Diagnostic correlation between sonohysterography and hysteroscopy in the assessment of uterine cavity after cesarean section

Abstract

Background: The evolution of sonohysterography (SHG) over the past years has contributed significantly to the assessment of uterine cavity. Objectives: To compare SHG versus the “gold standard” diagnostic hysteroscopy (DH) for the assessment of the uterine cavity in women with previous cesarean section (CS). Design: Comparative observational cross-sectional study. Setting: Department of Obstetrics and Gynecology, Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University. Subjects: Seventy-five women with previous CS(s), complaining of infertility, menstrual disorders or recurrent pregnancy loss. The inclusion criteria were: age between 20 and 35years; previous 1–3 CS(s); and the duration from the last CS ranging from 1 to 5years. Methods: Transvaginal SHG with saline infusion as contrast medium for assessment of the thickness of the scar, filling defect in the scar (niche) and intrauterine adhesions. DH was performed to confirm different findings. Main outcome measures: The findings at SHG were compared to DH; and the accuracy of SHG was calculated. Results: The scar thickness at SHG was significantly lower in cases with scar defect at DH (P=0.016). SHG was comparable to DH as shown by sensitivity, specificity, +ve predictive value, −ve predictive value and overall accuracy of 87%, 100%, 100%, 95% and 96%, respectively, in the diagnosis of scar defect; and 76%, 100%, 100%, 87% and 91%, respectively, in the diagnosis of intrauterine adhesions. Conclusion: SHG is reliable and feasible, and may be recommended as an alternative to DH for the assessment of the uterine cavity and uterine scar in women with previous CS.

Keywords

• Sonohysterography
• Hysteroscopy
• Uterine cavity
• Cesarean section