Intrauterine Lesions Research Articles

Hysteroscopy as a Primary Tool in Exploration and Treatment of Infertility: Single Center Experience in Western Romania.

(1) Background: Infertility is a disease that affects millions of individuals worldwide. Intrauterine lesions are common in infertile women, hysteroscopy being considered the gold standard for assessing them, even if in routine clinical practice indirect imaging techniques are the first-line investigative tools. The aim of the study was to evaluate hysteroscopic findings among women with unexplained infertility and to analyze fertility outcomes after operative hysteroscopy; (2) Methods: a retrospective cohort study was conducted among 198 women with infertility that had undergone hysteroscopy as the first step of their infertility workup. (3) Results: The median age of the participants was 34 years, 67.7% of them being diagnosed with primary infertility. The most common abnormalities were endometrial polyps, uterine synechiae and uterine fibroids. In addition, pregnancy rates were 23.1% after hysteroscopic polypectomy, 11.1% after hysteroscopic myomectomy and 23.8% after uterine synechiae resection; (4) Conclusions: Endometrial polyps were the most common uterine abnormality found in women with infertility. Hysteroscopic interventions appeared to increase pregnancy rates and outcomes among these women.

Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions.

To evaluate the accuracy of transvaginal ultrasound in the diagnosis of intrauterine lesions, using hysteroscopy as the gold standard. This was a prospective observational study with 307 patients. All patients underwent hysteroscopy after a previous transvaginal ultrasound to compare the results. The hysteroscopy was performed by experienced examiners, and transvaginal ultrasounds were performed in various public and private services, which is reflective of routine healthcare practices in obstetrics and gynecology. The sensitivity, specificity, and accuracy of the transvaginal ultrasound were calculated using hysteroscopy as the gold standard. The level of agreement between the two exams was calculated using the Kappa test. The mean age was 56.55 ± 12.3 years. For endometrial polyps, we observed a sensitivity of 39.8%, specificity of 72.7%, accuracy of 52.8%, and Kappa index of 0.11 (p = 0.025). For fibroids, the sensitivity was 46.7%, specificity was 95.0%, accuracy was 87.9%, and Kappa index was 0.46 (p < 0.001). For endometrial thickening, the sensitivity was 68.7%, specificity was 41.7%, accuracy was 47.6%, and Kappa index was 0.06 (p = 0.126). For endometrial atrophy, we found a sensitivity of 6.7%, specificity of 99.3%, accuracy of 90.2%, and Kappa index of 0.10 (p = 0.006). For the other findings, the sensitivity was 15.6%, specificity was 99.6%, accuracy was 87.3%, and Kappa index was 0.23 (P < 0.001). Our study demonstrated a low level of accuracy of transvaginal ultrasound for the diagnosis of endometrial lesions, when performed by a non-experienced professional. Thus, it is important to consider the use of hysteroscopy to avoid unnecessary and inappropriate treatments.

Hysteroscopy as a diagnostic tool in women with recurrent pregnancy loss, a prospective randomized controlled study

Background:Uterine abnormalities, are implicated as one of the causes of recurrent miscarriages, and have been estimated to be diagnosed in as many as 10% to 15% of patients with repeated miscarriages. The present study was designed to assess the value of hysteroscopy in the diagnosis of intra-uterine lesions in women with recurrent pregnancy loss. Design: This is a prospective cohort study which was done in El-Sayed Galal hospital, faculty of medicine, Al-Azhar university after the approved of the research ethics committee, during the period from March 2018 to April 2019 and included 300 patients aged 18 to 40 years with a history of unexplained pregnancy loss prior to 20 weeks of pregnancy Results: 300 patients with history of recurrent pregnancy loss were included in this study, 44% had a normal finding, 14% had intrauterine septum, 2% had bicornuate uterus, 15.3% had endometrial polyp, 0.7% had submucous myoma, 1.3% had tubular cavity, 2% had subseptate uterus, 2% had fundal cupping and 18.7% had intrauterine adhesions. There was statistically significant correlation between the numbers of E&C and different pathological finding, cases with tubular cavity showed the highest mean number of E&C and also there was statistical significant difference between degree of adhesion and number of abortion which the moderate degree associated with highest number of abortionConclusion: Hysteroscopy has an important role in the diagnosis of causes in women with recurrent pregnancy loss.

