Uterine Cavity Abnormalities Research Articles

Histeroscopia ambulatorial em casos de abortamento consecutivo

OBJETIVO: Avaliar a prevalencia de alteracoes anatomicas uterinas diagnosticadas atraves da histeroscopia ambulatorial em uma populacao de pacientes com mais de dois abortamentos consecutivos. Comparar a prevalencia de alteracoes uterinas entre as pacientes com dois abortos em relacao as pacientes com tres ou mais abortamentos de repeticao. METODOS: Foi realizado um estudo transversal em 66 pacientes com diagnostico de dois ou mais abortamentos de repeticao. As pacientes foram divididas em dois grupos: Grupo A (ate dois abortamentos, 23 pacientes) e Grupo B (tres ou mais abortamentos, 43 pacientes), sendo submetidas a histeroscopia diagnostica ambulatorial em que foram identificadas alteracoes congenitas e adquiridas da cavidade uterina. RESULTADOS: Foram encontradas em 22 (33,3%) pacientes alteracoes uterinas, sendo em nove casos alteracoes congenitas [utero arqueado (quatro casos), septo uterino (dois casos) e utero bicorno (um caso)] e em 13 pacientes alteracoes adquiridas [sinequia (sete casos), polipo endometrial (quatro casos) e mioma uterino (dois casos). Nao houve diferenca significativa entre grupos em relacao as alteracoes uterinas adquiridas e congenitas. Foi encontrada uma correlacao positiva entre alteracoes anatomicas na histeroscopia e numero de abortamentos (r = 0,31; p = 0,02). CONCLUSAO: As pacientes com mais de dois abortamentos apresentam uma alta prevalencia de alteracoes uterinas diagnosticadas por histeroscopia. No entanto nao ha diferenca na prevalencia ou na distribuicao das lesoes em relacao ao numero de abortamentos

Office hysteroscopy study in consecutive miscarriage patients

To assess the prevalence of uterine anatomical abnormalities found by office diagnostic hysteroscopy in a population of patients experiencing more than two consecutive miscarriages and compare the prevalence of uterine abnormalities between patients with two miscarriages and those with three or more consecutive miscarriages. A cross-sectional study of 66 patients with two or more consecutive miscarriages diagnosis was conducted. Patients were divided into two groups: Group A (up to two miscarriages, 23 patients), and Group B (3 miscarriages, 43 patients). They underwent an outpatient diagnostic hysteroscopy study, with either congenital or acquired abnormalities of the uterine cavity being identified. Uterine changes were found in 22 (33.3%) patients, with 9 cases of congenital changes [arcuate uterus (4 cases), septate uterus (2 cases), and bicornuate uterus (1 case)], and 13 patients with acquired changes [intrauterine adhesions (7 cases), endometrial polyp (4 cases), and uterine leiomyoma (2 cases)]. No significant differences were found between the groups as regarding both acquired and congenital uterine changes. A positive correlation was found between anatomical changes on hysteroscopy and number of miscarriages (r = 0.31; p = 0.02). Patients with more than two miscarriages have a high prevalence of uterine cavity abnormalities diagnosed by hysteroscopy; however there are no differences in prevalence or distribution of these lesions related to the number of recurrent miscarriages.

Hematometra in uterus didelphys with right hemivagina and right renal agenesis

Developmental anomalies of the Mullerian Duct System are some of the more fascinating disorders encountered by obstetricians and gynecologists. Mullerian defects represent a broad spectrum of abnormalities ranging from uterine and vaginal agenesis to duplication of the uterus and vagina to minor uterine cavity abnormalities. They are frequently associated with abnormalities of the renal and axial skeletal system. The reported incidence rate varies widely from 0.2 to 7.4%1. Didelphys uterus is a rare congenital anomaly and is composed of two separate normal sized uteri and endocervical canals with cervices that are fused at the lower uterine segment. Obstructed unilateral vagina in patients with uterus didelphys is uncommon and is frequently associated with ipsilateral renal and ureter agenesis also known as Wunderlich-Herlyn-Werner Syndrome2. Workup for these patients includes ultrasonography and /or hysterosalpingography. If these investigations are inconclusive then MRI and IVP need to be done3. Case Report

Narrow band imaging hysteroscopy: a new diagnostic technique in recurrent IVF failure?

