Role of trans vaginal sonography with hysteroscopy in detection of uterine causes of abortions
Keywords:Hysteroscopy, Recurrent abortion, Sensitivity, Transvaginal sonography
Background: Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are only few evidence-based diagnostic and treatment strategies. Objective of this study was to compare the role of trans vaginal sonography with hysteroscopy in detection of uterine causes of abortions.
Methods: This prospective cohort study was conducted in the department of obstetrics and gynaecology, Kasturba Hospital, Daryaganj, Delhi. The study was conducted from January 2016 to December 2016.
Results: On transvaginal sonography majority of women i.e. 39(78%) patients had normal ultra-sonographic findings. 11(22%) showed various abnormal findings. Most commonly diagnosed abnormal finding on TVS was polyp, seen in 5(10%) patients. It was seen as a well-defined, uniformly hyperechoic mass within the endometrial cavity. normal hysteroscopic findings were seen in 27(54%) patients. Rest 23(46%) patients had abnormal uterine factors as diagnosed by hysteroscopy.Synechiae was detected in 9(18%) patients. It was the most common abnormality detected on hysteroscopy. Out of 9 patients who had synechiae, 2 had severe dense adhesions. In 6 patients, the adhesions were mild and flimsy. While minimal adhesions were noted in 1 patient, seen near the cornua.
Conclusions: hysteroscopy is still the gold standard for diagnosis and most definitive procedure of choice if any kind of operative intervention is required.
Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in selected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17:761-71.
Li TC, Makris M, Tomsu M, Tuckerman E, Laird S. Recurrent miscarriage: aetiology, management and prognosis. Hum Reprod Update. 2002;8:463-81.
Weiss A, Shalev E, Romano S. Hysteroscopy may be justified after two miscarriages. Hum Reprod. 2005;20(9):2628-31.
Lancet M, Kessler I. A review of Asherman‟s syndrome and results of modern treatment. Int J Fertil. 1988;33:14-24.
Schenker JG. Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynaecol Reprod Biol. 1996;65:109-13.
Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Fertil Steril. 1982;37:593-610.
Salzani A, Yela DA, Gabiatti JR, Bedone AJ, Monteiro IM. Prevalence of uterine synechia after abortion evacuation curettage. Sao Paulo Med J. 2007;125:261-4.
Neuwirth RS, Levin B, Keltz MD. Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol. 1999;94:168-71.
Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C, Pellicer A. Reproductive impact of congenital uterine anomalies. Hum Reprod. 1997;12:2277-81.
Friedler S, Margalioth EJ, Kafka I, Yaffe H. Incidence of post abortion intra-uterine adhesions evaluated by hysteroscopy - a prospective study. Hum Reprod. 1993;8:442-4.