Role of Chromohysteroscopy in Patients of Abnormal Uterine Bleeding

Abnormal uterine bleeding (AUB) is the most common clinical problem in gynecology with hysteroscopy permitting the direct visualization of uterine cavity to diagnose various intra-uterine lesions. Scientists have incorporated the usage of dyes to stain specific lesions in endometrium which is called as chromohysteroscopy. The present study was conducted on 100 women of perimenopausal age group (40–55 years) with the aim to strengthen the importance of chromohysteroscopy in patients of AUB and to widen its applicability in detecting subtle endometrial changes which can be missed on routine hysteroscopy. On hysteroscopy, endometrium in 88 patients appeared to be normal, and 12 patients had abnormal endometrium (eight hyperplasic, three atrophic, one diffuse polypoidal). Out of these 12, only four patients had confirmed pathology on histopathological examinations (HPE) (two simple hyperplasia, one atrophic endometrium, one carcinoma endometrium). Thus, hysteroscopy had sensitivity of only 26.67% and specificity of 90.59% with PPV of 33.32 and PPV of 87.50 in predicting diffuse endometrial changes. Out of eight HE on hysteroscopy, only two (25%) were confirmed on histopathological examination. On chromohysteroscopy, out of 100 patients, 15 patients had dark stained endometrium, and among these, 12 patients had confirmed endometrial abnormalities on HPE (seven simple hyperplasia, four inflammatory endometrium, one carcinoma endometrium). Thus, chromohysteroscopy has sensitivity of 80.00% in detecting endometrial pathologies. Methylene blue is relatively very safe dye with fewer complications and has more predilections for hyperplastic and inflammatory endometrium. It does not require any sophisticated instrumentation or clinical skills during its usage and can be successfully employed along with hysteroscopy to predict hidden pathological areas during hysteroscopy without any harm.

What is the accuracy of two-dimensional (2D) and three-dimensional (3D) saline infusional sonography (SIS) for the diagnosis of focal intrauterine lesions?

What is the accuracy of two-dimensional (2D) and three-dimensional (3D) saline infusional sonography (SIS) for the diagnosis of focal intrauterine lesions?

Can we rely on blind endometrial curettage for complete removal of focal intrauterine lesion? A prospective clinical study

ObjectiveTo investigate the diagnostic and therapeutic efficiency of dilatation-curettage (D&C) combined with aspiration curettage for endometrial pathology compared to hysteroscopy alone in this study. Material and methodsA total of 143 patients who have suspicion of endometrial mass like lesion, increased endometrial thickness (>5-mm at menopause and/or endometrial thickness upper than 5-mm in patients under tamoxifen treatment due to breast cancer during 2-D transvaginal ultrasonography examination) were enrolled. All patients underwent procedures in order of hysteroscopy, D&C plus aspiration and second look hysteroscopy. Data for age, menopausal status, tamoxifen treatment, endometrial histology, hysteroscopy and D&C findings were recorded and statistically analyzed. ResultsInitial hysteroscopy revealed focally growing endometrial lesion in 96 patients. Second look hysteroscopy showed persistent focal lesion in 77 patients (80 %) after D&C plus aspiration. Endometrial blind curettage failed to diagnose 42 % (25/60) of endometrial polyps, none of submucous myomas as well as 27 % (3/11) of premalignant and malignant endometrial lesions. The sensitivity, specificity, overall accuracy, positive predictive value and negative predictive value of hysteroscopy were found as 84.1 %, 83.3 %, 83.9 %, 93.8 %, and 63.8 %, respectively. ConclusionsHysteroscopy showed significant superiority in the diagnosis and definitive treatment of endometrial pathologies specifically in focally growing endometrial lesions compared to D&C plus aspiration.

