Skip to main content
SpringerLink
Log in

Comparison of hysterosalpingography, hysterosonography and hysteroscopy in evaluation of the uterine cavity in patients with recurrent pregnancy losses

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Aim

To evaluate the accuracy and acceptability of hysterosonography (HS) in the diagnosis of uterine anomalies in patients with recurrent pregnancy loss.

Method

Sixty non-pregnant patients with a history of at least three previous recurrent miscarriages were submitted to the HS, HSG and hysteroscopy (HTC) exams. The findings fall into three categories: synechiae, polypoid lesions and abnormal uterine cavity shape. The HTC exam was used as the gold standard. The findings of the HS and the HSG were compared to the HTC’s and the agreement was evaluated using the Kappa coefficient. Significance was established at < 0.05. Sensitivity, specificity, positive and negative predictive values were determined for each method.

Result

Uterine anomalies were present in 38.3% (23) of the patients: 16 (26.7%) with synechiae, 3 (5.0%) with polypoid lesions and 8 (13.3%) with abnormal uterine cavity shape. Accuracy of the HS and the HSG was 90.9 and 85.2%. General sensitivity of the HS was superior to the HSG (90.5 vs. 75.0%). It also had a higher degree of agreement with the HTC (Kappa = 0.81 vs. 0.68). The HS caused significantly less pain than the other two methods.

Conclusions

The HS had higher diagnostic accuracy in the detection of uterine cavity anomalies and it was better tolerated by the patients when compared to hysterosalpingography and hysteroscopy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American College of Obstetricians, Gynecologists (2002) Management of recurrent early pregnancy loss ACOG Practice bulletin, no 24, February 2001. Int J Gynaecol Obstet 78:179–190

    Article  Google Scholar 

  2. Salim R, Regan L, Woelfer B, Backos M, Jurkovic D (2003) A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod 18(1):162–166

    Article  PubMed  CAS  Google Scholar 

  3. Gronlund L, Hertz J, Helm P, Colov NP (1999) Transvaginal sonohysterography and hysteroscopy in the evaluation of female infertility, habitual abortion or metrorrhagia. A comparative study. Acta Obstet Gynecol Scand 78:415–418

    Article  PubMed  CAS  Google Scholar 

  4. Brown SE, Coddington CC, Schnorr J, Toner JP, Gibbons W, Oehninger S (2000) Evaluation of outpatient hysteroscopy, saline infusion histerosonography, and hysterosalpingography in infertile women: a prospective, randomized study. Fertil Steril 74(5):1029–1034

    Article  PubMed  CAS  Google Scholar 

  5. Laifer-Narin Sl, Ragavendra N, Parmenter EK, Grant E (2002) False-normal appearance of the endometrium on conventional transvaginal sonography comparison with saline hysterosonography. AJR Am J Roentgenol 178:129–133

    PubMed  Google Scholar 

  6. Widrich T, Bradley LD, Mitchinson AR, Collins RL (1996) Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol 174:1327–1334

    Article  PubMed  CAS  Google Scholar 

  7. Keltz MD, Olive DL, Kim AH, Arici A (1997) Sonohysterography for screening in recurrent pregnancy loss. Fertil Steril 67(4):670–674

    Article  PubMed  CAS  Google Scholar 

  8. Ninomiya T, Albuquerque LET, Varjão DM, Faria KB, Oliveira RCM, Diniz LEV (2003) Evaluation of the uterine cavity by sonohysterography in patients with implantation failure after in vitro fertilization. Rev Bras Ginecol Obstet 25(7):519–523

    Article  Google Scholar 

  9. Dueholm M, Forman A, Jensen ML, Laursen H, Kraus P (2001a) Transvaginal sonography combined whit saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients whit abnormal uterine bleeding. Ultrasound Obstet Gynecol 18:54–61

    Article  CAS  Google Scholar 

  10. Kroon CD, Bock GH, Dieben SWM, Jansen FW (2003a) Saline contrast hysterosonography in abnormal uterine bleeding: a systematic review and meta-analysis. BJOG 110:938–947

    Google Scholar 

  11. Donadio NK, Donadio N, Torres MMG (2004) Three-dimensional hysterosonography in infertility: preliminary study. Rev Bras Ginecol Obstet 26(10):773–780

