https://orcid.org/0000-0002-8429-6376
Abstract
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.
Abbreviations
CS, cesarean section; SHG, Sonohysterography; RMT, Residual myometrial thickness; D, Depth; W, Width; BW, Base width; ICSI, Intracytoplasmic sperm injection; 2D SHG, 2 dimensional sonohysterography; 3D SHG, 3 dimensional sonohsterography.
Data Availability
The study was registered in clinicaltrials. gov with identification Clinical trials. gov ID: NCT04076904.
The data that support the results reported in the manuscript are present but will not be shared because it has no additive information to the research but we are ready to reveal it when necessary.
Data Sharing Statement
The authors do not intend to share individual identified participant data.
There are no other study-related documents will be made available
Corresponding author Mahmoud Alalfy, Orcid ID: 0000-0002-8429-6376
Acknowledgment
We would like to thank all staff members who helped us in completing this research.
Author Contributions
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Disclosure
All authors declare that they have no financial or personal relationships with other people or organizations that could inappropriately influence (bias) this work.