Hysterolaparoscopy (pan-endoscopy) in the management of female infertility in Nigeria: A report of 230 cases

Background: Hysterolaparoscopy has emerged as a better evaluation tool than laparoscopy and dye test in cases of infertility because of the ability to evaluate intra uterine lesions. Objective: To examine the role of Hysterolaparoscopy in the management of infertile women who were seen in 2 Fertility/ Gynaecological Endoscopy units in Nigeria. Methods: A cross sectional descriptive survey of the first 230 infertile women who were managed in the fertility and Gynaecological endoscopy units of Nnamdi Azikiwe University Teaching Hospital Nnewi Anambra State, Nigeria and Holy Rosary Specialist Hospital & Maternity, Onitsha, Nigeria. Data were analyzed with STATA software, version 12.0 SE (Stata Corporation, TX, USA). Result: The mean age of the women was 35.6+/- 5.9 years and the mean duration of infertility was 4.6+/- 2.7 years. More than half (53.9%. n=43) of the women had secondary infertility. Ninety -eight (42.61%) of the women had done a pelvic surgery in the past and pelvic ultrasound study was abnormal in 95(41.3%) of them. Abnormal hysteroscopy was found in 152 (66.1%) of the women and comprised mainly of intrauterine adhesions (41.%; n=95), endometrial polyps (20.%; n= 46), submucous fibroids (16.1%; n=37) and mullerian duct abnormalities (14.8%; n=34). Other findings were lost IUCD (6.1%'n=14), retained fetal bone (2.6%; n=6) and incarcerated omentum (2.2%; n=5). Abnormal laparoscopy findings were seen in 171 (74.4%) of the women. The main abnormal laparoscopy findings were tubal pathologies (161, n=70.0%), pelvic adhesions (39.6%, n=91), polycystic ovaries (33.0%; n=76), and endometriosis (8.8%, n=19). Tubal pathologies comprised mainly tubal occlusions (56.5%, n=130), hydrosalpinx (41.7%, n= 96) and plastered tubes (25.7%, n=59). Bilateral tubal occlusion was seen in 46 (20.0%). Conclusion: Hysterolaparoscopy is an effective tool for evaluating tuboperitoneal and intrauterine lesions among infertile women. There is a need to develop the capacity for this investigative modality.

The role of transvaginal ultrasound in the evaluation of endometrial infertility

Il est important d´explorer la cavité utérine dans le bilan d´une infertilité, car de nombreuses lésions intra-utérines peuvent être retrouvées. L´échographie endovaginale (EEV) est un examen de première intention dans le bilan d´une infertilité féminine. Elle permet une évaluation de la cavité utérine à la recherche d´anomalie responsable du trouble de la fertilité et aussi de mettre en évidence des lésions pouvant entraîner des échecs de transfert ou d´implantation. Il s´agit d´un examen facilement réalisable, et reproductible. Notre objectif est de détailler les lésions endométriale détectable par EEV pour préciser la place de l´EEV dans le bilan d´infertilité.

Role of pre IVF hysteroscopy in women with unexplained infertility for detecting unsuspected intrauterine lesions and effect on pregnancy outcome

Objective: The relevance of routine hysteroscopy before IVF is debatable and there is no consensus on the effectiveness of routine pre IVF hysteroscopy in improving pregnancy outcome. The purpose of this study is to assess the role of pre IVF hysteroscopy in women with unexplained infertility in detecting unsuspected intrauterine lesions and its effect on pregnancy outcome. Materials and Methods: This was retrospective observational study conducted at Medicover Fertility Center, New Delhi, India. In the study group (n = 60), women with unexplained infertility of more than three years with normal transvaginal ultrasonography were included, where hysteroscopy was done in post-menstrual period, 1–2 months before starting IVF treatment. In the control group (n = 60), pre IVF hysteroscopy was not done. Results: The study and control group did not differ for age, body mass index, duration and type of infertility. There was a high prevalence (31.6%) of unsuspected intrauterine abnormalities in women with unexplained infertility with normal transvaginal ultrasound findings. The clinical pregnancy rate was 48.3% (29/60) in study group and 36.7% (22/60) in control group. The clinical pregnancy rate (CPR) was observationally higher in women with pre IVF hysteroscopy, but the difference was not statistically significant (P value = 0.193). Conclusion: There was high prevalence rate of unsuspected intrauterine lesions in women with unexplained infertility. Clinical pregnancy rates were not significantly higher in patients who underwent pre IVF hysteroscopy. Further larger studies and randomized controlled trials are needed to verify the positive outcome of use of hysteroscopy prior to IVF.

