Office Hysteroscopy Versus Hysterosalpingography in Recurrent First Trimestric Abortion: A Comparative Study
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- Category: Vol. 85, September 2017
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Office Hysteroscopy Versus Hysterosalpingography in Recurrent First Trimestric Abortion: A Comparative Study, GAMAL A. IBRAHIM, SEIF EL-DIN A. ABD EL-MONEIM, SHERIN M. SOBH, HAITHAM M. MOHAMED ABD EL-SALAM and EMAN F. OMRAN
Abstract
Objective: The aims of this work were to assess the prevalence of uterine abnormalities by hysteroscopy and HYSTEROSALPINGOGRAPHY (HSG) in patients with recurrent first trimestric pregnancy loss (RPL) and to evaluate the diagnostic accuracy of HSG in diagnosis of uterine abnor-malities in comparison to hysteroscopy.
Study Design: Interventional diagnostic study.
Patients and Methods: 50 patients who had three or more consecutive early pregnancy losses in the in the age between 20 to 40 years were included. Patients with chronic medical disorders or previous uterine operations (other than cesarean section and curettage) were excluded. Office hysteroscopy was done in the follicular phase followed by HSG in the following cycle.
Results: The mean ± SD age was 29.3±5.45. Number of miscarriages ranged from 3 to 5 pregnancy losses. More than
3 miscarriages were present in 18 (36%) of cases. Abnormal hysteroscopic findings were present in 15 (30%) cases. How-ever, uterine abnormalities were detected in only 8 (16%) cases by HSG. The overall accuracy, sensitivity and specificity for HSG were 84% (95% CI: 67% to 93%), 53.3% (95% CI: 27% to 78%) and 100% (95% CI: 90% to 100%) respectively. The specificity measures for HSG in diagnosis of individual uterine abnormalities were high; however the sensitivity measures were variable. The sensitivity for detection of uterine anomalies was higher than that for detection of acquired uterine abnormalities. 5 out of 6 endometrial polyps, I out of
4 myomas and 1 out of 2 cases with intra-uterine synechiae were missed by HSG.
Conclusion: Although HSG had high specificity for diag-nosis of uterine abnormalities, the sensitivity for detection of these abnormalities (especially acquired abnormalities) was low in comparison to hysteroscopy. Therefore, office hyst-eroscopy should be a part of RPL workup even in cases with normal HSG.