Saline Infusion Sonohysterography Research Articles

Sonohysterography Assessment of the Structural Abnormalities of the Uterus in Women with Infertility in Ethiopia

Background: Female factor infertility is associated with a high incidence of the uterine cavity and fallopian tube pathology in developing countries with a high prevalence of STDs, therefore various methods are available for structural evaluation of the female reproductive system, among them is saline infusion sonohysterography (SISHG). The study aimed to assess the role of SISHSG in female infertility evaluation in areas where the gold standard investigating modalities are not readily available.
 Methods: A hospital-based cross-sectional study was carried out in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, between January 2019 to August 2019 G.C. SISHSG consists of instillation of saline into the endometrial cavity with simultaneous pelvic ultrasonography (US). Fifty consecutive female patients referred to the Radiology Department for SISHSG are included in the study. Sensitivity, specificity, positive and negative predictive values were calculated for 26 patients who had both SISHSG and conventional HSG.
 Result: The majority of the patients were in the age group of 35-40(38%) and 34 (68%) had secondary infertility. The commonest abnormalities detected were uterine myoma 10(20%), Asherman syndrome/cervical stenosis 7 (14%), and tubal blockage 6(10%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SISHSG in normal study, Asherman syndrome/cervical stenosis and chronic endometritis was 100%, as compared to the gold standard conventional HSG. For bilateral tubal blockage the SISHSG had 50% sensitivity, 90% specificity, 66.7% PPV and 81.8% NPV, however, for unilateral tubal blockage SISHSG had low sensitivity 33%.
 Conclusion: SISHSG is readily available, easy-to-do, safe and radiation-free procedure and has high sensitivity and specificity in detecting uterine cavity abnormality. We advocate its use as a first step of investigation modality in the evaluation of female infertility.

The effect of uterine closure technique on cesarean scar niche development after multiple cesarean deliveries.

To use saline infusion sonohysterography (SIS) to evaluate the effect of uterine closure technique on niche formation after multiple cesarean deliveries (CDs). Patients with at least one prior CD were evaluated for niche via SIS. Subgroups of any number repeat CD (>1 prior), lower-order CD (<4 prior), and higher-order CD (≥4 prior) were analyzed, stratifying by hysterotomy closure technique at last cesarean preceding imaging; techniques included Technique A (endometrium-free double-layer closure) and Technique B (single- or double-layer routine endo-myometrial closure). Niche defects were quantified (depth, length, width, and residual myometrial thickness). The primary outcome was clinically significant niche, defined as depth >2 mm. Statistical analysis was performed using chi-square, ANOVA, t-test, Kruskal-Wallis, and multiple logistic regression, with p-values of <0.05 were statistically significant. A total of 172 post-cesarean SIS studies were reviewed: 105 after repeat CDs, 131 after lower-order CDs, and 41 after higher-order CDs. Technique A was associated with a shorter interval to imaging and more double-layer closures. Technique B was associated with more clinically significant niches across all subgroups, and these niches were significantly longer and deeper when present. Multiple logistic regression demonstrated a 5.6, 8.1, and 11-fold increased adjusted odds of clinically significant niche following Technique B closure in the repeat CD (p<0.01), lower-order CD (p<0.001), and higher-order CD (p=0.04) groups, respectively. While multiple CDs are known to increase risk for niche defects and their sequelae, hysterotomy closure technique may help to reduce niche development and severity.

Utility of Repeat Uterine Cavity Evaluation in the Infertility Workup.