1153 Laparoscopic Combined Hysteroscopic Management of Cesarean Scar Pregnancy with Temporary Occlusion of Bilateral Internal Iliac Arteries: A Retrospective Cohort Study

Study Objective To report on our experience of surgery of cesarean scar pregnancy with temporary occlusion of the bilateral internal iliac arteries. Design Single center, retrospective review of patients who were diagnosed as cesarean scar pregnancy between December 2017 and December 2018. All patients were managed by laparoscopic cornuostomy and simultaneously repair the defect with temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no remnants of the pregnancy and deal with intrauterine lesions synchronously. Setting Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province. Patients or Participants 5 patients were enrolled, the vital signs of all the patients were stable. Interventions All 5 patients were managed by laparoscopic cornuostomy and simultaneously repair the defect with temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no remnants of the pregnancy and 3 patients free intrauterine adhesions synchronously. Measurements and Main Results No one was converted to laparotomy. Intra-operative bleeding was minimal and the postoperative recoveries were uneventful. Human chorionic gonadotropin was normalized after 3-4 weeks. Conclusion Laparoscopy with temporary internal iliac artery occlusion technique offers effective surgical management of cesarean scar pregnancy, and hysteroscopy is necessary to deal with intrauterine lesions.

EP33.03: Comparison of 2D ultrasound with power Doppler, saline infusion sonohysterography, 3D ultrasound and hysteroscopy in diagnosing intrauterine lesions

EP33.03: Comparison of 2D ultrasound with power Doppler, saline infusion sonohysterography, 3D ultrasound and hysteroscopy in diagnosing intrauterine lesions

Laparoscopic combined hysteroscopic management of cesarean scar pregnancy with temporary occlusion of bilateral internal iliac arteries: A retrospective cohort study.

To report on our experience of surgery of cesarean scar pregnancy with temporary occlusion of the bilateral internal iliac arteries.Single center, retrospective review of patients who were diagnosed as cesarean scar pregnancy between December 2017 and December 2018. All patients were managed by laparoscopic cornuostomy and simultaneously repair the defect with temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no remnants of the pregnancy and deal with intrauterine lesions synchronously.Five patients were enrolled, the vital signs of all the patients were stable. All 5 patients were managed by laparoscopic cornuostomy and simultaneously repair the defect with temporary occlusion of the bilateral internal iliac arteries, followed by hysteroscopy to confirm no remnants of the pregnancy and 3 patients’ free intrauterine adhesions synchronously. No one was converted to laparotomy. Intra-operative bleeding was minimal and the postoperative recoveries were uneventful. Human chorionic gonadotropin was normalized after 3 to 4 weeks.Laparoscopy with temporary internal iliac artery occlusion technique offers effective surgical management of cesarean scar pregnancy, and hysteroscopy is necessary to deal with intrauterine lesions.

Studying the motor sphere of preschool children with mental development delay

Studying the motor sphere of preschool children with mental development delay

The Influencing Factors of Venous Intravasation During Transvaginal Four-dimensional Hysterosalpingo-contrast Sonography With SonoVue

Transvaginal 4-D hysterosalpingo-contrast sonography with SonoVue (TV 4-D HyCoSy) is the preferred imaging method for evaluating tubal patency. However, venous intravasation in 4-D HyCoSy may affect the diagnosis of tubal patency. The objective of this study was to analyze influencing factors of venous intravasation during TV 4-D HyCoSy. This study included 643 infertile patients who underwent TV 4-D HyCoSy. We analyzed the relationship between the incidence of venous intravasation and patients’ basic clinical data, endometrial thickness, inspection timing (clean day of menstruation) and tubal patency. A total of 169 (26.28%) patients exhibited intravasation during TV 4-D HyCoSy. The following are risk factors for venous intravation: secondary infertility, type C + C, type B + C and type B + B in bilateral fallopian tubal patency grouping; endometrial thickness ≤5.45 mm; and taking TV 4-D HyCoSy after menstruation ≤6 d. Infertility duration, intrauterine lesions, a history of pelvic inflammatory disease and a history of pelvic surgery were uncorrelated with venous intravasation. To reduce the incidence of venous intravasation, TV 4-D HyCoSy should be performed 7–10 d after menstruation or when endometrial thickness is thicker than 5.45 mm.

