Diagnostic Correlation Between Saline Infused Sonohystrography and Three Dimensional Transvaginal Ultrasound in the Assessment of Cesarean Section Scar Defect. A Study of a Diagnostic Test Accuracy

Abstract

BACKGROUND: The evolution of sonohysterography over the past years has contributed significantly to the assessment of uterine cavity. Saline infused sonohysterography (SHG) may be recommended as an alternative to Diagnostic Hysteroscopy for the assessment of the uterine cavity and uterine scar in women with previous Cesarean Section. Three-dimensional (3D) ultrasonography that enhances visualization of the lower uterine segment (LUS), myometrial thickness and the size of uterine diverticulum is a more recent tool used to diagnose post-cesarean section uterine diverticulum. OBJECTIVE: To compare accuracy of three-dimensional transvaginal ultrasound versus the “gold standard” saline infused sonography for assessing the characteristics, frequency of caesarean scar defects in symptomatic patients with a history of cesarean section. PATIENTS AND METHODS: This study was conducted with 72 women. patients were recruited from the ultrasound unit underwent both threedimentional transvaginal ultrasound and saline infused sonohysterography. This study, conforming to the declaration of Helsinki, was approved by the ethical committee of Obstetrics and Gynecology department, Ain Shams University, ethical committee number FMASU M D 52 \2021. RESULTS: 3D transvaginal ultrasound and sonohysterography showed almost good agreement regarding prevalence of niche with kappa (κ) 0.780 with p-value (p<0.001). Both imaging modalities show statistically significant higher mean value of volume in SIS was 591.67±271.05 comparing to 3D TVUS was 444.36±219.42, with p-value (p=0.004). CONCLUSION: There is a substantial agreement between 3D TVUS and SIS in evaluating various niche characteristics, encompassing depth, length, width, volume, AMT and RMT. The data strongly supports the advantages of 3D TVUS over SIS for assessing Cesarean scar defects, commonly known as "Niche." These benefits encompass cost-effectiveness, improved time efficiency, enhanced patient tolerability, and heightened patient satisfaction associated with the 3D TVUS procedure.