Background: Uterine cavity abnormalities contribute to infertility. The purpose of this study was to evaluate the incidence, recurrence rates, and risk factors for uterine cavity abnormalities in women undergoing infertility workup and treatment, focusing on the utility of routinely repeated imaging. Methods: Retrospective cohort study at single academic medical center of 833 infertile women who had uterine cavity evaluations performed at least 9 months apart. Results: Of 833 eligible patients, 664 (79.7%) had normal initial imaging and 169 (20.3%) had abnormal initial imaging. Among the former, 10% had abnormal uterine cavity on repeat saline infusion sonohysterography (SIS); among the latter, 32% had abnormal repeat SIS [Chi-square p < 0.0001, risk ratio 2.30 (95% confidence interval 1.85-2.86)]. On average, 23.1 ± 13.6 months passed between studies. Regardless of initial imaging findings, women with abnormal repeat SIS were older than those with normal repeat SIS, with no difference in time elapsed between studies. There were no associations between repeat imaging outcomes and body mass index, uterine instrumentation, number of treatment cycles, or maximum peak estradiol levels in a single cycle between studies. There was no difference in live birth rate among cycles started within 1 year after repeat SIS across groups. Conclusions: Uterine cavity abnormalities were found in 10% of patients on repeat imaging despite initially normal testing. No risk factors for cavity abnormality on repeat imaging were identified besides age and prior abnormality. It would be prudent to continue performing routine repeat uterine cavity evaluation for women undergoing fertility treatment, particularly if corrective measures had been taken in the past.

Hysteroscopic management of subfertility in cases with suspected endometrial polyps

Endometrial polyps (EPs) are a common benign gynecologic condition associated with abnormal uterine bleeding (AUB), infertility and recurrent pregnancy loss. Transvaginal ultrasound (TVU) provides an excellent diagnostic technique to identify the size and the anatomic location of endometrial polyps. Its accuracy increases when color Doppler, 3D investigation and saline-infused sonohysterography are used. However, hysteroscopy showed the highest diagnostic accuracy in infertile patients with suspected endometrial polyps and provides a safe and feasible opportunity for EPs removal. Objectives. This study aims to demonstrate the effectiveness of hysteroscopic polyps’ removal in infertile young female patients. Methodology. This study, conducted over a period of one year, included women who addressed our clinic for infertility. These patients were clinically examined and evaluated using transvaginal ultrasound (TVUS). Hysteroscopy was performed on all cases where TVUS raised the suspicion of endometrial polyps. Additionally, the incidence of pregnancies obtained within the first 12 months after the hysteroscopic removal of endometrial polyps was recorded. Results. Out of the cohort of 97 infertile patients, endometrial polyps were suspected in 33 patients. Before hysteroscopy, seven patients additionally underwent a sonohysterography (SHG) procedure. Abnormal uterine bleeding was the primary clinical manifestation (21 cases; 63.63%). EPs were histologically confirmed in 31 cases, and leiomyoma, in two cases. Of the 31 EPs cases, in 20 cases (64.51%) the localization was at the utero-tubal junction. Out of the 30 patients diagnosed with EPs and where the follow-up was possible, 18 individuals, constituting 60% of the group, successfully attained intrauterine pregnancies within the initial 12 months following their hysteroscopic procedure. Conclusions. Our study revealed a significant improvement in reproductive outcomes within the first year following EP resection. The prevalence of endometrial polyps has increased due to improved ultrasound techniques. SHG can potentially increase the ultrasound detection of endometrial polyps, especially in cases where the imagistic information is unclear. Nonetheless, hysteroscopy, known for its high diagnostic accuracy, remains the gold standard. Our research supports the importance of hysteroscopy for uterine cavity assessment and lesion management, and it highlights the increased chances of pregnancy after the lesion’s removal.

Evaluation of development of cesarean section scar niche in Patients with post cesarean section surgical site infection by 2 Dimension saline infusion sonohysterography:prospective study at Minia Maternity University Hospital

Evaluation of development of cesarean section scar niche in Patients with post cesarean section surgical site infection by 2 Dimension saline infusion sonohysterography:prospective study at Minia Maternity University Hospital

Cesarean scar disorder: Management and repair.

Cesarean scar disorder (CSD) is an entity recently defined as uterine niche with at least one primary or 2 secondary symptoms. CSDs can be visualized by hysterosalpingography, transvaginal sonography, saline infusion sonohysterography, hysteroscopy, and magnetic resonance imaging, but diagnosis should be performed by exams able to measure the residual myometrial thickness (RMT). Although there is a limited number of studies evaluating fertility and reproductive outcomes after different types of surgery, the following consideration should be kept in mind. Asymptomatic women should not be operated with the hope of improving obstetrical outcomes. It is reasonable to consider hormone therapy for CSDs as a symptomatic treatment in women who no longer wish to conceive and have no contraindications. In case of failure of or contraindications to medical treatment, surgery should be offered according to the severity of symptoms, including infertility, the desire or otherwise to preserve the uterus, the size of the CSD, and RMT measurement. Hysteroscopy is considered to be more of a resection than a repair, so women who desire pregnancy should be excluded from this technique in case of RMT <3mm. In this instance, repair is essential and can only be achieved by a laparoscopic or vaginal approach. The benefit of laparoscopic approach seems to persist after subsequent CS. Women with CSDs need to be given complete information, including available literature, before any treatment decision is made.

