Role of saline sonohysterography in the evaluation of abnormal uterine bleeding in comparison with transvaginal sonography

Arthi K., Adaikappan M and Lavanyakumari K

Objectives and Backround:     Menstrual dysfunction is a common cause of major discomfort in women of reproductive age. It is the most common gynaecological problem encountered in practice, accounting for 15% of outpatients and 25% of gynaecological surgeries. Both transvaginal sonography and saline infusion sonohysterography plays a vital role in the evaluation of the causes of menstrual dysfunction. The main aim of the study is to know the accuracy and detective ability of intrauterine pathology by saline Infusion sonohysterography in cases of abnormal uterine bleeding.
Materials and Methods: A Hospital Based Prospective Cohort Study was conducted on 50 patients in the reproductive and perimenopausal age group with complaints of abnormal uterine bleeding. Specific history was taken to rule out the systemic disorders responsible for abnormal uterine bleeding. After taking an informed consent, these patients were advised to undergo Transvaginal sonography and Saline sonohysterography.
Results: The age group of the patients in this study was 22-55years.Maximum number of patients had complaints for a duration of 4-6 months (36%). Menorrhagia (70%) was the most common complaint of the patients. In the present study there was statistically significant association between the detection of endometrial polyp and the diagnostic method used either SIS or TVS [Chi-square value-6.383 and P value=0.012]. SIS detected seven endometrial polyp cases whereas TVS detected none. Therefore it was concluded that SIS was superior to TVS in detection of endometrial polyps. Also the diagnostic efficacy of both the tests were compared using paired “t “test     showed significant difference between TVS and SIS[t-value-2.824 and P-value=0.007]. From the mean value observed it was concluded that SIS[mean=0.52060] is more effective method than TVS[mean=0.44309]in detecting intrauterine pathologies. The overall sensitivity of the saline infusion sonohysterography was 92.5%, specificity was 100%, the negative predictive value was 76.9%, the positive predictive value was 100% and the accuracy rate was 94%.
Conclusion: In the evaluation of menstrual dysfunction by saline infusion sonohysterography, saline outlines the uterine cavity and appears to be very sensitive in detecting submucous fibroid and endometrial polyps which are missed on using transvaginal ultrasound. In conclusion saline infusion sonohysterography when combined with transvaginal sonography is more sensitive, accurate, cost-effective, acceptable and simple method in the evaluation of the causes of AUB.


Download PDF: