Sonohysterography Research Articles

Ultrasonography of uterine leiomyomas: A prospective cross-sectional study

ABSTRACT Background, Sonographic Features of Uterine Leiomyomas Location: Subserosal: Located on the outer surface of the uterus.Intramural: Located within the muscular wall of the uterus. Submucosal: Protrude into the uterine cavity, often causing more symptoms like heavy menstrual bleeding. Size: Leiomyomas can range from very small (a few millimeters) to very large (over 20 centimeters).Size measurement is important for monitoring growth over time. Echotexture: Typically, fibroids appear as well-circumscribed, hypoechoic (dark) or heterogeneous masses.They may have calcifications, which appear as bright echoes within the fibroid. Shape: Generally round or oval.The borders are usually well-defined. Cystic Degeneration: Some fibroids may show areas of cystic degeneration, which appear as anechoic (clear) regions within the mass. Vascularity: Color Doppler ultrasonography can assess the blood flow within and around the fibroid.This is useful for differentiating fibroids from other masses and for planning treatment options like uterine artery embolization. Aims and Objectives: To complement diagnostic hysteroscopy for the assessment of a submucosal leiomyoma, a three-dimensional (3D) TVS can be combined with saline instillation into the uterine cavity. Diagnostic hysteroscopy and TVS have a good overall agreement in the diagnosis of submucosal leiomyomas and in the assessment of fibroids’ myometrial extension. In this regard, 3D saline contrast Sono hysterography may provide even more information than traditional 3D TVS. Materials and Methods: This study was conducted in the department of radiology and was a cross-sectional study that lasted 3 months (November 10, 2022–March 10, 2023). The sample size for this study was determined using predefined exclusion and inclusion criteria. The study population included 30 females aged 20–50 who visited the Diagnostic Centre with complaints of abnormal menstrual bleeding or changes in menstrual cycles. Results: The majority of fibroids (78%), on USG, appeared hypoechoic, with the remainder (10%) appearing heterogeneous. Conclusion: Ultrasound has a high sensitivity and specificity in the diagnosing uterine leiomyoma.

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.

Role of 3D Ultrasonography and Hysteroscpy in Detecting Uterine Cavity Pathologies

valuation of Uterine cavity can be done using Hysterosalpingography (HSG), Trans Vaginal Ultrasonography (TVS), Sonohysterography (SHG) and Hysteroscopy. Uterine cavity abnormalities, e.g., endometrial polyps, submucous myomas, intra- uterine adhesions, endometritis and uterine septum may result in Abnormal Uterine Bleeding (AUB) in the form of menorrhagia or metrorrhagiaor or failure to conceive.

Sonohysterography: A Formidable Diagnostic Tool in the Evaluation of the Caesarean Scar Defect in Comparison to MRI

Introduction: The use of the caesarean section (C-section) in obstetric care has exponentially increased in the past few decades. The caesarean scar defect (CSD) is a potential complication of C-section and is associated with a wide range of problems. The purpose of this study was to compare the evaluation of the CSD in non-pregnant women by sonohysterography (SHG) and MRI. Methods: This study was performed in patients having undergone a single C-section more than 6 months prior, presenting with abnormal uterine bleeding, dysmenorrhoea, or pelvic pain. Since ultrasonography and pelvic examination were inconclusive, these patients underwent MRI followed by saline infusion SHG. Measurements and characteristics of the ‘niche’ were acquired from both MRI and SHG and compared for analysis. Results: Patients with a single C-section presenting with prolonged bleeding, spotting, and dysmenorrhoea were included in this prospective study. SHG and MRI were used to measure scar thickness, width, depth, and adjacent myometrial thickness, in which the findings concurred. The mean defect depth was greater in patients with postmenstrual bleeding. Conclusion: SHG is noninferior to MRI, and SHG has the potential to assess the dynamic status of the CSD, with morphological clarity.

Evaluation of the Cesarean Scar Niche In Women With Secondary Infertility Undergoing ICSI Using 2D Sonohysterography Versus 3D Sonohysterography and Setting a Standard Criteria; Alalfy Simple Rules for Scar Assessment by Ultrasound To Prevent Health Problems for Women.

