A comparative study on the efficacy of saline infusion sonography and transvaginal sonography in abnormal uterine bleeding in premenopausal females

Authors

  • Dhivya S. Department of Obstetrics and Gynecology, Panimalar Medical College and Hospital, Chennai, Tamil Nadu, India
  • Tamilselvi D. Department of Obstetrics and Gynecology, Panimalar Medical College and Hospital, Chennai, Tamil Nadu, India
  • Sivaraman G. Department of Anaesthesia, Panimalar Medical College and Hospital, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20262106

Keywords:

Transvaginal ultrasonography, Saline infusion sonography, Premenopausal female, Abnormal uterine bleeding

Abstract

Background: Saline infusion sonography (SIS) and transvaginal ultrasonography (TVS) were widely used techniques for evaluation of cases with abnormal uterine bleeding (AUB). However, the superiority of these two techniques in terms of accuracy remains a question.

Methods: A total of 45 cases with AUB were subjected to both TVS and SIS and analysed for endometrial polyp or submucosal fibroids. The results of the imaging were compared with the histopathological results of the endometrium of the same patient. The data was analyzed using SPSS - Version 19.

Results:  In diagnosing thickened endometrium, diagnostic accuracy of TVS was reported as 91.1% with sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 96.7%, 78.6%, 90.9% and 91.7%, respectively. Similarly, for SIS, diagnostic accuracy (DA) was 93.3% with Sn, Sp, PPV and NPV were 96.7%, 85.7%, 93.8% and 92.3%, respectively. In adenomyosis, diagnostic accuracy of TVS was reported as 95.6% with Sn, Sp, PPV and NPV of 100%, 94.7%, 77.8% and 100%, respectively. Similarly, for SIS, Diagnostic accuracy was 100% with Sn, Sp, PPV and NPV were also 100%. In diagnosing fibroid, diagnostic accuracy of TVS was reported as 100% with Sn, Sp, PPV and NPV of 87.5%, 100%, 100% and 97.4%, respectively. Similarly, for SIS, diagnostic accuracy was 100% with Sn, Sp, PPV and NPV were 100%, each.

Conclusions: We infer that SIS is found to be better efficacious in diagnosing different pathologies of AUB cases compared to TVS among the premenopausal women.

References

Romero Asghar Z, Hosseini R, Azadehrah M, Azadehrah M. Evaluation of compatibility of ultrasound and hysteroscopic findings and histo-pathological results in women with abnormal uterine bleeding (AUB). PJMHS. 2021;15(1):633-40.

Nieuwenhuis LL, Hermans FJ, Bij de Vaate AJM, Leeflang MM, Brolmann HA, Hehenkamp WJ, et al. Three- dimentional saline infusion sonography compared to twodimentional saline infusion sonography for the diagnosis of focal intracavity lesions. Cochrane Database Syst Rev. 2017;5(5):11126.

Lapidus L, Grabe Z. Evaluation of palm coein classification and management of abnormal uterine bleeding in Latvian population. Indian J ObstetGynaecol Res. 2020;7(4):319-24.

Nayak B, Parida S, Rautrary PN, Mohapatra J, Samantaray S, Giri SK. Transvaginal sonography(TVS) in evaluation of endometrial carcinoma and its correlation with histopathology. A retrospective analysis. Indian J Gynaecol Oncolog. 2017;15:12.

Draz MH, El Saba TM, El Shorbagy SH. Saline infusion sonography versus hysteroscopy in the evaluation of uterine cavity in women with unexplained infertility. Tenta Med J. 2017;45:155-9.

Jiang T, Yuan Q, Zhou Q, Zhu Y, Cao Y. Do endometrial lesions require removal. A retrospective study. BMC Womens Health. 2019;19:61.

Malik N, Q tul Ain, Aftab S. Evaluation of uterine abnormalities in women with subfertility using saline infusion sono-graphy; A retrospective descriptive study. J Soc Obstet Gynaecol Pak. 2023;13(4):361-3.

Singham JHA, Monika A, Upasna S. Validity of hysteroscopy and transvaginal sonography in evaluating abnormal uterine bleeding. A retrospective study. J Clin Diagnostic Res. 2021;15(4):10-3.

Sarbhai V, Singla T. Diagnostic value of outpatient endometrial aspiration and transvaginal sonography vs inpatient hysteroscopy in evaluation of abnormal uterine bleeding. J Postgrad Med Edu Res. 2019;53(4):143-6.

Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding. American J Obstet Gynecol. 1997;177(1):102-8.

De Vries LD, Dijkhuizen FP, Mol BW, Brölmann HA, Moret E, Heintz AP. Comparisonof transvaginal sonography, saline infusion sonography and hysteroscopy in premenopausal women with abnormal uterine bleeding. J Clin Ultrasound. 2000;28(5):217-23.