The role of saline infusion sonohysterography in the evaluation of infertility

Aims: The study aimed to evaluate possible intrauterine pathologies that may not be visible in basal transvaginal ultrasonography in infertile patients using saline infusion sonohysterography.&#x0D; Methods: Between January 2019 and January 2020, 110 patients who presented to the Ankara University Faculty of Medicine, Obstetrics and Gynecology Infertility Polyclinic were enrolled in the study. Saline infusion sonohysterography was performed on primary and secondary infertile patients who were not diagnosed with endometrial pathology via ultrasonography.&#x0D; Results: Pathological findings were detected in 11 out of 110 patients (10.6%) during saline infusion sonohysterography, including polyps, myomas, and adhesions. These patients were referred to hysteroscopy by their practitioner. After the procedure, pathological findings were detected in 54.5% of cases by hysteroscopy. According to these data, the sensitivity of saline infusion sonohysterography in detecting intracavitary pathologies was 60%, specificity was 80.7%, positive predictive value was 54.5%, negative predictive value was 84%, and reliability was 75%.&#x0D; Conclusion: Saline infusion sonohysterography can detect endometrial pathologies not identified by TV USG, suggesting its cost-effective addition to routine evaluations for infertile patients and potential endometrial pathologies.

Identification of Endometrial Cancer-Specific microRNA Biomarkers in Endometrial Fluid.

Abnormal uterine bleeding is a common benign gynecological complaint and is also the most common symptom of endometrial cancer (EC). Although many microRNAs have been reported in endometrial carcinoma, most of them were identified from tumor tissues obtained at surgery or from cell lines cultured in laboratories. The objective of this study was to develop a method to detect EC-specific microRNA biomarkers from liquid biopsy samples to improve the early diagnosis of EC in women. Endometrial fluid samples were collected during patient-scheduled in-office visits or in the operating room prior to surgery using the same technique performed for saline infusion sonohysterography (SIS). The total RNA was extracted from the endometrial fluid specimens, followed by quantification, reverse transcription, and real-time PCR arrays. The study was conducted in two phases: exploratory phase I and validation phase II. In total, endometrial fluid samples from 82 patients were collected and processed, with 60 matched non-cancer versus endometrial carcinoma patients used in phase I and 22 in phase II. The 14 microRNA biomarkers, out of 84 miRNA candidates, with the greatest variation in expression from phase I, were selected to enter phase II validation and statistical analysis. Among them, three microRNAs had a consistent and substantial fold-change in upregulation (miR-429, miR-183-5p, and miR-146a-5p). Furthermore, four miRNAs (miR-378c, miR-4705, miR-1321, and miR-362-3p) were uniquely detected. This research elucidated the feasibility of the collection, quantification, and detection of miRNA from endometrial fluid with a minimally invasive procedure performed during a patient in-office visit. The screening of a larger set of clinical samples was necessary to validate these early detection biomarkers for endometrial cancer.

Utility of Saline Infusion Sonohysterography in Gynecology: A Review Article.

