[Diagnosis of uterine synechiae in patients with recurrent miscarriages: contribution of transvaginal hysterosonography].
BACKGROUND
The aim of this study was to determine the prevalence of uterine synechiae in patients with recurrent miscarriages and to evaluate the diagnostic accuracy of transvaginal ultrasound and of hysterosonography.


METHODS
Sixty non-pregnant patients with a history of at least three previous consecutive miscarriages were evaluated by transvaginal ultrasound, hysterosonography and hysteroscopy to detect uterine synechiae. Hysteroscopy was considered the gold standard. Agreement of findings disclosed by transvaginal ultrasound and by the hysterosonography were evaluated according to the Kappa coefficient and their significance was tested. Significance was established at < 0. 05 (Alpha error = 5%). Sensitivity, specificity, positive and negative predictive values were determined for each method.


RESULTS
Uterine synechiae were identified in 16 patients (26.7%). The accuracy of the transvaginal ultrasound and of the hysterosonography was 78.9% and 92.7%, respectively. When compared to the transvaginal ultrasound, hysterosonography had a much greater sensitivity (78. % vs. 20.0%) and a higher degree of agreement with hysteroscopy (Kappa = 80% vs. Kappa = 27%).


CONCLUSIONS
For diagnosis of uterine synechiae, hysterosonography had a higher level of agreement with hysteroscopy than the transvaginal ultrasound. In patients with recurrent miscarriages transvaginal ultrasound is not recommended for the investigation of uterine synechiae because of its low sensitivity. Hysterosonography, on the other hand, seems to offer an important contribution especially because it is a simple, low-cost and accurate method for diagnosis of uterine synechiae.
Guimarães Filho
Hélio Antonio
HA
Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da USP. helioagf@uol.com.br
Mattar
Rosiane
R
Araujo Júnior
Edward
E
Pires
Cláudio Rodrigues
CR
Moron
Antonio Fernandes
AF
D000026:Abortion, Habitual / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000191:economics / Q000379:methods* / Q000592:standards; D011237:Predictive Value of Tests; D015995:Prevalence; D012008:Recurrence; D000267:Tissue Adhesions / Q000000981:diagnostic imaging / Q000453:epidemiology; D014463:Ultrasonography / Q000191:economics / Q000379:methods* / Q000592:standards; D014591:Uterine Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014621:Vagina