Narrow band imaging (NBI) is an optical filter technology that improves the visibility of capillaries, veins and other subtle tissue structures, by narrowing the bandwidth of spectral transmittance using optical filters. In this short communication, we want to share our preliminary experience in assisted reproductive technology patients where we had used NBI hysteroscopy for the evaluation of uterine cavity abnormalities who had previous IVF failure.

A comparative study of 2-dimensional sonohysterography versus 3-dimensional sonohysterography in infertile patients with uterine cavity lesions and abnormalities

Abstract Objective To compare 2-dimensional sonohysterography to 3-dimensional sonohysterography in detection of uterine cavity abnormalities in infertile patients. Design Prospective controlled study. Patients and methods Seventy seven infertile patients underwent the following transvaginal ultrasound techniques; 2D and 2D sonohysterography, 3D and 3D sonohysterography. Sensitivity, specificity, PPV, NPV, accuracy of 2D sonohysterography and 3D sonohysterography were calculated and compared to the gold standard of hysteroscopy laparoscopy. Results All 77 patients were studied using all four techniques. Both techniques of 2D and 3D sonohysterography were effective in reaching correct diagnosis. The overall sensitivity, specificity, PPV, NPV and accuracy of 2D sonohysterography was; 87.2, 100, 100, 84.2, 92.4, and 89.3 and that of 3D sonohysterography was; 100, 100, 86.4, and 93.6. The highest accuracy was obtained in diagnosis of endometrial polyps (98.7 and 100) and Mullerian anomalies (98.7 and 100) and the least with intrauterine synechiae (93.4 and 94.7). Conclusion 2D and 3D sonohysterography perform similarly in the diagnosis of uterine abnormalities as compared to hysteroscopy laparoscopy. If 3D technology is not available, 2D sonohysterography performs just as well.

Le bilan anatomique de la femme du couple infécond

One third of infertility cases are due to anatomical abnormalities of the female reproductive tract: endometrial polyps (33%), bilateral tubal blockage (12%), hydrosalpinx (7%), sub-mucosal fibroids (3%) and pelvic endometriosis. These may need surgical correction which could restore fertility. This review aim to determine which examinations should be performed first. Hysterosalpingography shows sensitivity of only 65% but it increases the achievement of spontaneous pregnancy by three times. Office hysteroscopy has an excellent sensitivity (>95%) for diagnosing intra-uterine lesions. Pelvic ultrasound, whose good sensitivity is improved by adding 3D imaging and hysterosonography, seems as efficient as office hysteroscopy in diagnosing uterine cavity abnormalities. Moreover, it also efficiently diagnoses pelvic diseases such as hydrosalpinx or endometrioma without laparoscopy. A first line laparoscopy is indicated in for woman suspected of endometriosis or tubal pathology (history of complicated appendicitis, previous pelvic surgery, pelvic inflammatory disease). For the others straight forward cases, the majority of patients, hysterosalpingography and pelvic ultrasound seem to be sufficient as primary diagnostic tool.

Uterine Cavity Assessment Prior to IVF

Approximately 15% of couples are affected with subfertility, of which up to 20% remain unexplained. Uterine cavity abnormalities can be a contributing cause of subfertility and recurrent implantation failure. Uterine cavity assessment has been suggested as a routine investigation in the evaluation of subfertile women. Traditionally, hysterosalpingography has been the most commonly used technique in the evaluation of infertility. Transvaginal ultrasound scan allows visualization of the endometrial lining and cavity, and has been used as a screening test for the assessment of uterine cavity. Abnormal uterine findings on a baseline scan can be further evaluated with saline hysterosonography, which is highly sensitive and specific in identifying intrauterine abnormalities. Hysteroscopy is considered as the definitive diagnostic tool to evaluate any abnormality suspected on hysterosalpingography, transvaginal ultrasound scan or saline hysterosonography during routine investigation of infertile patients. Minimally invasive hysteroscopes have minimized the pain experienced by patients during the procedure and made it feasible to use hysteroscopy as a routine outpatient examination. Following recurrent IVF failure there is some evidence of benefit from hysteroscopy in increasing the chance of pregnancy in the subsequent IVF cycle, both in those with abnormal and normal hysteroscopic findings. Various possible mechanisms have been proposed for this beneficial effect, but more randomized controlled trials are needed before its routine use in the general subfertile population can be recommended.

