HYSTEROSCOPY IN THE DIAGNOSIS AND TREATMENT OF UTERUS ANOMALIES IN PATIENTS WITH PREGNANCY LOSS

Abstract

Introduction. The incidence of miscarriage is 15-25% of all pregnancies, increases with the age of women and has no tendency to decrease. One of the causes of miscarriage is congenital and acquired violations of the anatomical structure of the uterus. The frequency of congenital anomalies of genital organs in patients with miscarriage varies within 3-16%.Aim. To evaluate the diagnostic value and therapeutic possibilities of hysteroscopy in patients with congenital uterine anomalies and reproductive losses in history.Materials and methods. We conducted a retrospective assessment of the diagnostic value of hysteroscopy in the differential diagnosis of congenital uterine anomalies in 59 patients with reproductive losses in history and its therapeutic potential.Results. The informativeness of hysteroscopy in the diagnosis of uterine anomalies was retrospectively compared with the results obtained during hysterolaparoscopy. For 42 patients with uterine septum which was diagnosed intraoperatively was immediately performed the hysteroscopic metroplasty. The completeness of the excision of the intrauterine septum was assessed by comparing the 3D ultrasound data performed before the hysteroscopic metroplasty and in the next menstrual cycle after the operative intervention. In 4.8% of patients it was necessary to conduct a repeated surgical intervention, as during the first operation it was not possible to simultaneously achieve the complete dissection of the septum. The frequency of correctly classified anomalies of the uterus using the hysteroscopy was 84.7%. The greatest difficulties in evaluating the hysteroscopic pattern occurred in cases of differentiation of the uterus bicornis and the uterine septum. In such situations, the hysteroscopic examination should be supplemented by laparoscopy which allows to avoid making a false diagnosis. In the case of uterus unicornis, the hysteroscopic diagnosis coincided with the final one of 100%. However, even the combined use of hysteroscopy and laparoscopy causes significant difficulties in differentiating of subclasses of this anomaly which are based on the presence or absence of a functional cavity in the rudimentary horn. In such situations, 3D ultrasound is the highly informative method, according to which in our study, 42.9% of patients with unicornuate uterus had a functional cavity in the rudimentary horn which was an indication for its removing. In the case of uterus didelphys, the hysteroscopic diagnosis coincided with the data of hysterolaparoscopy in 60% of cases (p <0,05).Conclusions. Hysteroscopy should be integrated into the general diagnostic scheme when examining patients suspected of Muller anomalies. The frequency of correctly classified congenital uterus anomalies using the hysteroscopy is 84.7%. Simultaneous carrying out of laparoscopy and hysteroscopy gives an opportunity in 100% of cases to put the exact diagnosis of the uterine septum and to carry out the surgical correction of this anomaly with the preservation of the integrity of the uterine wall.