This study aimed to describe the role played by saline infusion sonohysterosalpingography (SIS) in the evaluation of uterine lesions. Saline infusion sonohysterosalpingography provides three-dimensional (3D) images with high resolution, which, in turn, gives a good orientation to clinicians and radiologists, in most cases, about the underlying endometrial and tubal pathologies. Saline infusion sonohysterosalpingography isan underused imaging modality that has some advantages over other conventional imaging modalities. It can be used in the diagnosis of gynecological conditions. Saline infusion sonohysterosalpingography gets an edge over other modalities because of its ease of use, cost efficacy, and non-invasive nature while having comparable or even better accuracy than most imaging modalities used in gynecological conditions. Its cost efficacy and excellent pathological characterization make it an imaging modality beneficial for Indian healthcare setups as a whole, and rural healthcare setups in particular where patients cannot afford expensive investigations. This review covers indications and contraindications, imaging technique, drawbacks in imaging, use of SISin various uterine pathologies, and, in the end, a comparison of SISwith other imaging modalities. Saline infusion sonohysterosalpingography is indicated in most of the prevalent gynecological diseases in India with the reported post-procedural complications being very few. There are a few contraindications as well which should be kept in mind and these are mentioned later. During the procedure, aseptic precautions should be taken. Comparison between imaging modalities will bring out the better modality for a particular case according to the need of the patient.

Case series of tubo-ovarian abscesses after saline infusion sonohysterography: reconsidering antibiotic prophylaxis.

Saline infusion sonohysterography (SIS) is useful for evaluating intrauterine pathology, particularly for patients with abnormal uterine bleeding and during assessment of infertility. Infectious complications are relatively rare, and tubo-ovarian abscess (TOA) after SIS has only been reported once in the literature. We present two additional cases of TOA after SIS that presented to our institution. First, a 40-year-old female with known endometriosis and bilateral tubal occlusion, presented with ruptured TOA fifteen days after SIS during fertility evaluation. The second, a 45-year-old female with endometriomas and a hydrosalpinx identified on SIS, diagnosed with TOAs four days after SIS for abnormal uterine bleeding evaluation. While hysterosalpingogram has defined antibiotic prophylaxis criteria, and despite likely similar mechanisms for ascending infections, current guidelines do not recommend prophylaxis after SIS. These cases suggest infectious complications, such as TOA, after SIS may be more common than previously reported, and as demonstrated by these cases can have serious clinical consequences for patients. Furthermore, by comparing to a technically similar procedure as HSG, it may be reasonable to consider if certain patients at high risk of complication may benefit from antibiotic prophylaxis to prevent serious clinical infections.

Pre-Peritoneal Dialysis Peritonitis After Saline Infusion Sonohysterogram in a Patient With an Embedded Catheter: A Case Report

Clear guidelines currently exist regarding antibiotic prophylaxis for patients on peritoneal dialysis (PD) prior to common diagnostic procedures. However, these guidelines do not include patients with subcutaneously embedded PD catheters who are awaiting PD initiation although both these populations share a great deal of risk factors for infections. Issues regarding antibiotic prophylaxis and avoidable infections are bound to keep occurring if physicians are not conscious of the risks of infections shared by all patients suffering from renal failure. Two weeks after a saline infusion sonohysterography (SIS), a 48-year-old woman with chronic kidney disease (CKD) G5 ND, type 2 diabetes, a subcutaneously embedded PD catheter, and prior abnormal uterine bleeding presented to the emergency department complaining of nausea, vomiting, diarrhea, weakness, and abdominal pain. The patient received no antibiotic prophylaxis prior to her SIS. The final diagnosis of peritonitis was established after acute kidney injury, gastroenteritis, and small bowel obstruction were considered and ruled out. A delay in the final diagnosis occurred because of the complex presentation, the fact that the patient had not yet initiated PD, and the presence of concomitant anion gap metabolic acidosis and an acute elevation of the patient's creatinine. The patient was started on broad-spectrum intravenous antibiotics when the diagnosis of peritonitis was established. Insulin and intravenous bicarbonate infusions were used to correct the patient's anion gap metabolic acidosis. Surgical debridement of the necrotic subcutaneous tissue and removal of the embedded PD catheter were necessary. The patient's infection resolved completely as did her anion gap metabolic acidosis. The patient had to transfer permanently from PD to hemodialysis for her renal replacement therapy. This case report serves as a good reminder that physicians should keep in mind the possibility of peritonitis in patients with embedded PD catheters. As these patients are also at risk of infections, antibiotic prophylaxis should be used in patients with embedded catheters in the same way it is used for PD patients prior to obstetrical, gynecological, or gastrointestinal procedures.

