Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal, QC.
Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Obstet Gynaecol Can. 2021 Aug;43(8):978-983. doi: 10.1016/j.jogc.2021.05.007. Epub 2021 May 25.
To determine feasibility and accuracy of post-hysteroscopic transvaginal ultrasonography (TVUS) measurement of pelvic fluid accumulation as a screening method for tubal patency (TP).
We conducted a retrospective cohort study of 85 patients who underwent uterine cavity assessment by office hysteroscopy at our university-affiliated fertility centre from November 2019 to October 2020. During the study period, two-dimensional (2D) TVUS was performed pre- and post-hysteroscopy to evaluate TP. Patient records were reviewed for demographics, diagnosis, and prior/subsequent TP testing. Predictive values for TP were calculated.
Pelvic fluid accumulation post-hysteroscopy was found in 65.9% of patients (56). Accumulation of fluid was seen with the use of as little as 10-50 mL of saline. Using more fluid did not increase the likelihood of demonstrating TP (P = 0.17). A trend towards more false-negative results for TP was observed when less fluid was used (7.7% with 10-50 mL vs. 3.8% with 60-190 mL and 1.3% with 200-760 mL; P = 0.10). The positive predictive value (PPV) of TVUS post-hysteroscopy in comparison to known patency/occlusion was 100%; negative predictive value (NPV) was 33%; sensitivity was 82.8%; and specificity was 100%. Similar values were seen in a second analysis that included patients with highly suspected patent or occluded tubes (n = 60); presumed predictive values were: PPV 100%, NPV 42%, sensitivity 78.8%, and specificity 100%. The use of more fluid did not increase pain (P = 0.75). This finding remains after accounting for confounders (e.g., pre-medication, endometrial biopsy).
TVUS pre- and post-hysteroscopy is feasible in an outpatient setting, and can serve as a reliable screening tool for TP. When hysteroscopy is performed and TP is not known, TVUS can be added for screening, potentially omitting the need for more invasive examinations. With limited non-urgent ambulatory services, it is of upmost importance to maximize information from a single procedure.
确定宫腔镜检查后经阴道超声（TVUS）测量盆腔积液作为输卵管通畅性（TP）筛查方法的可行性和准确性。
我们对 2019 年 11 月至 2020 年 10 月在我们大学附属生育中心接受门诊宫腔镜检查的 85 名患者进行了回顾性队列研究。在研究期间，对所有患者进行二维（2D）TVUS 检查以评估 TP。回顾患者记录，包括人口统计学、诊断和既往/后续 TP 检查。计算 TP 的预测值。
宫腔镜检查后发现 65.9%（56 例）的患者有盆腔积液。仅使用 10-50mL 生理盐水即可观察到积液。使用更多的液体并不能增加显示 TP 的可能性（P=0.17）。当使用较少的液体时，TP 的假阴性结果的趋势更明显（7.7%（10-50mL）vs. 3.8%（60-190mL）和 1.3%（200-760mL）；P=0.10）。与已知通畅/阻塞相比，宫腔镜检查后 TVUS 的阳性预测值（PPV）为 100%；阴性预测值（NPV）为 33%；敏感性为 82.8%；特异性为 100%。在纳入高度怀疑通畅或阻塞的患者（n=60）的二次分析中，也观察到了相似的结果；假定预测值为：PPV 100%，NPV 42%，敏感性 78.8%，特异性 100%。使用更多的液体并不会增加疼痛（P=0.75）。这一发现即使在考虑了混杂因素（例如，术前用药、子宫内膜活检）后仍然存在。
门诊宫腔镜检查后经阴道超声检查是可行的，可作为 TP 的可靠筛查工具。当进行宫腔镜检查且 TP 未知时，可添加 TVUS 进行筛查，从而可能避免更具侵入性的检查。在有限的非紧急门诊服务中，从单一程序中获取最多信息至关重要。
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