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

Figures & data

Figure 1 2D SHG image in a sagittal section of the uterus showing the triangular cesarean scar niche.

Figure 2 2D SHG image in a sagittal section of the uterus showing the triangular cesarean scar niche.

Table 1 Demographic Data of the Women Included in the Study

	Mean	Standard Deviation	Minimum	Maximum
Age	28.23	4.97	20.00	40.00
BMI	23.94	2.99	18.00	30.00

Table 2 Degree of Agreement Between 2D SHG and 3D SHG in Detection of Niche BW

Mean, SD, Minimum and Maximum of Niche Base Width by 2DSHG and 3DSHG
	Mean	Standard Deviation	Minimum	Maximum
Niche width by 2DSHG	1.89	0.24	1.30	5.40
Niche width by 3DSHG	2.32	0.27	1.20	5.80
95% Confidence Interval, Intraclass Coefficient and Cronbach’s Alpha for Niche Base Width
	value	95% Confidence Interval
		Lower Bound	Upper Bound	P value
Intraclass Correlation coefficient (ICC)	0.826	0.756	0.877	<0.001
Cronbach’s Alpha	0.905	0.861	0.935	<0.001

Note: <0.001 is statistically significant Results show a high degree of agreement.

Table 3 Degree of Agreement Between 2DSHG and 3D SHG in Detection of Niche Depth

Mean, SD, Minimum and Maximum of Niche Depth by 2DSHG and 3DSHG
	Mean	Standard Deviation	Minimum			Maximum
Niche Depth by 2DSHG	1.90	0.44	1.10			8.90
Niche Depth by 3DSHG	2.26	0.45	1.50			9.40
95 % confidence interval, Intraclass coefficient and Cronbach’s Alpha for niche depth
	Value	95% Confidence Interval
		Lower Bound		Upper Bound	P value
Intraclass Correlation coefficient (ICC)	0.971	0.958		0.980	<0.001
Cronbach’s Alpha	0.985	0.979		0.990	<0.001

Note: <0.001 is statistically significant Results show a high degree of agreement.

Table 4 Degree of Agreement Between 2D SHG and 3D SHG in Detection of RMT

Mean, SD, Minimum and Maximum of RMT by 2DSHG and 3DSHG
	Mean	Standard Deviation	Minimum			Maximum
RMT by 2D	7.24	1.09	4.80			9.20
RMT by 3D	7.97	1.13	5.10			9.30
95% Confidence Interval, Intraclass Coefficient and Cronbach’s Alpha for RMT
	Value	95% Confidence Interval
		Lower Bound		Upper Bound	P value
Intraclass Correlation coefficient (ICC)	0.423	0.256		0.565	<0.001
Cronbach’s Alpha	0.594	0.408		0.722	<0.001

Note: <0.001 is statistically significant Results show a moderate agreement.

Figure 3 2DSHG image in a sagittal section of the uterus showing the cesarean scar niche depth.

Table 5 Degree of Agreement Between 2D SHG and 3D SHG in Measurement of Niche Width

Mean, SD, Minimum and Maximum of RMT by 2DSHG and 3DSHG
	Mean		Standard Deviation		Minimum		Maximum		P value
Niche width by 3D SHG	8.22		1.42		5.20		12.80		<0.001
Niche width by 2D	5.75		1.08		3.00		9.00
95% Confidence Interval, Intraclass Coefficient and Cronbach’s Alpha for Niche Depth
		value		95% Confidence Interval
				Lower Bound		Upper Bound		P value
Intraclass Correlation coefficient (ICC)		0.251		−0.057-		0.603		<0.001
Cronbach’s Alpha		0.402		−0.122-		0.752		<0.001

Note: <0.001 is statistically significant Results shows a mild degree of agreement.

Figure 4 2D SHG image in a sagittal section of the uterus showing the cesarean scar niche BW.

Figure 5 (Aand B) demonstrate 3D SHG rendering image of the uterus showing the cesarean scar niche width in the coronal cut of the 3D volume, Figure 5 C shows 3D SHG with HD live rendering demonstrating the niche width .

Figure 6 3D SHG image of the uterus showing the cesarean scar niche depth.

Figure 7 3D SHG image of the uterus showing the cesarean scar niche BW.

Figure 8 2D SHG image of a sagittal section of the uterus showing the RMT.

Figure 9 3D SHG image in the sagittal cut that demonstrates the RMT with adhesions in front of the niche.

Figure 10 2D SHG image showing a sagittal section in 3rd degree RVF uterus with a markedly defective cesarean scar niche.

Figure 11 3D SHG image in the sagittal cut that demonstrates RMT/Depth ratio (less than 1) with a thin RMT with adhesions in front of the niche.