplines dans 9 ´ etablissements de la vall´ ee du Bas-Fraser, en Colombie-Britannique (Canada). Un suivi subs´ equent des tests de grossesse a ensuite ´ et´ e effectu´ e sur une p´ eriode de 3 ans. R´ esultats : L’analyse des protocoles avant mise en œuvre a fait apparaı ˆtre une grande disparit´ e entre ´ etablissements. Un total de 6333 HSG avait ´ et´ e programm´ e au cours de la p´ eriode d’´ etude apre `s leur mise en 1 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada 2 T.H. Chan School of Public Health, Harvard University, Boston, MA, USA 3 Lower Mainland Medical Imaging, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada 4 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 5 BC Cancer, Provincial Health Services Authority, Vancouver, British Columbia, Canada Corresponding Author: Dennis Parhar, MD, Department of Radiology, Vancouver General Hospital, Gordon and Leslie Diamond Health Centre, 11th Floor, 2775 Laurel Street, Vancouver, British Columbia, Canada V5Z 1M9. Email: parhar@alumni.ubc.ca Canadian Association of Radiologists’ Journal 1-6 ª The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0846537120921509 journals.sagepub.com/home/caj