Measuring uterine cavity volume with sonohysterography: A new objective method.

Introduction: The uterine cavity is a potential space with limited methods for evaluating its volume, limiting the evaluation of interventions' effectiveness in various uterine conditions. This study aims to objectively measure the uterine cavity volume using sonohysterography coupled with a Foley catheter to provide a normative model of age and parity-related uterine cavity volume. Methods: The research included 35 women (group 1) with a total abdominal hysterectomy and 150 women (group 2) who underwent sonohysterography for various gynecologic indications. Saline infusion sonography was administered to all patients. The most common shape obtained after the saline infusion was taken to measure the uterine cavity's dimensions and volume. The uterine cavity volumes, as measured by sonohysterography, and the volumes of saline injected after the hysterectomy were compared. Results: A significant association exists between uterine cavity volumes measured by sonohysterography and true volumes measured immediately after hysterectomy (p = 0.001). The association between uterine cavity volume measured by sonohysterography and using only a Foley catheter balloon was statistically insignificant (p = 0.13). A statistically significant positive association was observed between the uterine cavity volume and the patient's age and parity (p ⩽ 0.05). Conclusion: Measuring the uterine cavity volume using a paediatric Foley catheter balloon coupled with sonohysterography offers an objective approach to measuring a normal (without gross pathologies) uterus volume. This technique would improve the diagnostic accuracy and the management of women with distinct uterine cavity morphologies.

Uterine cavity evaluation after uterine preservation surgeries for morbidly adherent placenta.

Introduction: The morbidly adherent placenta (MAP) is usually associated with maternal morbidity and mortality. The objective of this study was to evaluate the uterine cavity after uterine preservation surgeries for MAP. Material and methods: The study group comprised women ≥ 28 weeks pregnant with confirmed MAP, with a desire for future fertility, and who agreed to uterine preservation surgery for MAP. The uterine preservation surgeries done for MAP include the following: uterine artery ligation, placental-myometrial en bloc excision, and/or internal iliac artery (IIA) ligation. Participants managed by uterine preservation surgeries for MAP were evaluated 3-6 months after the surgeries using office hysteroscopies to evaluate the uterine cavity after uterine preservation surgeries (primary outcome). The secondary outcome measures the pregnancy outcome after uterine preservation surgery. Results: The hysteroscopic examination of the uterine cavity after uterine preservation surgery for MAP showed normal uterine cavity in 36 participants (90%), while it showed abnormal uterine cavity in 4 participants (10%). The abnormal hysteroscopic findings were a single abnormal hysteroscopic finding (endometrial polyp) in 2 participants (5%) and 2 abnormal hysteroscopic findings (incompletely healed scar with unilateral tubal ostial occlusion) in 2 participants (5%). The incidence of pregnancy after uterine preservation surgeries for MAP was 7.5% (3/40). Conclusions: The uterine preservation surgeries for MAP in this study had no effect on menstrual pattern, uterine cavity, or future fertility. The effect of uterine preservation surgeries for MAP on menstrual pattern, uterine cavity, and future fertility should be evaluated in future larger studies.

Hysteroscopic tubal occlusion using iso-amyl-2-cyanoacrylate in patients with hydrosalpinx.

AIM: The aim of this work is to assess the effectiveness of hysteroscopic tubal occlusion using iso-amyl-2-cyanoacrylate, among infertile women with hydrosalpinx prior to in vitro fertilization (IVF). METHODS: Hysteroscopic injection of fallopian tubes with hydrosalpinx by 0.5 mL iso-amyl-2-cyanoacrylate was done in 40 infertile women planning for IVF. The patients were then followed-up after 1 and 3 months, with hysterosalpingography (HSG) to confirm complete tubal occlusion. Reinjection with iso-amyl-2-cyanoacrylate was done in these patients with incomplete tubal occlusion after 1 month of the first injection, followed by HSG 2 months later to confirm complete tubal occlusion. Data were prescribed as range, mean and standard deviation (for parametric variables) and range, number and percentage (for categorical variables). RESULTS: The total number of tubes injected in this study was 54, 42 (77.8%) of which were completely occluded after one injection while 12 (22.2%) were partially occluded. Reinjection of the partially occluded tubes was done, and (HSG) of all patients after 3 months of the primary injection confirmed 48 (88.9%) of the tubes completely occluded while 6 (11.1%) remained partially occluded. Thirty-two (80%) patients underwent one cycle of IVF/ET (embryo transfer), while 8 (20%) patients did not appear for follow-up. Among the patients who underwent IVF/ET, 24 (75%) got pregnant, while 8 (25%) failed to conceive. Among the pregnant patients, 8 (33.3%) delivered at term, 3 (12.5%) had first trimester abortion, while the remaining 13 (54.2%) did not deliver yet. CONCLUSION: Iso-amyl-2-cyanoacrylate used for hysteroscopic tubal occlusion in patients with hydrosalpinx prior to IVF is safe and effective.