Do endometrial lesions require removal? A retrospective study

BackgroundThis study aimed to evaluate the management of asymptomatic intrauterine lesions detected by ultrasonography.MethodsPatients who underwent diagnostic hysteroscopy for asymptomatic lesions, including pre- and post-menopausal endometrial polyps, post-menopausal endometrial thickening (ET ≥5 mm) and reduplicative endometrial heterogeneity detected by transvaginal ultrasonography (TVUS), were recruited for this study.ResultsIn the 792 recruited patients, the symptom-free focal masses within the uterine cavity detected by TVUS included 558 patients with pre- or post-menopausal endometrial polyps and 234 patients with postmenopausal endometrial thickening. No pre-menopausal patient presented with carcinoma. The polyp diameter (PD) was not identified as an independent risk factor for malignancy in this study. A significant difference (P = 0.036, < 0.05) in both benign and malignant endometrial lesions was observed between two groups of post-menopausal women stratified using an endometrial thickness cut-off of ≥11 mm.The TVUS was highly sensitive (94%) for pre-menopausal polyps. This technique had a specificity and positive predictive value of 84.4 and 92.7%, respectively, for postmenopausal polyps. The TVUS was clearly valuable for ruling out polyps, as indicated by a negative likelihood ratio (LR-) of 0.087.Among postmenopausal women with endometrial thickening, the area under the receiver operating characteristic curve was 0.828 (P < 0.001). An ET cut-off value of 12.5 mm yielded a sensitivity of 72.7% and specificity of 86%.ConclusionWe recommend follow-up alone for women with asymptomatic uterine polyps, particularly those who are pre-menopausal. Additionally, gynaecologists should consider risk factors such as age, obesity, polycystic ovarian syndrome, and diabetes. Prospective long-term follow-up studies should be conducted after hysteroscopic polypectomy to evaluate the recurrence rate of endometrial lesions.

Abnormal hysteroscopy findings among a cross section of infertile Nigerian women.

Intrauterine lesions are important causes of infertility. This study aims to evaluate the abnormal findings at hysteroscopy among infertile women seen in 2 new Fertility/Gynaecological Endoscopy units in Nigeria. A prospective study of 159 infertile women who had diagnostic hysteroscopy in Nnamdi Azikiwe University Teaching hospital Nnewi and Holy Rosary Specialist Hospital, Onitsha to evaluate the intrauterine lesions seen. Data analysis was done with STATA software, version 12.0 SE (Stata Corporation, TX, USA). Secondary infertility was the major type of infertility seen in 56.6% (n = 91) of cases and the mean duration of infertility was 4.3+/- 2.8 years. The indication for hysteroscopy was routine evaluation for infertility in 83.6% cases (n = 133). One hundred and twelve (70.4%) of the women had abnormal findings at hysteroscopy. The lesions detected were intrauterine adhesions (47.8%; n = 76), endometrial polyps (17.6%; n = 28), submucous fibroids (11.9%; n = 19) and mullerian duct abnormalities (10.7%; n = 17). Other findings were lost intrauterine copper devices (IUCD; 6.3%, n = 10), embedded fetal bone (2.5%; n = 4) and incarcerated omentum (1.9%; n = 3). Intrauterine adhesions were mainly moderate (40.8%; n = 31) and mild (34.2, n = 26) in severity while the submucous fibroids were mostly of type 0 (63.2%; n = 12). The commonest Mullerian abnormality seen was arcuate uterus (41.2%; n = 7). There was a high prevalence of abnormal findings on hysteroscopy among the studied women mostly intrauterine adhesions, endometrial polyps and submucous fibroids. These findings indicate a need to incorporate hysteroscopy in the routine evaluation of female infertility in the region.

The significance of sonographically thickened endometrium in asymptomatic postmenopausal women.

