Top

Published in:

01-08-2006 | Original Article

Comparison of hysterosalpingography, hysterosonography and hysteroscopy in evaluation of the uterine cavity in patients with recurrent pregnancy losses

Authors: Hélio Antonio Guimarães Filho, Rosiane Mattar, Cláudio R. Pires, Edward Araujo Júnior, Antonio F. Moron, Luciano M. M. Nardozza

Published in: Archives of Gynecology and Obstetrics | Issue 5/2006

Abstract

Aim

To evaluate the accuracy and acceptability of hysterosonography (HS) in the diagnosis of uterine anomalies in patients with recurrent pregnancy loss.

Method

Sixty non-pregnant patients with a history of at least three previous recurrent miscarriages were submitted to the HS, HSG and hysteroscopy (HTC) exams. The findings fall into three categories: synechiae, polypoid lesions and abnormal uterine cavity shape. The HTC exam was used as the gold standard. The findings of the HS and the HSG were compared to the HTC’s and the agreement was evaluated using the Kappa coefficient. Significance was established at < 0.05. Sensitivity, specificity, positive and negative predictive values were determined for each method.

Result

Uterine anomalies were present in 38.3% (23) of the patients: 16 (26.7%) with synechiae, 3 (5.0%) with polypoid lesions and 8 (13.3%) with abnormal uterine cavity shape. Accuracy of the HS and the HSG was 90.9 and 85.2%. General sensitivity of the HS was superior to the HSG (90.5 vs. 75.0%). It also had a higher degree of agreement with the HTC (Kappa = 0.81 vs. 0.68). The HS caused significantly less pain than the other two methods.

Conclusions

The HS had higher diagnostic accuracy in the detection of uterine cavity anomalies and it was better tolerated by the patients when compared to hysterosalpingography and hysteroscopy.

American College of Obstetricians, Gynecologists (2002) Management of recurrent early pregnancy loss ACOG Practice bulletin, no 24, February 2001. Int J Gynaecol Obstet 78:179–190CrossRef

Salim R, Regan L, Woelfer B, Backos M, Jurkovic D (2003) A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod 18(1):162–166PubMedCrossRef

Gronlund L, Hertz J, Helm P, Colov NP (1999) Transvaginal sonohysterography and hysteroscopy in the evaluation of female infertility, habitual abortion or metrorrhagia. A comparative study. Acta Obstet Gynecol Scand 78:415–418PubMedCrossRef

Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S (2000) Evaluation of outpatient hysteroscopy, saline infusion histerosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 74(5):1029–1034PubMedCrossRef

Laifer-Narin Sl, Ragavendra N, Parmenter EK, Grant E (2002) False-normal appearance of the endometrium on conventional transvaginal sonography comparison with saline hysterosonography. AJR Am J Roentgenol 178:129–133PubMed

Widrich T, Bradley LD, Mitchinson AR, Collins RL (1996) Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol 174:1327–1334PubMedCrossRef

Keltz MD, Olive DL, Kim AH, Arici A (1997) Sonohysterography for screening in recurrent pregnancy loss. Fertil Steril 67(4):670–674PubMedCrossRef

Ninomiya T, Albuquerque LET, Varjão DM, Faria KB, Oliveira RCM, Diniz LEV (2003) Evaluation of the uterine cavity by sonohysterography in patients with implantation failure after in vitro fertilization. Rev Bras Ginecol Obstet 25(7):519–523CrossRef

Dueholm M, Forman A, Jensen ML, Laursen H, Kraus P (2001a) Transvaginal sonography combined whit saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients whit abnormal uterine bleeding. Ultrasound Obstet Gynecol 18:54–61CrossRef

10.

Kroon CD, Bock GH, Dieben SWM, Jansen FW (2003a) Saline contrast hysterosonography in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG 110:938–947

11.

Donadio NK, Donadio N, Torres MMG (2004) Three-dimensional hysterosonography in infertility: preliminary study. Rev Bras Ginecol Obstet 26(10):773–780CrossRef

12.