BackgroundMany expressions were used to define the defect that is seen by ultrasound after cesarean section (CS) namely scar defect, niche, isthmocele, uterine pouch or diverticula.ObjectiveTo compare the accuracy of 2 dimensional sonohysterography (2D SHG) to 3 dimensional sonohysterography (3D SHG) in evaluating cesarean section uterine scar depth (D), base width (BW), width (W) and residual myometrial thickness (RMT) in women with secondary infertility and establishment of a standard criteria; Alalfy simple rules for scar assessment.Patients and MethodsThis was an observational cross-sectional comparative study that was conducted on women who presented with secondary infertility and were candidates for intracytoplasmic sperm injection (ICSI) and giving a history of a previous cesarean section. Assessment of uterine scar in each woman was performed using 2D transvaginal ultrasound with sonohysterography (SHG) followed by 3D transvaginal with SHG with evaluation of niche depth, width, RMT, niche BW and RMT/depth ratio. The study was conducted at Algezeera hospital, Egypt.ResultsThe present study revealed that 3D ultrasound with SHG is superior in evaluation of the RMT and niche width prior to ICSI providing better characterization of the scar niche.ConclusionScar niche should be assessed by a combined integrated 2D SHG and 3D SHG scan with the specific geometrical and anatomical considerations, Alalfy simple rules for scar niche assessment that involvemeasurement of niche depth, (Base width) BW, width, RMT and RMT/depth ratio in sagittal plane, RMT in coronal plane / niche width in coronal plane ratio (ratio less than 1 denotes scar weakness with more liability for dehiscence).Trial RegistrationClinical Trials.gov Id NCT04076904.

Sonohysterography findings in patients with abnormal uterine bleeding at Kenyatta National Hospital

Introduction Abnormal uterine bleeding (AUB) is one of the most common gynecological problems faced by women especially in the reproductive age as well as post-menopausal women. Several imaging modalities have been used to investigate this problem. Sonography is most easily accessible and easy to use modality for the initial management of AUB. Both transvaginal sonography (TVS) and transabdominal sonography are being used in many departments as the initial investigation modality. Though proven useful in the investigation of AUB, a normal finding in these modalities doesn't always rule out endometrial causes of AUB. Sonohysterography (SHG) which involves infusion of saline into the endometrial cavity,enables better visualization of the endometrium and the endometrial cavity and therefore characterization of endometrial abnormalities. Objective To determine the sonohysterographic findings in patients presenting with AUB in Kenyatta national hospital. Materials and Methods A total of 87 women with abnormal uterine bleeding who satisfied the inclusion criteria were enrolled in this study. A prior transabdominal and transvaginal sonography followed by a sonohysterography was performed in all cases. The presence of focal endometrial and subendometrial lesions and the descriptions of lesions were done. Results The age of women presenting with AUB was between 20 years and 45 years with the mean age of 31.57 ± 6.06 years. The most common presenting symptom was menorrhagia (25%) and the least was oligomenorrhea. Out of the 87 subjects, uterine fibroids were seen in 6 of the patients with menometrorrhagia, and 1 of the patients with metrorrhagia. TVS done prior to the SHG showed abnormalities within the endometrium in 8/87(9%). These included endometrial hyperplasia, fibroids, and floating clot within the uterine cavity. TVS provided false normal findings in 6(7%) cases out of the normal 79 cases. All the cases of partial endometrial synechiae were seen in patients presenting with oligomenorrhea. Out of the 13 abnormalities seen on SHG, 3(23%) were accurately detected on TVS. All the 3 were endometrial hyperplasia. Out of the 8/87 abnormalities provided by TVS, 3(37%) were accurate while 5(62%) were inconclusive. Conclusion Although TVS is a simple, minimally invasive low cost technique initially used in evaluating AUB, however a normal TVS study doesn't exclude endometrial pathology as has been shown in previous and this study. SHG can detect abnormalities in an otherwise normal TVS. For this reason, SHG is recommended to be used in combination with TVS as an initial investigation of choice in patient with AUB.

