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Sonohysterography for screening in recurrent pregnancy loss
M D Keltz1, D L Olive, A H Kim
1Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA.
Objective:
To evaluate the role of sonohysterography for screening of the uterine cavity in patients with recurrent pregnancy loss.
Design:
Prospective evaluation of sonohysterography, including comparison with available hysterosalpingography and hysteroscopy.
Setting:
University referral center.
Patient(S):
Thirty-four reproductive-aged women with at least two consecutive pregnancy losses.
Intervention(S):
Sonohysterography was performed on all patients, using saline instilled through an endocervically placed balloon catheter with concurrent vaginal sonography.
Result(S):
Seventeen of 34 sonohysterograms (50.0%) demonstrated intrauterine abnormalities. Eighteen of 34 cases have undergone hysteroscopy or, in 1 case, laparoscopy. All confirmed the positive or negative sonohysterographic finding, resulting in a sensitivity and specificity of 100%. Additionally, 100% (12/12) of the defects were diagnosed accurately at sonohysterography when confirmed by surgery. Twenty-seven of 34 patients also had a hysterosalpingogram that demonstrated a 90.0% sensitivity and 20.0% specificity based on hysteroscopic findings, yet only 5 of 11 (45.5%) defects were diagnosed accurately at hysterosalpingography when compared with surgery.
Conclusion(S):
Sonohysterography is a highly sensitive, specific, and accurate screening tool for the evaluation of uterine cavitary defects associated with recurrent pregnancy loss and offers several advantages over hysterosalpingography.