EVALUATION OF SOME TOOLS USED IN THE DIAGNOSIS OF CONGENITAL UTERINE ANOMALIES
AHMED M.S. HEGAZY AND MAHMOUD A.H. GEHAD*
Department of Anatomy, *Department of Obstetrics and GynecologyFaculty of Medicine, Benha University, Egypt
Background: There are several techniques available for the evaluation of uterine malformations. When the cavity only is to be assessed, hysterosalpingography (HSG) and hysteroscopy are especially useful. Laparotomy and laparoscopy can be also used for examination of the uterine fundus. There are two techniques, however, that combine the study of both these structures, which are indeed relevant for the diagnosis: magnetic resonance imaging (MRI) and three-dimensional (3D) ultrasound.Aim of the work: The objective of this study is to evaluate the diagnostic value of some diagnostic tools used in the diagnosis of congenital uterine anomalies.Patients and methods: This study was performed on thirty nine patients, they were HSG suggestive of congenital uterine anomalies. Every patient was subjected to complete clinical examination. Then, every patient was subjected to the following procedures;Two-Dimensional Transvaginal Sonography (2D-TVS), Three-Dimensional Transvaginal Sonography (3D-TVS), Two-Dimensional Saline Infusion Sonohysterography (2D-SIS) and Diagnostic Hysteroscopy (DHS)/laparoscopy in this sequence. Results: The most frequent clinical presentations of patients in this study were recurrent miscarriage (56.4%) followed by primary infertility(23.1%), secondary infertility(15.4%) and menorrhagia (5.1%). The rate of different types of congenital uterine anomalies diagnosed in this study were; Septate uterus 46.1%, bicornuate uterus 23.2%, arcuate uterus 20.5% and unicornuate uterus 10.2%.The results of studying the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of 2D-TVS, 3D-TVS and 2D-SIS in comparison with DHS/laparoscopy (the gold standard) proved that the results of the 3D-TVS has a very high accuracy rate in diagnosing congenital uterine anomalies in comparison with the gold standard (DHS/laparoscopy) test results regarding the sensitivity (100.0%), specificity (85.7%), positive predictive value (97.0%), negative predictive value (100.0%) and diagnostic accuracy (97.4%) followed by 2D-SIS regarding the sensitivity (84.4%), specificity (71.4%), positive predictive value (93.1%), negative predictive value (50%) and diagnostic accuracy (82.1%).Conclusion: From the present study it can be concluded that HSG and/or 2D-TVS can be used as an initial tool for the diagnosis of congenital uterine anomalies. Combined hysteroscopy and laparoscopy, 2D-SIS and 3D-TVS can be used for the definitive diagnosis.