Post-pregnancy loss hysteroscopy as a method for early diagnosis of congenital and acquired intrauterine causes

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 aimed at assessment of efficacy of post - abortion hysteroscopy for detection of congenital and acquired intrauterine anomalies. This study was conducted in Ain Shams Maternity hospital (outpatient clinic for RPL) during the period between November 2012 and August 2014. Fifty non-pregnant patients with a history of one or more previous 1st or 2nd trimesteric miscarriages before 20 weeks were recruited for the present study after obtaining informed consent, were collected from outpatient clinic for recurrent miscarriage and submitted to 2D transvaginal ultrasound examination at special care center of the fetus and hysteroscopy exam at early cancer detection unit. A 2D transvaginal ultrasound examination was performed at first, then, in another setting, hysteroscopic examination was done. Then, a comparison was done between 2D transvaginal ultrasound and hysteroscopy to detect the intracavitary uterine lesions. All patients had normal complete blood count, lupus anticoagulant and anticardiolipin antibodies were negative, prolactin level, FSH, LH, E2, TSH and progesterone level were normal and all patients were non diabetic by oral glucose tolerance test It was found that majority of the studied cases (48%) aged between (25-30) years; most of the patients were nullipara (56%). In this study we found that 20 of the patients had 1 previous miscarriage, 12 of the patients had 3 previous miscarriages, and 18 of the patients had 2 previous miscarriages. In this study it was found that most of the patients (18) had one previous first trimester miscarriages while (10) of the patients had ≥3 previous second trimester miscarriages. In the current study during comparison the result of hysteroscopy with that of the transvaginal ultrasound it was found that the hysteroscopy detect intrauterine abnormalities in 44% of the patient while the TVUS detect abnormalities only in 36% of the patient .Also the TVUS shows no abnormalities in 64% of the patient while the hysteroscopy shows normal findings in 56% of the patient As regard the hysteroscopic findings it was found that (12%)of the cases were intrauterine adhesions (IUAs), (8%) bicornuate uterus, (8%)subseptate uterus, (4%) septate uterus, (4%) endometrial polyp, (4%) submucous myoma, and (4%) incompetent cervix. The highest percentage of cases showed normal hysteroscopic findings (56%), intrauterine adhesions (IUAs) was the most frequent finding (12%).