ObjectiveTo investigate the correlation between sonographic, hysteroscopic, and pathological findings in postmenopausal asymptomatic patients with sonographically thickened endometrium.MethodsThe records of postmenopausal patients who attended the Menopause Outpatient Clinic of a tertiary women's hospital in Ankara, Turkey between January 1, 2012 and December 15, 2013 were retrieved. A total of 266 postmenopausal women without vaginal bleeding underwent hysteroscopic evaluation and endometrial sampling. Patients whose pathological records indicated an endometrial thickness equal to or greater than 6 mm (double layer) on transvaginal ultrasonography without any symptoms were included in the study.ResultsThe most frequently detected focal intrauterine lesions in asymptomatic women were endometrial polyps, which were diagnosed in 168 (63.1%) cases. Twenty-four (9%) patients were diagnosed as having simple hyperplasia, 4 (1%) atypical hyperplasia, and 8 (3%) endometrial adenocarcinoma. Two of the patients with adenocarcinoma were diagnosed based on endometrial polyps, and 6 cases showed endometrial hyperplasia on hysteroscopy, while histological examination showed endometrial carcinoma.ConclusionWe suggest 10.5 mm as the cutoff value for endometrial thickness and recommend hysteroscopy following dilatation and curettage to increase diagnostic efficacy and provide definitive treatment in asymptomatic postmenopausal women with thickened endometrium.

Diagnostic value of saline infusion sonohysterography for detecting endometrial focal lesion.

IntroductionDifferent diagnostic tools are available to evaluate endometrial focal lesion such as hysteroscopy, sonohystrography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with Abnormal Uterine Bleeding (AUB).MethodsThis cross-sectional study recruited 100 married women with chief complain of AUB referred to gynecologic clinics at the Amir Al-Momenin hospital, Semnan, Iran from March 2014 to February 2016. All participants were in the reproductive age and post-menopausal period that showed abnormal endometrial thickness or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus focal lesion resection and endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist.ResultsMean±SD age of women was 41.2±11.3 years. To diagnose the overall focal lesions, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SIS were 79.6, 89.1, 89.6, and 78.8% respectively. These figures were 75.0, 87.5, 82.5 and 81.7%, respectively to diagnose polyps. The SIS sensitivity, specificity, PPV and NPV values to diagnose the myomas were 60.0, 97.8, 75.0, and 95.7% respectively.ConclusionFindings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.

Balloon Catheter for Cervical Priming before Operative Hysteroscopy in Young Women: A Pilot Study

Aim: To investigate regarding the safety and effectiveness of a balloon catheter (Aqueduct-100 device) to dilate the uterine cervix before operative hysteroscopies. Secondary objectives were to evaluate the duration of the dilatation procedure and to investigate on physicians’ satisfaction with the device. Methods: Fifty women younger than 40 years, wishing pregnancies and diagnosed with apparently benign intrauterine lesions and/or uterine anomalies, were enrolled into this study and submitted to cervical priming with Aqueduct-100 device before operative hysteroscopy. Results: Initial cervical dilatation was ≤4 mm in all but one patient. Adequate (10 mm) cervical dilatation was achieved in only one patient, the remaining forty-nine needed additional cervical dilatation. All women, however, presented with a ≥6 mm cervical width after balloon catheter removal. The mean time to final cervical dilatation was 8.5 minutes. No perioperative complications occurred. Physicians reported, in the majority of cases, satisfaction for the dilatation achieved (66%), the ease of balloon catheter insertion/use (82%), and for the ease of additional dilatation (96%). Conclusions: Aqueduct-100 device before operative hysteroscopy is safe and useful to increase the baseline cervical width and facilitate additional dilatation, with good effects on physician satisfaction and acceptable dilatation times.

Comparative Study between Three-Dimensional Transvaginal Ultrasonography and Hysteroscopy in the Diagnosis of Uterine Cavity Abnormalities

Objective: It was aimed at carrying out a comparative study between three dimensional transvaginal ultrasonography and hysteroscopy in the accuracy of detecting intrauterine cavitary lesions. Study design: Three dimensional transvaginal ultrasonography was done followed by hysteroscopy for all cases (number=50). Data obtained were compared and analyzed to estimate the accuracy of 3D transvaginal ultrasound. Results: The comparison with using Hysteroscopy, the sensitivity, specificity, positive predictive value, negative predictive values and total overall accuracy of Three dimensional transvaginal ultrasonography for total abnormal findings were 89.13%, 100%, 100%, 44.44% and 90% respectively. Conclusion: The three dimensional transvaginal ultrasound is a sensitive method to evaluate the endometrial cavity lesions or abnormalities, before resorting to invasive procedures such as diagnostic hysteroscopy. But hysteroscopy allows direct visualization of the uterine cavity so it can detect small intrauterine lesions which could be missed by vaginal ultrasound.