EP15.14: Endometrial carcinomas in women with polycystic ovary syndrome: sonohysterographic findings

To describe the sonohysterographic features of endometrial carcinomas in women with polycystic ovary syndrome (PCOS) and to determine the diagnostic role of sonohysterography (SH) in the evaluation of these lesions. SH findings of 52 PCOS patients with histologically confirmed endometrial carcinomas were evaluated. The mean age was 33.5 years (range 22-45 years). Histology included endometrioid type in 51 cases and Grade 1 in 46 cases, and 46 patients was stage IA. 23 Patients had high dose progestin treatment and 29 patients undergo surgery. SH demonstrated the endometrial thickening in 39 cases, endometrial mass in 6 cases, and endometrial thickening with mass in 7 cases. The endometrial thickness ranged from 5.5 to 27 mm (mean 9.6 mm) and the mass size ranged from 2 to 4.3 cm. They appeared as a diffuse polypoid endometrial thickening and a sessile endometrial mass with an inhomogeneous hyperechogenicity, an irregular surface, and obliteration of endometrial cavity. The tumour involved only to the endometrium in 35 cases and there were superficial myometrial invasion in 15 cases, deep myometrial invasion in 2 cases, and cervical invasion in 4 cases. The SH features of endometrial carcinomas associated with PCOS included a diffuse polypoid endometrial thickening and a sessile endometrial mass with an inhomogeneous hyperechogenicity, an irregular surface, obliteration of the cavity, and absent myometrial invasion. SH may provide more diagnostic value in the evaluation of endometrial carcinomas in women with PCOS. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Comparison between 3D-Transvaginal Ultrasound and Hysteroscopy in Detecting Uterine Cavity Abnormalities

Background: unsuspected uterine cavity abnormalities, such as endometrial polyps, small submucous myomas, adhesions, and uterine septum may cause different gynecological complaints such as bleeding and negatively impact chances of success in ART by interfering with implantation or causing spontaneous abortion. Therefore, exclusion of intrauterine pathology is an important step before starting ART and treatment of any discovered lesion may improve ART outcome. The uterine cavity can be evaluated by hysterosalpingography (HSG), transvaginal ultrasound (TVS), sonohysterography (SHG), and hysteroscopy. Hysteroscopy is the gold standard for investi-gation of the uterine cavity, particularly when pathology is suspected. Objective: to assess diagnostic accuracy of three dimensional transvaginal ultrasound (3D-TVS) compared with hysteroscopy in detecting uterine cavity abnormalities. Study design: this prospective observational cross-sectional study was conducted during the January 2018 to June 2018. One hundred women with different uterine pathologies were enrolled. In the mid to late follicular phase of each subject’s menstrual cycle, three D transvaginal ultrasound and hysteroscopy were performed in each patient. Hysteroscopy is widely considered to be the gold standard method for investigation of the uterine cavity. Uterine cavity characteristics and abnormalities were recorded. Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios were evaluated. Results: hysteroscopy was successfully performed in all subjects. Hysteroscopy diagnosed pathological findings in 100 of 100 cases (100%). There were 50 endometrial polyps, 13 submucous myomas, 29 septate uterus, and 8 intrauterine adhesions. Three-dimensional transvaginal ultrasound in comparison with hysteroscopy had 85% diagnostic accuracy, 68.2% sensitivity, 91.5% specificity, 79% positive predictive value, and 86% negative predictive value. The positive and negative likelihood ratios were 8.01 and 0.3, respectively. 3D-TVS successfully detected every case of submucous myoma. For detection of endometrial polyps, 3D-TVS had 80.0% sensitivity, 100.0% specificity, and 90% diagnostic accuracy. For detection of septate uterus, 3D-TVS had 93.10% sensitivity, 100.0% specificity, and 98% diagnostic accuracy. Conclusion: three D-TVS demonstrated 84.1% diagnostic accuracy for detecting uterine cavity abnormalities in infertile women. A significant percentage of patients had evidence of uterine cavity pathology. Hysteroscopy is, therefore, recommended for accurate detection and diagnosis of uterine cavity lesion.

