Hysterosalpingographic accuracy of peritubal adhesion.

The purpose of this study was to determine diagnostic accuracy of hysterosalpingography by using different diagnostic criteria in peritubal adhesion diagnosis. The authors retrospectively reviewed cases in which both hysterosalpingography and laparoscopy were performed. Fifty-nine of 84 cases had laparoscopy proved peritubal adhesion. Five hysterosalpingographic signs (convoluted tube, vertical tube, ampullary dilatation, peritubal halo and loculation of the spillage of contrast material) defined by Karasick and Goldfarb were used to diagnose peritubal adhesion. All cases were analyzed by two different diagnostic criteria: first diagnostic criterion, presence of one or more signs means abnormal; second diagnostic criterion, presence of two or more signs means abnormal. Peritubal adhesion was diagnosed in 70 of 84 cases by using the first diagnostic criterion, 53 of 84 cases by using the second diagnostic criterion. The first diagnostic criterion displayed 94.9 per cent sensitivity, 44 per cent specificity, 80 per cent positive predictive value, 79.76 per cent accuracy and the likelihood ratio of 1.69. The second diagnostic criterion showed 74.6 per cent sensitivity, 64 per cent specificity, 83 per cent positive predictive value, 71.43 per cent accuracy and the likelihood ratio of 2.07. The authors conclude that using the 2nd diagnostic criterion is more appropriate than using the 1st diagnostic criterion in diagnosing peritubal adhesion.

Role of hydrogynaecography in detection of pelvic adhesion

20 patients were recruited from the fertility clinic and were subjected to hydrogynecography. This technique entails the instillation of about 200 ml normal saline into the peritoneal cavity through an intrauterine cannula. Transvaginal sonography of the pelvis is then carried out to visualize adhesions. Confirmation of ultrasonographic findings was done by subsequent diagnostic laparoscopy. Pelvic adhesions were identified by hydrogynecography in 12 patients. In the remaining 8, 4 women were free of pelvic abnormalities, as confirmed by laparoscopy and the other 4 had either short film periovarian and peritubal or higher pelvic omental adhesions. Statistical analysis of these data indicates that hydrogynecography had a positive predictive value of 100%, a negative one of 50% and an overall predictability of 80%. The simplicity and reliability of the test as well as its low cost present major advantages for its application in infertility investigation, particularly in patients who had been subjected to multiple laparotomies and laparoscopies. The nature of detectable pelvic adhesions by HGC in relation to their extent, thickness and location was analyzed in this study. Existing lower pelvic, tubal and periovarian adhesions were most easily defined in all subjects [N= 12]. However, short filmy adhesions between the ovaries and fallopian tubes or broad ligament were not visualized in 2 patients. Anatomically, fluid could not develop adequate contrast because of close proximity of adhesions to these structures. Hydrogynecography has also failed in detecting higher omental adhesions in the outer pelvis or around the rectosigmoid colon in 2 females. In either case of failed HGC technique, i.e. short filmy periovarian or higher pelvic adhesions, the significance of such adhesions on fertility outcome is questionable. The most frequent side effect noted during HGC procedure is uterine cramps felt by the patient during fluid installation. This was minimized by slow injection of the fluid and did not necessitate the administration of sedatives or spasmolytics. None of the patients subjected to the procedure showed signs of infection within the next few days