Comparison of Saline Infusion Sonohisterography (SIS) and Histeroscopy Examination in Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time, affecting 20% of the adolescent age group, and 50% of women aged 40-50 years in Indonesia. The causes of AUB are pregnancy, anovulatory dysfunction, uterine leiomyoma, endometrial polyps, endometrial hyperplasia, or endometrial carcinoma. This study aims to compare the accuracy of Saline Infusion Sonohysterography (SIS), hysteroscopy and endometrial histopathology in determining pathological abnormalities in women with AUB.Material and Method: This cross sectional diagnostic study was conducted at General Hospital dr. Kariadi Semarang and its network hospitals in June 2020. Samples were determined by consecutive sampling, including married women, not pregnant, had no genital infection and did not present with any malignancy. Histopathological examination of the endometrium is the gold standard for AUB diagnosis. Research data were obtained from secondary data from patient's medical records including demographic characteristics, clinical history, pregnancy history, SIS examination data, hysteroscopy and endometrial histopathology.Result: There were 51 subjects with a mean age of 31.67 ± 5.21 years. The most common complaints were intermenstrual bleeding (37.3%), followed by irregular menstrual bleeding (21.6%), heavy menstrual bleeding (13.7%), and amenorrhea (5.9%). Sensitivity value of SIS examination ranged from 81.5-100% and specificity ranged from 30.77-100%. Hysteroscopy has a sensitivity value range of 87.5-98% and a specificity value of 62.5-100%.Conclusion: SIS examination could be an alternative for endometrial structural abnormalities diagnosis in AUB if hysteroscopy is unavailable.

A Hidden Uterine Adhesion

A 34-year-old patient with a history of myomas and adenomyosis was referred with a 3-year history of primary infertility. She underwent laparoscopic and hysteroscopic myomectomies before presentation. Initial transvaginal ultrasound reported myometrial cysts with the largest measuring 2.0 × 2.0 × 1.4 cm (Fig. 1). Follow-up saline infusion sonohysterography reported a normal uterine cavity. She underwent in vitro fertilization, which yielded one cryopreserved blastocyst. Before embryo transfer, she received 3 months of leuprolide to shrink the cysts; however, there was no change in cyst size on subsequent ultrasound.

Accuracy of Three-Dimensional Saline Infusion Sono-Hysterography Versus Diagnostic Hysteroscopy in Diagnosis of Uterine Cavity Lesions

Accuracy of Three-Dimensional Saline Infusion Sono-Hysterography Versus Diagnostic Hysteroscopy in Diagnosis of Uterine Cavity Lesions

8383 Removal of Intrauterine Adhesions Using an Ultrasound-Guided Balloon Therapy

<h3>Study Objective</h3> To demonstrate a novel technique to treat intrauterine adhesions (IUAs) in an outpatient setting found at the time of saline infusion sonohysterography (SIS). <h3>Design</h3> N/A. <h3>Setting</h3> A single academic fertility center. <h3>Patients or Participants</h3> Patients found to have intrauterine adhesions on SIS during fertility evaluation or routine cavity assessment prior to embryo transfer. <h3>Interventions</h3> During an SIS, a balloon-tip catheter is inserted through the cervix into the uterine cavity. Saline is infused into the cavity to reveal the IUA. Under ultrasound guidance, the balloon is deflated, and the catheter is pushed toward the IUA where the balloon is then reinflated. Using a gentle sweeping motion in a repetitive cephalad-caudad manner on the external portion of the catheter, the balloon is used to mechanically disrupt the suspected IUA. This process can be repeated if necessary. <h3>Measurements and Main Results</h3> Resolution of IUAs. <h3>Conclusion</h3> This "see and treat" technique is a safe and cost-effective option for management of mild IUAs that can be performed in a single patient visit and may prevent the need for more invasive surgical procedures in the operating room.