Franco RC, Machado JC, Elias Junior J, Berezowski AT, Nogueira AA, Sala MM (2000) Endouterine cavity investigation: Comparative study between x-ray hysterography, sonohysterography and hysteroscopy. Rev Bras Ginecol Obstet 22(10):619–625CrossRef

13.

Duce MN, Oz U, Ozer C, Yildiz A, Apaydin FD, Çil F (2003) Diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps. Aust N Z J Obstet Gynaecol 43:448–452CrossRef

14.

Leone FPG, Lanzani C, Ferrazzi E (2003) Use of strict sonohysterorographic methods for preoperative assessment of submucous myomas. Fertil Steril 79(4):998–1002PubMedCrossRef

15.

Lasmar RB, Barrozo PRM, Dias R, Oliveira MAP, Pontes A, Dias DS (2004) Submucous fibroids: presurgical classification to evaluate the viability of hysteroscopic surgical treatment. Rev Bras Ginecol Obstet 26(4):305–309CrossRef

16.

Romano F, Cicinelli E, Anastacio PS, Epifani S, Fanelli F, Galantino P (1994) Sonohysterography versus hysteroscopy for diagnosing endouterine abnormalities in fertile women. Int J Gynaecol Obstet 45(3):253–260PubMedCrossRef

17.

Traina E, Mattar R, Moron AF, Albuquerque Neto LC, Matheus ED (2004) Diagnostic accuracy of hysterosalpingography and transvaginal sonography to evaluate uterine cavity diseases in patients with recurrent miscarriage. Rev Bras Ginecol Obstet 26(7):527–528CrossRef

18.

Glatstein IZ, Sleeper LA, Lavy Y, Simon A, Adoni A, Palti Z et al (1997b) Observer variability in the diagnosis and management of the hysterosalpingogram. Fertil Steril 67:233–237CrossRef

19.

Soares SR, Barbosa dos Reis RR, Camargos AF (2000) Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril 73(2):406–411PubMedCrossRef

20.

Kim HA, McKay H, Keltz MD, Nelson HP, Adamson GD (1998) Sonohysterographic screening before in vitro fertilization. Fertil Steril 69:841–844PubMedCrossRef

21.

Accorsi Neto AC, Gonçalves WJ, Mancini SN, Soares Jr JR, Haidar MA, Lima JR et al (2003) Comparison between hysterosonography, hysteroscopy and histopathology in the evaluation of postmenopausal woman uterine cavity. Rev Bras Ginecol Obstet 25(9):667–672CrossRef

22.

Crespigny L, Kuhn R, McGinnes D (1997) Saline infusion sonohysterography, an underutilized technique. Aust N Z Obstet Gynaecol 37(2):206–209CrossRef

Title: Comparison of hysterosalpingography, hysterosonography and hysteroscopy in evaluation of the uterine cavity in patients with recurrent pregnancy losses
Authors: Hélio Antonio Guimarães Filho
Rosiane Mattar
Cláudio R. Pires
Edward Araujo Júnior
Antonio F. Moron
Luciano M. M. Nardozza
Publication date: 01-08-2006
Publisher: Springer-Verlag
Published in: Archives of Gynecology and Obstetrics / Issue 5/2006
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-006-0186-3

At a glance: The STEP trials

Springer Medicine

Comparison of hysterosalpingography, hysterosonography and hysteroscopy in evaluation of the uterine cavity in patients with recurrent pregnancy losses

Abstract

Aim

Method

Result

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Aim

Method

Result

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2006

Prediction of HELLP syndrome with assessment of maternal dual hepatic blood supply by using Doppler ultrasound

Antibodies to β2-glycoprotein I and annexin V in women with early and late idiopathic recurrent spontaneous abortions

Rupture of rudimentary uterine horn pregnancy at 37 weeks gestation with fetal survival

Calcineurin antagonists in vulvar lichen sclerosus

The effect of hormone replacement therapy on the levels of serum lipids, apolipoprotein AI, apolipoprotein B and lipoprotein (a) in Turkish postmenopausal women

Paget’s disease of the nipple diagnosed by MRI