Sonohysterographic Findings of Endometrial Carcinomas in Women with Polycystic Ovarian Disease

To describe the sonohysterographic features of endometrial carcinomas in women with polycystic ovarian disease (PCOD) and to determine the diagnostic role of sonohysterography (SH) in the evaluation of these lesions. SH findings of 48 PCOD patients with histologically confirmed endometrial carcinomas were evaluated. The mean age was 33.5 years (range 22-45 years). Histology included endometrioid type in 47 cases and Grade 1 in 43 cases, and 43 patients was stage IA. 20 Patients had high dose progestin treatment and 28 patients undergo surgery. SH demonstrated the endometrial thickening in 35 cases, endometrial mass in 6 cases, and endometrial thickening with mass in 7 cases. The endometrial thickness ranged from 5.5 to 27 mm (mean 9.6 mm) and the mass size ranged from 2 to 4.3 cm (mean 2.9 cm). They appeared as a diffuse polypoid thickening and a sessile mass with an inhomogeneous hyperechogenicity, an irregular surface, and obliteration of the cavity. The tumor involved only to the endometrium in 32 cases and there were superficial myometrial invasion in 14 cases, deep myometrial invasion in 2 cases, and cervical invasion in 3 cases. The SH features of endometrial carcinomas associated with PCOD included a diffuse polypoid endometrial thickening and a sessile endometrial mass with an inhomogeneous hyperechogenicity, an irregular surface, obliteration of the cavity, and absent myometrial invasion. SH may provide more diagnostic value in the evaluation of endometrial carcinomas in women with PCOD.

Various Types of Niche Imaging by Sonohysterography: A Pictorial Review

ABSTRACT Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. Recently cesarean section delivery has been raised around the world markedly; therefore women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual Spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs have been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently. How to cite this article Ahmadi F, Akhbari F, Niknejad F. Various Types of Niche Imaging by Sonohysterography: A Pictorial Review. Donald School J Ultrasound Obstet Gynecol 2014;8(3):311-315.

Various Types of Niche Imaging by Sonohysterography

: Cesarean scar defects (CSD) or niche are the myometrial discontinuity at the previous cesarean section scar region. We aimed to depict various types of niche imaging by sonohysterography. Recently, the rate of cesarean section delivery has markedly risen around the world; therefore, women with cesarean scar defects are increased and present in up to 19% of women post cesarean section. The increase of repeat cesarean section has been associated with an increase in complications in subsequent pregnancies such as scar pregnancy with life threatening bleeding, uterus rupture, placenta accreta and its subtypes and prolonged postmenstrual spotting. The deeper the niche (or the thinner the overlying myometrium), the higher the risk for complications in a subsequent pregnancy. Various shapes of uterine cesarean scar defects (niche) in TVS and SHG include: thin linear defect, wedge shape defect, droplet defect, semicircular defect, rectangle defect, inclusion cyst defect, irregular defect, multiple defects. Although the ability of transvaginal ultrasound (TVUS) to detect cesarean scars remains unknown, its higher frequency and proximity to the pelvic organs has been used as a powerful tool for detecting the uterine scar of a previous cesarean section. Recently with the increasing use of sonohysterography (SHG) (transvaginal ultrasound with saline infusion) detection of scar defect has been enhanced frequently.

Sonohysterography: Principles, technique and role in diagnosis of endometrial pathology

Sonohysterography (SHG), which provides enhanced endometrial visualization during standard transvaginal ultrasonography, is a relatively safe procedure for the evaluation of endometrial pathology. It can be used to evaluate patients with abnormal vaginal bleeding or infertility. This modality offers real time imaging of the endometrium without exposure to ionizing radiation. SHG is typically used in patients for whom standard transvaginal ultrasonography does not show the endometrium well, show a potential abnormality for which further imaging is required, or in patients without endometrial pathology defined on routine transvaginal imaging but in whom there is a strong clinical suspicion of an abnormality. This article will discuss the utility of the sonohysterogram in evaluation of various endometrial pathologies. Imaging examples of these pathological entities will be illustrated as well.

