Saline infusion sonography versus 3d ultrasound in evaluation of endometrial cavity

To compare the diagnostic accuracy of 3D ultrasonography with 2D saline infusion sonohysterography [SIS] in evaluation of intracavitary lesions with reference to hysteroscopy as the gold standard. Prospective cross sectional comparative study. 64 women [20 patients with infertility, 16 patients with recurrent pregnancy loss and 28 patients with abnormal uterine bleeding] with abnormal uterine cavity provisionally diagnosed by transvaginal ultrasound were included in the study. An informed consent was obtained from all patients. Patients were examined by 3D ultrasound followed by 2D SIS. Diagnostic office mini-hysteroscopy was done one or two days later. Sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and diagnostic accuracy were calculated for 3D ultrasound and 2D SIS as compared with the findings of hysteroscopy. The hysteroscopic findings were 7 septate uterus, 7 intrauterine adhesions [IUAs], 23 endometrial polyps and 27 submucus myomas. Both SIS and 3D ultrasound were equally accurate in diagnosing septate uterus [100% sensitivity and diagnostic accuracy]. 3D ultrasound was more accurate than SIS in the diagnosis of acquired intracavitary lesions as a whole [sensitivity 92.9% vs 89.4%, diagnostic accuracy 93.75% vs 90.6% for 3D ultrasound and SIS respectively]. SIS was more sensitive than 3D ultrasound for the diagnosis of IUAs [sensitivity 100% vs 85.7%, diagnostic accuracy 100% vs 98.4% for SIS and 3D ultrasound respectively] and endometrial polyps [sensitivity 100% vs 86.9%, diagnostic accuracy 100% vs 95.3% for SIS and 3D ultrasound respectively]. On the other hand, 3D ultrasound was more accurate than SIS in diagnosing submucus myomas [sensitivity 100% vs 77.7%, diagnostic accuracy 100% vs 90.6% for 3D ultrasound and SIS respectively]. 3D ultrasound and SIS are sensitive modalities for evaluation of uterine cavity abnormalities. Both were of equal diagnostic accuracy in diagnosing septate uterus. SIS was more accurate in the diagnosis of intrauterine adhesions and endometrial polyps while 3D ultrasound was more accurate in the diagnosis of submucus myomas

Embryosonographic features: can they predict the fate in cases of threatened abortion?

To evaluate the prognostic value of different sonographic milestones of embryonic life in cases of first trimester threatened abortion. Two hundred pregnant females in their first trimester were recruited in the study. One hundred and fifty women with a diagnosis of threatened abortion constituted the study group and fifty matched controls of uncomplicated pregnancy served as a control group. All study patients were subjected to vaginal sonography to evaluate milestones of embryonic life and Doppler ultrasound study of uterine artery waveforms. Serial weekly examination were done till the end of first trimester. Seven hundred and thirty scans are performed to evaluate the following: crown-rump length, gestational age, mean sac diameter, yolk sac, liquor volume, placentation site, embryonic cardiac rate, retro-chorial hematomas and cervical length. Doppler studies of uterine and spiral arteries were also done. Our results have shown significant relations between these findings and the prognosis of cases at risk for abortion. The milestones that adversely affect the prognosis in pregnancies at risk for abortion include fetal bradycardia, retarded growth of the fetus, small sac size, absence of yolk sac and S/D ratio of uterine arteries >4.5