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 sonohysterographic 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. (C) 1997 by American Society for Reproductive Medicine.