Postpartum Changes in Uterine Position and Occurrence of Cesarean Scar Defects: A Retrospective Observational Study

Background: Over the past several decades, rates of cesarean delivery have increased considerably worldwide. As cesarean section (CS) may also result in changes to uterine position, the relationship between delivery modes, postpartum uterine position and cesarean scar defect (CSD) warrants elucidation. Materials &amp; Methods: Here, we conducted a retrospective observational study evaluating 921 women (482 underwent vaginal delivery and 439 underwent CS) who had undergone transvaginal ultrasonography (TVU) early in their pregnancy (&lt;8 weeks). Subsequent ultrasonography was performed 3–6 months postpartum to evaluate uterine position for all women and saline infusion sonohysterography (SIS) for women who underwent CS. The outcome was the uterine position for all of the women and the CSD for women underwent CS. Results: A total of 716 women (371 of whom underwent vaginal delivery and 345 of whom underwent CS) were concluded in the study. Postpartum uterine position was found to be significantly changed from anteflexion (81.9% for vaginal delivery and 82.0% for CS) to retroflexion (29.1% for vaginal delivery and 46.7% for CS) after both vaginal (p &lt; 0.001) and CS (p &lt; 0.001) deliveries. CSD was diagnosed by SIS in 146 of 345 (42.3 95% CI 37.1–47.6) women that underwent CS. CSD prevalence among anteflexed and retroflexed uterus were 46.7% (95% CI 39.5%–54.0%) and 37.3% (95% CI 29.7%–44.8%), respectively (p = 0.08). Conclusions: This study revealed that uterus became retroflexed in patients who underwent either CS or vaginal deliveries. CS resulted in a significantly greater proportion of retroflexed uterus than did vaginal delivery. CSD prevalence among women with retroflexed uterus in the postpartum has no difference with those with anteflexed uterus.

The effect of misoprostol on the removal of endometrial polyps: A pilot clinical trial.

BackgroundEndometrial polyps are one of the most common gynecological disorders with a high frequency among infertile women. Hysteroscopic polypectomy remains the gold standard for the treatment of endometrial polyps. As alternative treatments, few drugs have been evaluated to date.ObjectiveTo investigate the possible effect of misoprostol on the elimination of endometrial polyps.Materials and MethodsIn this clinical trial we examined 30 infertile women whose endometrial polyps were confirmed by transvaginal ultrasound with saline injection. All women were administered 400 mg of misoprostol: 200 mg orally and 200 vaginally. 8 hr later, sonography with saline injection was performed again and all women were examined for the presence or absence of endometrial polyps. Finally, the diagnosis was confirmed for all women using hysteroscopy. The main outcome of this study was the elimination of endometrial polyps after misoprostol administration.ResultsThe average size of the endometrial polyps was 14.33 4.26 mm, with a range of 7-22 mm. After misoprostol administration, in 12 out of the 30 women who had shown endometrial polyps in the initial examination, no polyp was found. At follow-up it was found that the smallest endometrial polyp that had been eliminated was 8 mm and the largest was 22 mm.ConclusionThe findings of our study revealed that misoprostol can remove up to 40% of endometrial polyps. This drug has the potential to be used as a safe and low-cost first-line treatment before performing hysteroscopic polypectomy.

P-747 Prevalence of Caesarean scar defect (CSD) and clinical impact on reproductive outcomes in patients undergoing in vitro fertilization (IVF)

