OBJECTIVE: To evaluate the importance of sonohysterography, hysterography and hysteroscopy in screening the uterine cavity in patients with recurrent pregnancy loss (RPL).
MATERIAL AND METHODS: Twenty six patients with at least two consecutive pregnancy losses (not due to cervical incompetence, were selected among patients attending the Obstetrics and Gynecology department, King Khalid military Hospital, Saudi Arabia, during the period from March 1996 till July 1997. Each patient had a Sonohysterography using a microparticle galactose ultrasonic medium (Echovist – 200, Schering) instilled into the uterine cavity through an intracervical catheter with concurrent vaginal ultrasonography. Each patient had also a standard hysterography using an aqueous contrast medium (Ultravist 300-Schering) and hysteroscopy under general anaesthesia using a 7-mm rigid hysteroscope with an operative sheath (wolf). All the procedures were carried out during the follicular phase of the menstrual cycles.
RESULTS: On Hysteroscopy, twelve out of 26 cases of RPL (46.1%) demonstrated intrauterine lesions including: 3 uterine adhesions (11.5%). 5 polyps (19.2%), 2 submucous fibroids (7.7%) and 2 subseptate uterus (7.7%). Using hysteroscopy as the standard, Sonohysterography revealed overdiagnosis in 2 cases (uterine adhesion and polyp) and hysterography revealed over diagnosis in 5 cases (2 uterine adhesions, 2 polyps and one fibroid) giving a specificity rate of 87.5 % and 73.7 respectively. Both sonohysterography and hysterography overlooked one case of subseptate uterus giving a sensitivity rate of 92.3%
CONCLUSION: Sonohysterography compares to hysterography offers a sensitive and more specific method for diagnosing intrauterine lesions in recurrent aborters. However the nature of the lesion could not be definitely diagnosed except with hysteroscopy which also offers an operative means. |
