Sonohysterography for screening in recurrent pregnancy loss

Objective: To evaluate the role of sonohysterography for screening of the uterine cavity in patients with recurrent pregnancy loss. Design: Prospective evaluation of sonohysterography, including comparison with available hysterosalpingography and hysteroscopy. Setting: University referral center. Patient(s): Thirty-four reproductive-aged women with at least two consecutive pregnancy losses. Intervention(s): Sonohysterography was performed on all patients, using saline instilled through an endocervically placed balloon catheter with concurrent vaginal sonography. Result(s): Seventeen of 34 sonohysterograms (50.0%) demonstrated intrauterine abnormalities. Eighteen of 34 cases have undergone hysteroscopy or, in 1 case, laparoscopy. All confirmed the positive or negative sonohysterography finding, resulting in a sensitivity and specificity of 100%. Additionally, 100% (12/12) of the defects were diagnosed accurately at sonohysterography when confirmed by surgery. Twenty-seven of 34 patients also had a hysterosalpingogram that demonstrated a 90.0% sensitivity and 20.0% specificity based on hysteroscopic findings, yet only 5 of 11 (45.5%) defects were diagnosed accurately at hysterosalpingography when compared with surgery. Conclusion(s): Sonohysterography is a highly sensitive, specific, and accurate screening tool for the evaluation of uterine cavitary defects associated with recurrent pregnancy loss and offers several advantages over hysterosalpingography.