    Article  Google Scholar 

  12. Franco RC, Machado JC, Elias Junior J, Berezowski AT, Nogueira AA, Sala MM (2000) Endouterine cavity investigation: Comparative study between x-ray hysterography, sonohysterography and hysteroscopy. Rev Bras Ginecol Obstet 22(10):619–625

    Article  Google Scholar 

  13. Duce MN, Oz U, Ozer C, Yildiz A, Apaydin FD, Çil F (2003) Diagnostic value of sonohysterography in the evaluation of submucosal fibroids and endometrial polyps. Aust N Z J Obstet Gynaecol 43:448–452

    Article  Google Scholar 

  14. Leone FPG, Lanzani C, Ferrazzi E (2003) Use of strict sonohysterorographic methods for preoperative assessment of submucous myomas. Fertil Steril 79(4):998–1002

    Article  PubMed  Google Scholar 

  15. Lasmar RB, Barrozo PRM, Dias R, Oliveira MAP, Pontes A, Dias DS (2004) Submucous fibroids: presurgical classification to evaluate the viability of hysteroscopic surgical treatment. Rev Bras Ginecol Obstet 26(4):305–309

    Article  Google Scholar 

  16. Romano F, Cicinelli E, Anastacio PS, Epifani S, Fanelli F, Galantino P (1994) Sonohysterography versus hysteroscopy for diagnosing endouterine abnormalities in fertile women. Int J Gynaecol Obstet 45(3):253–260

    Article  PubMed  CAS  Google Scholar 

  17. Traina E, Mattar R, Moron AF, Albuquerque Neto LC, Matheus ED (2004) Diagnostic accuracy of hysterosalpingography and transvaginal sonography to evaluate uterine cavity diseases in patients with recurrent miscarriage. Rev Bras Ginecol Obstet 26(7):527–528

    Article  Google Scholar 

  18. Glatstein IZ, Sleeper LA, Lavy Y, Simon A, Adoni A, Palti Z et al (1997b) Observer variability in the diagnosis and management of the hysterosalpingogram. Fertil Steril 67:233–237

    Article  CAS  Google Scholar 

  19. Soares SR, Barbosa dos Reis RR, Camargos AF (2000) Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril 73(2):406–411

    Article  PubMed  CAS  Google Scholar 

  20. Kim HA, McKay H, Keltz MD, Nelson HP, Adamson GD (1998) Sonohysterographic screening before in vitro fertilization. Fertil Steril 69:841–844

    Article  PubMed  CAS  Google Scholar 

  21. Accorsi Neto AC, Gonçalves WJ, Mancini SN, Soares Jr JR, Haidar MA, Lima JR et al (2003) Comparison between hysterosonography, hysteroscopy and histopathology in the evaluation of postmenopausal woman uterine cavity. Rev Bras Ginecol Obstet 25(9):667–672

    Article  Google Scholar 

  22. Crespigny L, Kuhn R, McGinnes D (1997) Saline infusion sonohysterography, an underutilized technique. Aust N Z Obstet Gynaecol 37(2):206–209

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics, São Paulo’s Federal University, Paulista Medical School, Rua Napoleão de Barros, 715-8° andar, São Paulo, São Paulo, 05407-000, Brazil

    Hélio Antonio Guimarães Filho, Rosiane Mattar, Cláudio R. Pires, Edward Araujo Júnior, Antonio F. Moron & Luciano M. M. Nardozza

  2. Rua Reinaldo Tavares de Melo, 142/901 Manaíra, 58038-300, João Pessoa, Paraíba, Brazil

    Hélio Antonio Guimarães Filho, Rosiane Mattar, Cláudio R. Pires, Edward Araujo Júnior, Antonio F. Moron & Luciano M. M. Nardozza

Authors
  1. Hélio Antonio Guimarães Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosiane Mattar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cláudio R. Pires
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edward Araujo Júnior
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio F. Moron
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luciano M. M. Nardozza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hélio Antonio Guimarães Filho.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guimarães Filho, H.A., Mattar, R., Pires, C.R. et al. Comparison of hysterosalpingography, hysterosonography and hysteroscopy in evaluation of the uterine cavity in patients with recurrent pregnancy losses. Arch Gynecol Obstet 274, 284–288 (2006). https://doi.org/10.1007/s00404-006-0186-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-006-0186-3

Keywords

Search

Navigation