采用二维子宫超声造影与三维子宫超声造影对接受卵胞浆内单精子注射的继发性不孕女性剖宫产瘢痕憩室进行评估并制定标准；阿拉尔菲超声瘢痕评估简易规则以预防女性健康问题。
Evaluation of the Cesarean Scar Niche In Women With Secondary Infertility Undergoing ICSI Using 2D Sonohysterography Versus 3D Sonohysterography and Setting a Standard Criteria; Alalfy Simple Rules for Scar Assessment by Ultrasound To Prevent Health Problems for Women.
作者信息
Alalfy Mahmoud, Osman Omneya M, Salama Sameh, Lasheen Yossra, Soliman Mahmoud, Fikry Mohamed, Ramadan Mohamed, Alaa Doaaa, Elshemy Shaimaa, Abdella Rana
机构信息
Reproductive Health and Family Planning Department, National Research Centre, Dokki, Cairo, Egypt.
Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt.
出版信息
Int J Womens Health. 2020 Nov 3;12:965-974. doi: 10.2147/IJWH.S267691. eCollection 2020.
BACKGROUND
Many expressions were used to define the defect that is seen by ultrasound after cesarean section (CS) namely scar defect, niche, isthmocele, uterine pouch or diverticula.
OBJECTIVE
To compare the accuracy of 2 dimensional sonohysterography (2D SHG) to 3 dimensional sonohysterography (3D SHG) in evaluating cesarean section uterine scar depth (D), base width (BW), width (W) and residual myometrial thickness (RMT) in women with secondary infertility and establishment of a standard criteria; Alalfy simple rules for scar assessment.
PATIENTS AND METHODS
This was an observational cross-sectional comparative study that was conducted on women who presented with secondary infertility and were candidates for intracytoplasmic sperm injection (ICSI) and giving a history of a previous cesarean section. Assessment of uterine scar in each woman was performed using 2D transvaginal ultrasound with sonohysterography (SHG) followed by 3D transvaginal with SHG with evaluation of niche depth, width, RMT, niche BW and RMT/depth ratio. The study was conducted at Algezeera hospital, Egypt.
RESULTS
The present study revealed that 3D ultrasound with SHG is superior in evaluation of the RMT and niche width prior to ICSI providing better characterization of the scar niche.
CONCLUSION
Scar niche should be assessed by a combined integrated 2D SHG and 3D SHG scan with the specific geometrical and anatomical considerations, Alalfy simple rules for scar niche assessment that involvemeasurement of niche depth, (Base width) BW, width, RMT and RMT/depth ratio in sagittal plane, RMT in coronal plane / niche width in coronal plane ratio (ratio less than 1 denotes scar weakness with more liability for dehiscence).
TRIAL REGISTRATION
Clinical Trials.gov Id NCT04076904.
背景
剖宫产术后超声所见的缺陷有多种表述，即瘢痕缺损、憩室、峡部缺损、子宫袋或憩室。
目的
比较二维子宫输卵管超声造影（2D SHG）与三维子宫输卵管超声造影（3D SHG）在评估继发不孕女性剖宫产子宫瘢痕深度（D）、底部宽度（BW）、宽度（W）和残余肌层厚度（RMT）方面的准确性，并建立标准评估标准；即阿拉菲瘢痕评估简易规则。
患者与方法
这是一项观察性横断面比较研究，研究对象为继发不孕且拟行卵胞浆内单精子注射（ICSI）并曾有剖宫产史的女性。对每位女性进行子宫瘢痕评估时，先采用二维经阴道超声联合子宫输卵管超声造影（SHG），随后采用三维经阴道超声联合SHG，评估憩室深度、宽度、RMT、憩室BW及RMT/深度比值。该研究在埃及的盖泽拉医院开展。
结果
本研究表明，三维超声联合SHG在ICSI前评估RMT和憩室宽度方面更具优势，能更好地对瘢痕憩室进行特征描述。
结论
应结合二维SHG和三维SHG扫描，并考虑特定的几何和解剖因素来评估瘢痕憩室，即阿拉菲瘢痕憩室评估简易规则，包括在矢状面测量憩室深度、（底部宽度）BW、宽度、RMT以及RMT/深度比值，在冠状面测量RMT/冠状面憩室宽度比值（该比值小于1表示瘢痕薄弱，裂开风险更高）。
试验注册号
ClinicalTrials.gov标识符NCT04076904。
Zotero 插件