Abstract Study question Can sonohysterography-detected CSD have a deleterious effect on reproductive outcomes in women with secondary infertility undergoing IVF? Summary answer A 68% prevalence of CSD has been estimated in the study population. CSD significantly reduces the ongoing pregnancy rates in women undergoing IVF cycles. What is known already here is limited and conflicting evidence about the relation between Caesarean section, CSD and IVF treatment outcomes. Notably, most of the previous studies did not investigate the presence of CSD in infertile women with a history of Caesarian delivery. Furthermore, even if considered, the diagnosis of CSD is commonly based on transvaginal ultrasound assessment. Given the lower sensitivity of this method compared to saline infusion sonohysterography, an underestimation of the real effect is plausible. Study design, size, duration Retrospective cohort study of 122 women with a history of Caesarean delivery and an indication to IVF for secondary infertility referred to an Italian public assisted reproductive centre between 1 January 2016 and 30 April 2021. Participants/materials, setting, methods Women aged 18-43 with secondary infertility and a history of Caesarean delivery, tested for CSD with a saline infusion sonohysterography were included. Women with congenital uterine anomalies, intra-cavitary uterine pathologies, adenomyosis or previous myomectomy were excluded. CSD was defined as an anechoic indentation on the cesarean scar at the midsagittal plane, with a depth ≥ 2 mm. Main results and the role of chance Among the 122 women included, 83 (68%) were diagnosed with CSD by saline infusion sonohysterography. One hundred and fourteen patients underwent at least one IVF cycle: 76 (case group) had a CSD, 38 (control group) had a normal Caesarean scar. Groups were similar in patients and treatment characteristics. Clinical pregnancy rate was 43% in the CSD group and 71% in the control group (odds ratio [OR] 0.31; 95% confidence interval [CI], 0.14-0.72; p = .006). Ongoing pregnancy rates were 33% and 58%, respectively (OR, 0.34; 95% CI, 0.15-0.76; p = .015). Similar results were obtained after adjusting for potential confounders on the regression analysis. Ectopic pregnancy and miscarriage rate along with obstetric and neonatal complications were similar in both groups. In a subgroup-analysis comparing women with CSD who achieved pregnancy and those who did not, pregnant patients had a greater residual myometrial thickness compared to those who did not get pregnant, even if this finding did not reach statistical significance (5.3 mm versus 4.4 mm, p .07). Limitations, reasons for caution Retrospective nature of the study does not permit to infer a causal association between CSD and the reduced chance of pregnancy. Our results are representative of an infertile population but generalization needs further investigation. The sample size was too small to reveal the potential effect on obstetric and neonatal outcomes. Wider implications of the findings In infertile patients with a previous Caesarean section, the presence of CSD is more common than previously thought. The presence of CSD might significantly reduce the IVF success rate. This finding is important in relation to the rising of Caesarean section rates and the possible application of CSD surgical repair. Trial registration number not applicable

Adjunctive azithromycin prophylaxis protects women from uterine cesarean scar defect: A randomized controlled trial.

Cesarean scar defect (CSD) is a long-term outcome of cesarean section (CS) and associated with numerous gynecological and obstetric problems. Previous studies indicate that infection may be a risk factor for CSD. Adjunctive azithromycin was shown to reduce the risk of postoperative infection in patients undergoing non-elective primary cesarean delivery in labor or after the rupture of membranes compared with standard antibiotic prophylaxis. This study investigated the protective effect of adjunctive azithromycin in combination with single-dose cephalosporin against CSD in women undergoing non-elective cesarean delivery. A randomized, double-blind, controlled clinical trial was conducted in a University hospital in Shanghai, China. A total of 242 women who underwent their first non-elective CS were randomly assigned to receive 1500 mg cefuroxime sodium plus 500 mg intravenous azithromycin (n=121; experimental group) or 1500 mg cefuroxime sodium plus a placebo (n=121; placebo group). The primary outcome was CSD prevalence, as determined by transvaginal ultrasound and saline infusion sonohysterography within 6months of delivery. Secondary outcomes were changes in infectious indicators (eg hypersensitive C-reactive protein and procalcitonin), postoperative morbidity, and use of postoperative antibiotics. We also examined the operative procedure, pathogenic microorganism cultures, and fetal outcomes. Outcomes were compared between groups with the chi-squared test, Fisher's exact test, or Student's t test. Between May 2018 and May 2021, 121 women were randomized to each arm. Because the sonographic follow up was disrupted by the coronavirus disease 2019 pandemic and strict management policies, we merged the follow-up time points (6 weeks and 6months) into a single time period (6 weeks to 6months); 104 and 108 women in the experimental and placebo groups, respectively, completed the first sonographic follow up. CSD was diagnosed by sonography in 34/104 (32.7%) and 50/108 (46.3%) patients in the experimental and placebo groups, respectively (relative risk 0.71, 95% confidence interval 0.50-0.99; p=0.043). Characteristics of CSD and short-term infection outcomes did not differ between groups. A single dose of intravenous 500 mg azithromycin adjunctive to single-dose cefuroxime prophylaxis significantly reduced the incidence of CSD in women undergoing non-elective CS.

Role of Saline Infusion Sonohysterography and Transvaginal Colour Doppler Ultrasonography in Evaluating Uterine Polyps: A Prospective Study

Role of Saline Infusion Sonohysterography and Transvaginal Colour Doppler Ultrasonography in Evaluating Uterine Polyps: A Prospective Study