dimensional ultrasound evaluation of the uterine cavity before and after myomectomy in cases of multiple fibroids

ABSTRACT

The aim of this work was to evaluate the role of three - dimensional [3D] transvaginal ultrasonography [TVS] of the uterine body and cavity in cases of multiple myomas going to do myomectomy and its impact on the integrity of the cavity after myomectomy. The present study was carried on 42 patients with multiple fibroids planned for myomectomy. They were divided into two groups; 16 patients [group I] were examined before and within three months after myomectomy by transabdominal, conventional 2D and 3D TVS in multiplanar mode at the coronal view. 26 patients [group 2] who did myomectomies within three months were examined by 3D ultrasound only after the operation. In both groups, the uterus was evaluated for size, shape of the cavity, presence of intrauterine adhesions and any submucous myomas or polyps. The results of the present study showed that the two groups were comparable as regards the age, gravidity, parity and number of myomas diagnosed preoperatively [p>0.05]. Intraoperatively, fibroids were pure interstitial in 75% of patients in group [1] and 80.77% of patients in group [2], however, fibroids were combined submucous and interstitial in 25% and 19.23% of patients in group 1 and 2 respectively with insignificant difference between both groups [P > 0.05]. The uterine cavity was opened in 31.25% and 15.38% of patients of group 1 and 2 with significant difference between the two groups, [p<0.05]. Postoperatively, 3D TVS revealed normal uterine cavity in all patients of group 1 [100%] and in 88.5% of patients in group 2 with insignificant differences between the two groups, p> 0.05. Three patients in group 2 [11.5%] showed abnormal coronal view in multiplanar mode of 3D scan. Two patients showed intrauterine adhesions with cavity distortion in one of them. One patient showed missed submucous fibroid. Preoperative evaluation of the uterine cavity with 3D TVS in patients planed for myomectomy allows better identification of the position of the uterine fibroids, thus, providing surgeons with guidelines for easy removal of the fibroids and avoid distortion of the uterine cavity when it is opened. Also, postoperative 3D evaluation allows early postoperative diagnosis and management of operative complications and insures an intact uterine cavity for subsequent spontaneous pregnancy or pregnancy following assisted reproductive technology [ART]