Krampl E, Bourne T, Hurlen-Solbakken H, Istre O. Transvaginal ultrasonography sonohysterography and operative hysteroscopy for the evaluation of abnormal uterine bleeding. American J Obstet Gynecol. 2001;80(7):616-22.

Dueholm M, Forman A, Jensen ML, Laursen H, Kracht P. Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding. Ultrasound in obstetrics and gynecology. J Int Society Ultrasound Obst and Gynecol. 2001;18(1):54-61.

Farquhar C, Ekeroma A, Furness S, Arroll B. A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta obstetricia et gynecologica Scandinavica. 2003;1;82(6):493-504.

Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertility andsterility. 2005;1;84(3):682-6.

Cepni I, Ocal P, Erkan S, Saricali FS, Akbas H, Demirkiran F, et al. Comparison of transvaginal sonography, saline infusion sonography and hysteroscopy in the evaluation of uterine cavity pathologies. Australian and New Zealand Obstet Gynaecol. 2005;45(1):30-5.

Mohamed ah. comparative study of transvaginal ultrasonography and saline infusionsonohysterography in evaluation of endometrial and subendometrial abnormalities in patients with abnormal uterine bleeding.

Tur-Kaspa I, Gal M, Hartman M, Hartman J, Hartman A. A prospective evaluation of uterine abnormalities by saline infusion sonohysterography in 1,009 women with infertility or abnormal uterine bleeding. Fertility and sterility. 2006;1;86(6):1731-5.

Erdem M, Bilgin U, Bozkurt N, Erdem A. Comparison of transvaginal ultrasonography and saline infusion sonohysterography in evaluating the endometrial cavity in pre-and postmenopausal women with abnormal uterine bleeding. Menopause. 2007;1;14(5):846-52.

Aslam M, Ijaz L, Tariq S, Shafqat K, Ashraf R, Kazmi T. Comparison of transvaginal sonography and saline contrast sonohysterography in women with abnormal uterine bleeding: correlation with hysteroscopy and histopathology. International journal of health sciences. 2007;1(1):17.

Yildizhan B, Yildizhan R, Ozkesici B, Suer N. Transvaginal ultrasonography and saline infusion sonohysterography for the detection of intra-uterine lesions in pre-and postmenopausal women with abnormal uterine bleeding. Journal of International Medical Research. 2008;36(6):1205-13.

Grimbizis GF, Tsolakidis D, Mikos T, Anagnostou E, Asimakopoulos E, Stamatopoulos P, et al. A prospective comparison of transvaginal ultrasound, saline infusion sonohysterography and diagnostic hysteroscopy in the evaluation of endometrial pathology. Fertility and sterility. 2010;1;94(7):2720-5.

Choudry A, Shukr I, Khan S, Hafeez H, Jamal S, Anwer A. Acceptability and accuracy of saline infusion sonohysterography in women with postmenopausal bleeding. J Coll Physicians Surg Pak. 2010;20(9):571-5.

Hauge K, Ekerhovd E, Granberg S. Abnormal uterine bleeding refractory to medical therapy assessed by saline infusion sonohysterography. Acta obstetricia et gynecologica scandinavica. 2010;1;89(3):367-72.

Mathew M, Gowri V, Rizvi SG. Saline infusion sonohysterography–an effective tool forevaluation of the endometrial cavity in women with abnormal uterine bleeding. Acta obstetricia et gynecologica Scandinavica. 2010;89(1):140-2.

Bingol B, Gunenc MZ, Gedikbasi A, Guner H, Tasdemir S, Tiras B. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding. Arch Gynecol Obstetrics. 2011;284:111-7.

Sharma M, Joshi S, Sharma A, Nagar O, Khuteta R, Bagarahatta M. Role of saline infusion sonography in abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2013;2(4):533-8.

Chawla I, Tripathi S, Vohra P, Singh P. To evaluate the accuracy of saline infusion sonohysterography (SIS) for evaluation of uterine cavity abnormalities in patients with abnormal uterine bleeding. J Obst Gynecol India. 2014;64:197-201.

Nallapati S, Pallavee P, Ghose S. Comparative study of saline infusion sonography and hysteroscopy for evaluation of uterine cavity in abnormal uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2015;4:828-32.

Downloads

Published

2026-06-26

How to Cite

S., D., D., T., & G., S. (2026). A comparative study on the efficacy of saline infusion sonography and transvaginal sonography in abnormal uterine bleeding in premenopausal females. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 15(7), 2579–2585. https://doi.org/10.18203/2320-1770.ijrcog20262106

Issue

Section

Original Research Articles