Rasheedy Radwa, Sammour Hazem, Elkholy Abdellatif, Fadel Ebtesam
Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Obstetrics and Gynecology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Gynecol Obstet Hum Reprod. 2019 Dec;48(10):827-831. doi: 10.1016/j.jogoh.2019.05.013. Epub 2019 May 8.
to assess the agreement between saline contrast sonohysterography (SCSH) and transvaginal sonography (TVS) in the evaluation of cesarean section scar defect (CSD) regarding its width, depth, and shape and also in assessing the anterior myometrium, and residual myometrium related to the scar.
a prospective study during the period between August 2017 and January 2018 was conducted in which 102 consecutive participants underwent primary cesarean section in Ain Shams University Maternity Hospital were assessed six weeks after CS to evaluate for CSD presence by using both SCSH and TVS.
CSD could be detected only in 59.8% of women by TVS and 70.5% by SCSH with good agreement strength (Cohen kappa = 0.805). TVS was 84.72% sensitive and 100.00% specific in identifying CSD diagnosed by SCSH. The PPV, NPV, and accuracy of TVS were 100.00%, 73.17%, and 89.21%, respectively. The mean anterior myometrial thickness (AMT) did not differ when assessed by both TVS and SCSH, while the mean niche width was 2.56 ± 1.98 mm with SCSH compared to 2.17 ± 1.63 mm with TVS(r = 0.954), and its mean depth was 2.76 ± 2.02 mm for SCSH and 1.57 ± 1.51 mm in TVS(r = 0.812). The mean residual myometrium was 10.09 ± 2.74 mm in SCSH while was 11.18 ± 2.50 mm for TVS(r = 0.914) CONCLUSION: cesarean scar defects in non-pregnant women are better evaluated at SCSH than at unenhanced TVS as more defects detected by SCSH and better evaluation of its shape, borders and size.
评估生理盐水造影超声子宫输卵管造影（SCSH）和经阴道超声检查（TVS）在评估剖宫产瘢痕缺损（CSD）的宽度、深度和形状方面的一致性，以及评估前壁肌层和与瘢痕相关的残余肌层的情况。
在2017年8月至2018年1月期间进行了一项前瞻性研究，对艾因夏姆斯大学妇产医院102例连续接受初次剖宫产的参与者在剖宫产术后六周进行评估，通过SCSH和TVS评估CSD的存在情况。
TVS仅能在59.8%的女性中检测到CSD，而SCSH为70.5%，一致性强度良好（Cohen卡方值=0.805）。TVS在识别经SCSH诊断的CSD方面敏感性为84.72%，特异性为100.00%。TVS的阳性预测值、阴性预测值和准确性分别为100.00%、73.17%和89.21%。通过TVS和SCSH评估时，前壁肌层平均厚度（AMT）无差异，而SCSH测得的平均切口憩室宽度为2.56±1.98mm，TVS为2.17±1.63mm（r=0.954），SCSH测得的平均深度为2.76±2.02mm，TVS为1.57±1.51mm（r=0.812）。SCSH测得的平均残余肌层为10.09±2.74mm，TVS为11.18±2.50mm（r=0.914）。结论：对于未怀孕女性的剖宫产瘢痕缺损，SCSH比未增强的TVS评估效果更好，因为SCSH能检测到更多缺损，且对其形状、边界和大小的评估更好。
