Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Hayat Fertility and Women's Health Center, Maadi, Cairo, Egypt.
J Minim Invasive Gynecol. 2012 Jul-Aug;19(4):503-8. doi: 10.1016/j.jmig.2012.03.021.
To estimate the degree of agreement between 3-dimensional sonohysterography (3D-SHG) and vaginoscopic hysteroscopy (VH) in detection of uterine cavity abnormalities in patients with recurrent implantation failure in in vitro fertilization cycles.
Comparative observational cross-sectional study (Canadian Task Force classification II-1).
Private assisted-conception unit.
One hundred forty-three patients with a history of at least 2 previous implantation failures despite transfer of good quality embryos in assisted-conception cycles.
3D-SHG was followed by VH. The Cohen κ for interrater agreement was calculated for the level of agreement between the 2 diagnostic procedures. Procedure time in seconds was recorded for both procedures. Patients were asked to rate their degree of discomfort or pain during both procedures using a visual analog scale.
There was a substantial degree of concordance between 3D-SHG and VH (κ = 0.77; 95% confidence interval, 0.6-0.84). The median procedure time for 3D-SHG was 296 seconds (range, 231-327 seconds), and for VH was 315 seconds (range, 232-361 seconds), and the difference was statistically significant (p =.02). The visual analog scale pain scores also showed that 3D-SHG, with a median pain score of 2.1 (range, 1-3) was better tolerated than VH, with a median pain score of 2.9 (range, 2-4) (p < .001).
Our results show that there is a substantial degree of concordance between 3D-SHG and VH in diagnosing uterine cavity anomalies. We also found that 3D-SHG took significantly less time and induced less patient discomfort than did VH. We recommend that 3D-SHG should be the method of first choice for outpatient evaluation of the uterine cavity.
评估三维超声子宫造影（3D-SHG）与阴道镜宫腔镜检查（VH）在体外受精周期中反复种植失败患者宫腔异常检测中的一致性程度。
比较观察性横断面研究（加拿大任务组分类 II-1）。
私人辅助受孕单位。
143 例至少有 2 次既往种植失败史的患者，尽管在辅助受孕周期中移植了优质胚胎。
3D-SHG 后行 VH。计算两种诊断方法之间一致性的 Cohen κ 进行评估。记录两种方法的程序时间（以秒为单位）。患者在两种检查过程中，使用视觉模拟评分法（VAS）对其舒适度或疼痛程度进行评分。
3D-SHG 与 VH 之间存在高度一致性（κ=0.77；95%置信区间，0.6-0.84）。3D-SHG 的中位检查时间为 296 秒（范围，231-327 秒），VH 为 315 秒（范围，232-361 秒），差异有统计学意义（p=.02）。VAS 疼痛评分也显示，3D-SHG 的中位疼痛评分为 2.1（范围，1-3），比 VH 的中位疼痛评分 2.9（范围，2-4）更易耐受（p<0.001）。
我们的结果表明，3D-SHG 与 VH 在诊断宫腔异常方面具有高度一致性。我们还发现，3D-SHG 检查时间明显短于 VH，且引起的患者不适感低于 VH。我们建议 3D-SHG 应该作为宫腔评估的首选门诊检查方法。
