Assessment of the Prevalence of Uterine Anomalies by Hysteroscope in Women with Recurrent Miscarriage

Abstract

Office hysteroscopic examination is now an established step in the diagnostic work up of cases with abnormal uterine bleeding, infertility, and recurrent miscarriage that can be performed safely and efficiently without anesthesia in most cases. Hysteroscopy offers great assistance for the interpretation of uncertain findings from other diagnostic methods. Furthermore, it enables direct visualization of cervical canal, uterine cavity and increase the precision and accuracy in the diagnosis of intrauterine abnormalities. This study was conducted at Ain Shams University Maternity Hospital from May 2014 to February 2015 after informed written consent which was obtained from each participate for inclusion in this study. The aim of this study was the assessment of the prevalence and types of uterine defects in patients with recurrent pregnancy loss (RPL) through hysteroscopy. This study included one hundred and twenty non pregnant patients with history of two or more consecutive unexplained first and second trimester abortion before 20 weeks.  Summary and Conclusion  145 On admission, every patient was subjected to detailed history and all patients had normal complete blood count, urine analysis, lupus anticoagulant and anticardiolipin antibodies were negative, all of the partners had a normal semen analysis and exclusion of patient with genital tract cancer (cervical or uterine), active pelvic infection, viable intrauterine pregnancy. Regarding to the results of this study the mean age was 295.8 the median no previous abortion was 3(2-4) with 75.8% of this was first trimesteric abortion. The median no of previous deliveries was 1(0-2) and hysteroscopic finding was 60.8% of patients had normal finding and 36.7% had single hysteroscopic abnormality and 2.5% had two abnormality we also found that the most common hysterosopic abnormality was uterine adhesion 12.5% of all abnormality and all of this patients had adhesiolysis, then uterine septum 10% of patients, 5% of them had uterine septoplasty and 1 case had uterine septum excision and the least hysteroscopic abnormality was cervical polyp 1 patient (0.8%). The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as  Summary and Conclusion  146 regard age, number of previous abortion, number of previous deliveries, mode of delivery NVD or C.S. But there was statistically significant as regard timing of abortion, history of hypomenorrhea or abnormal uterine bleeding as associated symptom with recurrent abortion. By using multivariable binary logistic regression model for predictors of abnormal hysterosopic finding it was found that abnormal uterine bleeding if associated with patients recurrent miscarriage it gives a high suspection for structural uterine abnormalities (SUAs) in this patients if hysterosopcy done.