Systematic Review of Cesarean Scar Assessment in the Nonpregnant State: Imaging Techniques and Uterine Scar Defect

To review the ability of imaging techniques to predict incomplete healing of uterine cesarean scars before the next pregnancy. A systematic literature review searched for studies on women who underwent previous low-transverse cesarean, evaluated by hysterography, sonohysterography (SHG), or transvaginal ultrasound (TVU). The median prevalence of scar defects was computed with 95% confidence intervals (95% CIs). Odds ratio (OR, 95% CI) identified risk factors of incomplete healing. The analysis included 21 studies. The proportions of suspected scar defects detected by hysterography, SGH, and TVU were 58% (33 to 70), 59% (58 to 85), and 37% (20 to 65), respectively. Two studies found that women with a large uterine scar defect had a higher risk of uterine rupture or uterine scar dehiscence than those with no scar defect or small scar defect (OR: 26.05 [2.36 to 287.61], p <0.001). The only reported risk factor for scar defect was the occurrence of more than one previous cesarean (OR: 2.24 [1.13, 4.45], p = 0.02). Hysterography, SGH, and TVU can detect uterine scar defects in ~50% of women with previous cesarean.

Transvaginal sonographic evaluation at different menstrual cycle phases in diagnosis of uterine lesions

Purpose:Intrauterine lesions (IULs) are a common finding in women of reproductive age, particularly infertile women. Transvaginal sonography (TVS) is a popular tool for IUL detection, but there are conflicting data with respect to its accuracy.Methods:Five hundred and six women were enrolled into the study. Of these, 496 underwent hysterosalpingography and subsequent TVS six different times during the course of their menstrual cycle. If a lesion was detected, it was further evaluated by sonohysterography (SHG) and hysteroscopy.Results:Of 496 women, 41 were shown to have IULs by TVS and those lesions were confirmed in 39 by SHG and hysteroscopy. All 39 lesions were detectable during the ovulatory and early luteal phase (days 16–19) of the menstrual cycle. Accuracy of TVS during different phases was largely dependent on the size of the lesion. TVS falsely detected two lesions and missed fine adhesions in two patients.Conclusion:Accuracy of TVS in detection of IULs is highly dependent on the menstrual cycle phase, with the ovulatory and early luteal phase being the optimal time for this examination.

Comparação entre ultrassonografia transvaginal e histerossonografia na avaliação de pacientes com sangramento uterino anormal

OBJETIVO: Avaliar a eficácia da ultrassonografia transvaginal (USTV) e da histerossonografia (HSG) e compará-las na avaliação de alterações endometriais em portadoras de sangramento uterino anormal. MATERIAIS E MÉTODOS: Estudo transversal com 30 pacientes, idade entre 29 e 71 anos, 21 delas (70%) na pré-menopausa e 9 (30%) na pós-menopausa. Utilizou-se solução salina a 0,9% para contraste na HSG. Foi considerado o achado histeroscópico e/ou histopatológico como método padrão. Utilizou-se o teste de MacNemar para comparação dos testes diagnósticos. RESULTADOS: A histeroscopia diagnosticou 18 casos (60%) de alterações intracavitárias, sendo 10 pólipos (33,3%). A USTV apresentou sensibilidade e especificidade de 83,3% e a HSG mostrou sensibilidade de 94,4% e especificidade de 91,6%. O teste de MacNemar evidenciou sensibilidade (p = 0,500) e especificidade (p = 1,000) semelhantes entre a USTV e a HSG para detecção de alterações endometriais. No diagnóstico de pólipo, a HSG apresentou maior sensibilidade (90,9% × 27,3%; p = 0,016), com especificidade semelhante (89,5% × 94,7%; p = 1,000). CONCLUSÃO: A HSG e a USTV apresentam boas taxas de predição para doenças endometriais em pacientes com sangramento uterino anormal. A HSG apresenta sensibilidade e especificidade semelhantes às da USTV na detecção dessas doenças, porém apresenta sensibilidade maior para pólipos.

Diagnostic accuracy of sonohysterography, hysterosalpingography and diagnostic hysteroscopy in diagnosis of arcuate, septate and bicornuate uterus