Hysteroscopy is effective tool to detect and treat the abnormalities of uterine cavity of implantation failure patients in ivf from our experience of 200 cases

OBJECTIVE: Abnormality of the uterine cavity is a cause of implantation failure in in vitro fertilization. Out patient hysteroscopy is a diagnostic tool to detect abnormalities of the uterine cavity and subsequent operative hysteroscopy can be used as a therapeutic tool. The present study was conducted to evaluate whether hysteroscopy is effective tool to diagnose and treat the patients with implantation failure in IVF from the experience of 200 cases.

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy in postmenopausal bleeding

To compare the diagnostic accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) with respect to pathological diagnosis in the detection of uterine cavity abnormalities associated with abnormal uterine bleeding among postmenopausal women. Being a prospective, investigator-blind trial, the present study was conducted on 137 postmenopausal women, with abnormal uterine bleeding, admitted to the Department of Obstetrics and Gynecology of Istanbul Bilim University, Florence Nightingale Hospital and Fertigyn Woman Health and IVF Center. After TVS, all patients underwent SIS using Cook Soft 500 IVF transfer catheter and HS, consecutively. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated to compare the diagnostic accuracy of TVS, SIS and HS. Most commonly encountered endometrial lesions were polypoid lesion (38.0%) and hyperplasia (28.4%) among our study population consisting of 137 women (mean age 61.6 ± 9.6 years) in their postmenopausal stage. Overall sensitivity rates were 70.0% for TVS, 89.6% for SIS and 92.3% for HS, while the overall specificity rates were 50.0, 77.3 and 80.7%, respectively. HS had PPV of 96.2% and NPV of 65.3%, whereas PPV was determined to be 80.9 versus 95.3% and NPV was 35.4 versus 58.3% for TVS and SIS, respectively. As an easy to perform, safe and well-tolerated procedure yielding high diagnostic accuracy, saline infusion SIS via this catheter seems to be superior to TVS and very close to HS. It may be used as the primary method for the detection of uterine abnormalities among postmenopausal women with abnormal uterine bleeding.

The pattern of hysterosalpingographic findings in women being investigated for infertility in Nnewi, Nigeria.

Tubal occlusion is the commonest cause of female infertility in the developing societies. Hysterosalpingography remains a vital method of assessing tubal patency especially in resource limited settings such as ours. To review the pattern of hysterosalpingographic findings among women being investigated for infertility in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria over a period of five years (2001-2005). The data obtained from the request forms and radiologists' reports were analyzed using SPSS version 11. The level of statistical significance was set at p < 0.05. Of the 320 studied, 230 were found suitable for analysis. Their ages ranged from 20 to 44 years (mean 32.8 +/- 5.8 years). The indications were primary infertility in 103 (44.8%), secondary infertility in 88(38.3%), while in 39 (16.9%) patients the type of infertility was not specified. The reports revealed that 67 (29.1%) had normal HSG Cervical abnormalities were found in 34 (14.8%), uterine cavity abnormalities in 108 (47.0%). Tubal pathologies were seen in 100 (43.5%) with bilateral tubal occlusion in 43 (18.7%) and bilateral hydrosalpinges in 6 (2.6%) patients. Tubal pathology remains a major contributor to female infertility in this part of the world.

Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization

Whether implantation occurs after in vitro fertilization (IVF) depends on the embryo, uterine receptivity or a combination of both. The prevalence of minor intrauterine abnormalities identified at hysteroscopy in cases with a normal transvaginal sonography (TVS) has been recorded to be as high as 20-40%. Diagnosing and treating such pathology prior to initiating IVF/intra-cytoplasmic sperm injection (ICSI), has been widely advocated without high-quality evidence of a beneficial effect. The objective of the current study was to assess, by screening office hysteroscopy, the prevalence of unsuspected intrauterine abnormalities in an asymptomatic population of IVF patients, in whom TVS had not revealed any pathology. The prevalence of unsuspected intrauterine abnormalities in patients allocated for a randomized controlled trial was prospectively assessed at two tertiary infertility care units: Academic Hospital at the Dutch-speaking Brussels Free University and University Medical Center Utrecht. A total of 678 unselected, asymptomatic, infertile women with a regular indication for a first IVF/ICSI treatment underwent office hysteroscopy. Only asymptomatic patients, aged < or = 42 years, with a normal TVS and no previous hysteroscopy were included. The presence of predefined intrauterine abnormalities was recorded and described in a standardized manner. Endometrial polyps were identified in 41 (6%) women and submucous myomas in 6 women (1%). Some women were also diagnosed with intrauterine adhesions (2%) or septa (2%). The overall prevalence of any predefined intrauterine abnormality in this IVF/ICSI population was 11%. The observed prevalence of unsuspected intrauterine abnormalities in asymptomatic patients indicated for their first IVF/ICSI treatment appeared to be clearly lower than previously reported (11 versus 20-45%). This may have implications for the significance of these abnormalities regarding prospects in IVF/ICSI treatment cycles.