Human amnion as a temporary biologic barrier after hysteroscopic lysis of severe intrauterine adhesions: pilot study.

STUDY OBJECTIVE: To estimate the efficacy of fresh and dried amnion graft after hysteroscopic lysis of severe intrauterine adhesions in decreasing its recurrence and encouraging endometrial regeneration. DESIGN: Pilot prospective randomized comparative study (Canadian Task Force classification I). SETTING: Ain Shams Medical School, Cairo, Egypt. PATIENTS: Forty-five patients with severe intrauterine adhesions. Primary symptom was infertility with or without menstrual disorders such as amenorrhea or hypomenorrhea. INTERVENTIONS: Patients were randomized preoperatively using a computer-generated randomization sheet into 3 groups of 15 patients each. Allocation to any group was concealed in an opaque envelope, which was opened at the time of operation. Hysteroscopic lysis of intrauterine adhesions was followed by insertion of an intrauterine balloon only (group 1) or either fresh amnion graft (group 2) or dried amnion graft (group 3) for 2 weeks. Diagnostic hysteroscopy was performed at 2 to 4 months postoperatively. MEASUREMENTS AND MAIN RESULTS: Adhesion grade, menstruation, uterine length, complications, and reproductive outcome were determined. There was significant improvement in adhesion grade with amnion graft vs intrauterine balloon alone (p = .003). Improvement was greater with fresh amnion than with dried amnion (p = .01). Normal menstruation occurred in 4 patients (28.6%) in group 1, 5 (35.7%) in group 2, and 7 (46.7%) in group 3. Of 43 patients, 41 (95.3%) were treated in 2 endoscopic sessions (95.3%), and 2 patients (4.7%) were treated in 3 endoscopic sessions. Uterine perforations occurred in 2 patients (4.7%), and cervical tears in 3 (7.0%). Ten patients (23.3%) achieved pregnancy, 8 (80%) after amnion graft and 2 (20%) without amnion. Six of the 10 patients (60%) miscarried, and 4 (40%) were either still pregnant or delivered at term without complications. CONCLUSION: Hysteroscopic lysis of severe intrauterine adhesions with grafting of either fresh or dried amnion is a promising adjunctive procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration.

Amnion graft following hysteroscopic lysis of intrauterine adhesions.

AIM: To evaluate the safety and efficacy of amnion grafting after hysteroscopic lysis of intrauterine adhesions. METHODS: In a pilot study involving 25 patients with moderate or severe intrauterine adhesions, hysteroscopic adhesiolysis was followed by intrauterine application of a fresh amnion graft over an inflated balloon of a Foley's catheter for 2 weeks. Follow-up hysteroscopy was performed after 4 months. Outcome measures included recurrence of adhesions, achievement of normal menstrual flow, and improvement in the uterine length. RESULTS: Moderate (group A) and severe (group B) adhesions were found in 12 and 13 subjects, respectively. Uterine perforation occurred in two patients in group B, one treated conservatively and the other via laparoscopy. No clinical evidence of infection was observed, and spontaneous expulsion of the balloon occurred within days in three patients, with easy removal after 2 weeks in the rest of the subjects. Significant improvement in uterine length was found in both groups. Despite improvement, failure to achieve normal menstrual flow was found in 16.7% in group A versus 23.1% in group B. Follow-up hysteroscopy revealed adhesion reformation in 48%, all belonging to group B, all with minimal adhesions. Moderate adhesions were found in only two subjects with previous tuberculous endometritis. CONCLUSION: Hysteroscopic lysis of intrauterine adhesions with amnion grafting seems to be a promising procedure for decreasing recurrence of adhesions and encouraging endometrial regeneration. Randomized comparative studies are needed to validate its benefits, including reproductive outcome.