Comparison between hysteroscopy and 3D Ultrasound for assessment of uterine cavity in patient with recurrent pregnancy loss

Ibrahim, Aya S.; El-Mashad, Ashraf I.; Elsaid, Mostafa A.; Edris, Yehia S.

doi:10.21608/bmfj.2025.386424.2421

Comparison between hysteroscopy and 3D Ultrasound for assessment of uterine cavity in patient with recurrent pregnancy loss

Document Type : Original Article

Authors

¹ Resident physician at Toukh Central Hospital

² Professor of obstetrics and gynecology Faculty of medicine- Benha University

³ Professor of Obstetrics and Gynecology Faculty of Medicine - Benha University

10.21608/bmfj.2025.386424.2421

Abstract

Background: Recurrent pregnancy loss affects 1–3 out of every 100 couples and has multifactorial etiology like uterine abnormalities, thrombophilia, and immune factors but often is unexplained. Uterine abnormalities are common in RPL and can cause implantation and placental growth problems but have a very good prognosis after surgical treatment. Diagnostic modalities like 3D transvaginal ultrasound are more accurate than 2D US in evaluating uterine abnormalities. Aim: The primary objective was to assess the diagnostic accuracy of hysteroscopy and 3D US in detecting uterine cavity abnormalities, specifically partial septate uterus, in cases with RPL. Patients and methods: This prospective investigation at Benha University Hospital comprised 36 cases of RPL with partial septate uterus, divided based on the uterine indentation angle. All underwent clinical examination, laboratory investigations, and imaging with 2D and 3D transvaginal US. Diagnostic hysteroscopy, being the gold standard, was noted to be beneficial for detecting subtle uterine anomalies that were missed by the other methods. Results: there was a significant agreement was observed between 3D US and hysteroscopy outcomes (Kappa = 0.833, p < 0.001). Hysteroscopy showed high accuracy in predicting outcomes consistent with 3D US, with an AUC of 0.917, sensitivity of 88.9%, and specificity of 94.4%. Conclusion: Hysteroscopy is a highly accurate and reliable tool for diagnosing partial septate uterus in RPL, with excellent concordance with 3D US. It was found to be exquisitely sensitive and specific, as good as advanced imaging. Hysteroscopy is especially useful in low-resource settings both as a diagnostic and therapeutic tool.

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