Clinical value of hysteroscopy in diagnosis of postmenopausal uterine bleeding

Objective To investigate the value of hysteroscopy in the diagnosis of postmenopausal uterine bleeding.Methods 106 cases of outpatient of postmenopausal bleeding were analyzed.Hysteroscopic diagnosis and the biopsy result were compared in all patients.Results Histological diagnosis was 73 cases of uterine cavity abnormality,33 cases of normal were diagnosed in hysteroscopy.78 cases of pathological abnormalities,and 28 cases of normal were diagnosed.Comparing to histology, sensitivity was 95.89% ,specificity 84.85% , positive predictive value 93.33% , negative predictive value of 90.32%.Conclusion Hysteroscopy combined pathology was the best method to diagnose postmenopausal uterus bleeding. Key words: Hysteroscope; postmenopausal uterine bleeding; Diagnosis

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Hysterohydrosonoscopy—an integrated modality for uterine imaging

Office hysteroscopy and hydrosonography have long been viewed as competitive methods. This study was aimed to find out whether a combined approach of hysteroscopy followed by hydrosonography could provide more accurate information about the uterine lumen. Consecutive patients referred for diagnostic hysteroscopy were recruited to the study. Each patient had a transvaginal ultrasound scan, hysteroscopy, and immediately thereafter hydrosonography. Additional information retrieved by hydrosonography was recorded. When hysteroscopy revealed a normal uterine cavity, no further information was gained from hydrosonography. However, in 80% of the cases where hysteroscopy showed an abnormal uterine cavity (e.g., septum, adhesions, fibroid, endometrial polyp), hydrosonography added significant information regarding the size of the lesion, degree of fibroid encroachment, or luminal contour. We conclude that a combination of diagnostic hysteroscopy and hydrosonography could serve as a simple “one-stop” approach for full evaluation of the uterine cavity.

Comparative Evaluation of Saline Infusion Sonohysterography and Hysterolaparoscopy for Diagnosis of Uterine Cavity Abnormalities and Tubal Patency in Infertility: A One Year Cross- sectional Study

ABSTRACT Objective To compare the diagnostic efficacy of saline infusion sonohysterography (SIS) with hysterolaparoscopy in evaluation of uterine cavity and tubal patency. Methods This prospective one year cross-sectional study was conducted at the assisted reproduction center (ARC), KLES Dr Prabhakar Kore Hospital and Medical Research Centre, Belgaum. A total of 60 patients underwent SIS for evaluation of uterine cavity and tubal patency. Subsequently all patients underwent hysterolaparoscopy with chromopertubation (CPT). Results of SIS and hysterolaparoscopy with chromopertubation were compared. Results For evaluation of uterine cavity, when compared with hysteroscopy, SIS had a sensitivity of 97.8%, specificity of 88.8%, positive predictive value (PPV) of 97.8% and negative predictive value (NPV) of 88.8%. For evaluation of tubal patency when SIS was compared to laparoscopy with CPT, SIS had a sensitivity of 83.3%, specificity of 82.9%, PPV of 42.9% and NPV of 97.5%. Conclusion Saline infusion sonohysterography is a noninvasive, simple, easy and cost-effective procedure. SIS is more sensitive and specific for evaluation of uterine cavity as compared to evaluation of tubal patency.

Comparison of advantages of three-dimensional and two-dimensional ultrasound in embryo transfer

Objective To compare the advantages of three-dimensional(3D) and two-dimensional(2D) ultrasound in embryo transfer. Methods A total of 319 patients accepted embryo transfter were included in this study. 2D and 3D ultrasound were used to investigate the uterine cavity and transfer distance from the fundus (TDF),respectivly. They were divided into four groups according to TDF difference(D-TDF) between 2D and 3D ultrasound(group of DTDF<3mm,group of DTDF3～5mm,group of 6～9 mm,group of DTDF≥10 mm. Pregnancy outcomes among the four groups were compared. Results Of the 319 patients, 41 were observed to have abnormal uterine cavity. For 140 patients, the TDF measured by 2D ultrasound were different from that measured by 3D ultrasound. Clinical pregnancy rate and implantation rate were found lowest in group of TDF≥10 mm mm (7.7% vs 34.1%,38.1% ,40.0% and 3.6% vs 18.2% ,21.2% ,20.0%, P <0.05). Conclusions 2D ultrasound is limit and deficient for embryo transfer, especially for the visualization of uterine cavity and location of catheter tip, however, it may be better achieved with 3D ultrasound. It is helpful to use the 3D ultrasound to place the catheter tip accurately and improve the pregnancy rate of embryo transfer. Key words: Ultrasonography; Embryo transfer

Comparison of saline infusion sonography and histological findings in the evaluation of uterine cavity pathologies

To evaluate the accuracy of saline infusion sonography for the diagnosis of endometrial cavity abnormalities in patients who presented with abnormal uterine bleeding. Eighty-three women suspected of having endometrial cavity abnormalities were evaluated using saline infusion sonography. The results of this technique were compared with the histological evaluation reports of these women either with hysteroscopy or laparotomy prospectively. The positive predictive value (PPV) for endometrial polyps was 25%; the negative predictive value (NPV) was 93%; the sensitivity for endometrial polyps was 80% and the specificity was 87%. The PPV, the NPV, the sensitivity and the specificity for submucous fibroids were 65, 85, 81 and 89%, respectively. Saline infusion sonography was a reliable and accurate method for investigations of the endometrium and uterine cavity with good correlation, with histological results of more invasive procedures. It can be a good alternative technique for the evaluation of uterine cavity abnormalities where office hysteroscopy is not available.

P42.15: MR imaging of abnormal uterine cavity: emphasis on differential diagnosis with endometrial carcinoma

P42.15: MR imaging of abnormal uterine cavity: emphasis on differential diagnosis with endometrial carcinoma

Diagnostic hysteroscopy in abnormal uterine bleeding: a systematic review and meta‐analysis

This study was conducted to assess the accuracy and feasibility of diagnostic hysteroscopy in the evaluation of intrauterine abnormalities in women with abnormal uterine bleeding. Electronic databases were searched from 1 January 1965 to 1 January 2006 without language selection. The medical subject heading (MeSH) and textwords for the following terms were used: hysteroscopy, diagnosis, histology, histopathology, hysterectomy, biopsy, sensitivity and specificity. University Hospital. The inclusion criteria were report on accuracy of diagnostic hysteroscopy in women with abnormal uterine bleeding compared to histology collected with guided biopsy during hysteroscopy, operative hysteroscopy or hysterectomy. Electronic databases were searched for relevant studies and references were cross-checked. Validity was assessed and data were extracted independently by two authors. Heterogeneity was calculated and data were pooled. Subgroup analysis was performed according to validity criteria, study quality, menopausal state, time, setting and performance of the procedure. The pooled sensitivity, specificity, likelihood ratios, post-test probabilities and feasibility of diagnostic hysteroscopy on the prediction of uterine cavity abnormalities. Post-test probabilities were derived from the likelihood ratios and prevalence of intrauterine abnormalities among included studies. Feasibility included technical success rate and complication rate. One population of homogeneous data could be identified, consisting of patients with postmenopausal bleeding. In this subgroup the positive and negative likelihood ratios were 7.9 (95% CI 4.79-13.10) and 0.04 (95% CI 0.02-0.09), raising the pre-test probability from 0.61 to a post-test probability of 0.93 (95% CI 0.88-0.95) for positive results and reducing it to 0.06 (95% CI 0.03-0.13) for negative results. The pooled likelihood ratios of all studies included, calculated with the random effects model, were 6.5 (95% CI 4.1-10.4) and 0.08 (95% CI 0.07-0.10), changing the pre-test probability of 0.46 to post-test probabilities of 0.85 (95% CI 0.78-0.90) and 0.07 (0.06-0.08) for positive and negative results respectively. Subgroup analyses gave similar results. The overall success rate of diagnostic hysteroscopy was estimated at 96.9% (SD 5.2%, range 83-100%). This systematic review and meta-analysis shows that diagnostic hysteroscopy is both accurate and feasible in the diagnosis of intrauterine abnormalities.

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

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