To evaluate the diagnostic accuracy of sonohysterography (SHG), hysterosalpingography (HSG) and diagnostic hysteroscopy (DH) in uterine anomaly detection and to assess the role of these various modalities in the differential diagnosis of arcuate, septate and bicornuate uteri. Eighty-three women, with a history of recurrent spontaneous abortions or infertility and initial diagnosis of uterine anomaly were included in the study. Diagnostic work-up comprised of SHG, HSG and DH. To assess the accuracy of these methods all the patients underwent hysterolaparoscopy to establish the final diagnosis. The correlation between the results of each method was evaluated and diagnostic accuracy of each method was assessed in the whole group of women as well as in subgroups of arcuate, septate and bicornuate uteri using receiver operator curve (ROC) method by estimating the area under the curve (AUC). In the overall diagnosis of uterine anomalies, SHG with accuracy of 95.2% and correlation index of 0.873 (P < 0.001) proved to be a significantly better tool compared to DH (SHG(AUC) = 0.924 versus DH(AUC) = 0.761 P = 0.008), while no significant differences were observed between SHG versus HSG and DH versus HSG. SHG showed significantly higher accuracy (100.0%) compared to DH (80.7%) and HSG (80.7%) in differentiation of a septate (SHG(AUC) = 1.000 versus DH(AUC) = 0.816 P < 0.001 and SHG(AUC) = 1.000 versus HSG(ACC) = 0.818; P < 0.001) and bicornuate uterus (SGH(AUC) = 1.000 versus DH(ACC) = 0.707; P < 0.001 and SHG(ACC) = 1.000 versus HSG(AUC) = 0.790; P = 0.002). SHG is a noninvasive, cost-effective method available in an outpatient setting that is highly accurate in identifying uterine anomalies, in particular septate and bicornuate uterus.

Diagnostic correlation between sonohysterography and hysteroscopy in the assessment of uterine cavity after cesarean section

The evolution of sonohysterography (SHG) over the past years has contributed significantly to the assessment of uterine cavity. To compare SHG versus the “gold standard” diagnostic hysteroscopy (DH) for the assessment of the uterine cavity in women with previous cesarean section (CS). Comparative observational cross-sectional study. Department of Obstetrics and Gynecology, Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University. Seventy-five women with previous CS(s), complaining of infertility, menstrual disorders or recurrent pregnancy loss. The inclusion criteria were: age between 20 and 35years; previous 1–3 CS(s); and the duration from the last CS ranging from 1 to 5years. Transvaginal SHG with saline infusion as contrast medium for assessment of the thickness of the scar, filling defect in the scar (niche) and intrauterine adhesions. DH was performed to confirm different findings. The findings at SHG were compared to DH; and the accuracy of SHG was calculated. The scar thickness at SHG was significantly lower in cases with scar defect at DH (P=0.016). SHG was comparable to DH as shown by sensitivity, specificity, +ve predictive value, −ve predictive value and overall accuracy of 87%, 100%, 100%, 95% and 96%, respectively, in the diagnosis of scar defect; and 76%, 100%, 100%, 87% and 91%, respectively, in the diagnosis of intrauterine adhesions. SHG is reliable and feasible, and may be recommended as an alternative to DH for the assessment of the uterine cavity and uterine scar in women with previous CS.

Value of 3-Dimensional Sonohysterography in Infertility Work-up

Study Objective To compare the diagnostic value of 2-dimensional (2D) and 3-dimensional (3D) sonohysterography (SHG) and outpatient hysteroscopy (OH) in detecting intrauterine lesions in infertile women. Design Comparative, observational, cross-sectional study (Canadian Task Force Classification II-2). Setting University hospital. Patients One hundred eighty women with a normal uterine cavity at transvaginal ultrasound and hysterosalpingography (HSG) underwent infertility workup at our outpatient clinic. Interventions All patients underwent 2D-SHG, 3D-SHG, and OH. Measurements and Main Results Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 2D-SHG and 3D-SHG were compared with OH in detecting intrauterine lesions. For 2D-SHG, sensitivity was 0.70 (95% confidence interval [CI], 0.49–0.85), specificity was 1.0 (95% CI, 0.96–1.0), PPV was 1.0 (95% CI, 0.79–1.0), NPV was 0.95 (95% CI, 0.9–0.97), and accuracy was 95.5%. For 3D-SHG, sensitivity was 0.92 (95% CI, 0.74–0.98), specificity was 1.0 (95% CI, 0.97–1.0), PPV was 1.0 (05% CI, 0.83–1.0), NPV was 0.98 (95% CI, 0.95–0.99), and accuracy was 98.8%. For OH, sensitivity was 1.0 (95% CI, 0.85–1.0), specificity was 1.0 (95% CI, 0.97–1.0), PPV was 1.0 (95% CI, 0.84–1.0), NPV was 1.0 (0.97–1.0), and accuracy was 100%. Thus, 3D-SHG is comparable to OH in diagnosing intrauterine lesions (p = .23), and both are superior to 2D-SHG (p <0.001). Conclusion The diagnostic value of 3D-SHG is comparable to OH in detecting intrauterine lesions, and both are superior to 2 D-SHG. 3D-SHG should be included in the infertility workup even in women with a normal uterine cavity at transvaginal ultrasound or hysterosalpingography.

OC21.04: Endometrial thickness and the prevalence of endometrial carcinoma in asymptomatic postmenopausal patients, a systematic review of the literature

Objectives: Endometrial polyps in asymptomatic postmenopausal women are present in 15–20% of patients. The prevalence of preand malignant endometrial lesion on atrophic endometrium in this group has been recently estimated to be 1.6% and 0.2%, respectively (Ferrazzi et al., AJOG 2009). The objective of this 10 year study was to observe the natural history of endometrial polyps on atrophic endometrium (thickness ≤4 mm) in asymptomatic postmenopausal women. Methods: 396 asymptomatic postmenopausal women with sonographic diagnosis of endometrial polyp were prospectively recruited. Patients on HRT and/or TMX treatment were excluded. All patients underwent transvaginal sonography (TVS) with color power Doppler (CD) evaluation, and sonohysterography (SHG). Sonographic follow-up at 3, 6, 12 and every 12 months was proposed as an option to standard hysteroscopic polypectomy. Surgery was considered in case of a high blood flow score (color score 3–4 according to IETA definitions), or in case of bleeding and/or volume growth >50% at follow-up. Demographic, sonographic and surgical data were recorded. Results: Sonographic follow-up was chosen by 292 patients (group A). 32 patients were lost at follow-up. 40 patients underwent surgery because of drop-out, uterine bleeding or increased volume at follow up, or for other gynaecological indications. Two endometrial cancers were diagnosed after uterine bleeding at 16 and 69 months of followup, respectively. In group B, surgical removal was performed in 104 patients by hysteroscopic polipectomy. One pre-malignant lesion was found in surgically treated patients (simple hyperplasia with focal atypia confirmed at hysterectomy). Conclusions: This observational study adds evidence to the feasibility of a conservative management of asymptomatic polyps. Monitoring criteria by using TVS, CD and SHG assessment need to be established.

OC21.03: Natural history of asymptomatic endometrial polyps in postmenopausal women: a 10‐year follow‐up study

Endometrial polyps in asymptomatic postmenopausal women are present in 15–20% of patients. The prevalence of pre- and malignant endometrial lesion on atrophic endometrium in this group has been recently estimated to be 1.6% and 0.2%, respectively (Ferrazzi et al., AJOG 2009). The objective of this 10 year study was to observe the natural history of endometrial polyps on atrophic endometrium (thickness ⩽ 4 mm) in asymptomatic postmenopausal women. 396 asymptomatic postmenopausal women with sonographic diagnosis of endometrial polyp were prospectively recruited. Patients on HRT and/or TMX treatment were excluded. All patients underwent transvaginal sonography (TVS) with color power Doppler (CD) evaluation, and sonohysterography (SHG). Sonographic follow-up at 3, 6, 12 and every 12 months was proposed as an option to standard hysteroscopic polypectomy. Surgery was considered in case of a high blood flow score (color score 3–4 according to IETA definitions), or in case of bleeding and/or volume growth > 50% at follow-up. Demographic, sonographic and surgical data were recorded. Sonographic follow-up was chosen by 292 patients (group A). 32 patients were lost at follow-up. 40 patients underwent surgery because of drop-out, uterine bleeding or increased volume at follow up, or for other gynaecological indications. Two endometrial cancers were diagnosed after uterine bleeding at 16 and 69 months of follow-up, respectively. In group B, surgical removal was performed in 104 patients by hysteroscopic polipectomy. One pre-malignant lesion was found in surgically treated patients (simple hyperplasia with focal atypia confirmed at hysterectomy). This observational study adds evidence to the feasibility of a conservative management of asymptomatic polyps. Monitoring criteria by using TVS, CD and SHG assessment need to be established.