Evaluation of the Diagnostic Role of Hysterosalpingography in Cesarean Scar Niche Diagnosed by Hysteroscopy

Document Type : Original Article

Authors

1 Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University

2 Master degree, Resident of Obstetrics and Gynecology Faculty of Medicine, Ain Shams University

3 Professor of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University

Abstract

Background: term CS niche (defect) describes the presence of hypoechoic area within the myometrium in the isthmus (lower uterine segment) with discontinuation of myometrium at the site of previous CS. Cesarean sections have increased worldwide and there is an increasing awareness of the adverse long-term sequelae associated with the procedure. The World Health Organization estimates that there are approximately 18.5 million women who undergo this procedure annually, with rates in the Western world increasing from 14.5% to 27.2% between the years 2000 and 2017.   
Aim of the Work: To evaluate diagnostic role of hysterosalpingography (HSG) in cesarean scar niche at Early Cancer Detection and Gynecological Endoscopy Unit at Ain Shams Maternity Hospital within 6 months.  
Patients and Methods: 
Type of Study: Diagnostic Accuracy Test. 
Study Setting: Early Cancer Detection and Gynecological Endoscopy Unit at Ain Shams Maternity Hospital. 
Study Period: 6 Months from the first of March 2022 to the end of August 2022.   
Study Population: All women undergoing Office Hysteroscopy at Early cancer Detection and Gynecological Endoscopy Unit at Ain Shams Maternity Hospital was checked to meet the inclusion criteria for the study.
Results: There was not statistically significant between according to number of C.S. delivery. HSG test has low sensitivity (16%) but high PPV (100%) for detecting this condition, while the hysteroscopy has higher sensitivity (100%) but an undefined specificity and PPV since there are no true negatives. The NPV is 0% for both tests since there are no true negatives. The study results cannot provide recommendation regarding routine Hysterosalpingography examinations of CS scar defect. Women should avoid CS without medical indications and multiple abortions with uterine curettage. Nevertheless, more prospective high-quality studies are needed to establish the clinical significance of the CS scar niche and to define guidelines for the possible prevention of the CS scar niche in a subsequent pregnancy.
Conclusion: no sufficient evidence to recommend HSG as a first-line diagnostic tool for the cesarean scar niche. However, in healthcare settings without ready access to hysteroscopy, HSG may serve as an acceptable alternative as it is well-tolerated, cost-effective, less invasive, and doesn’t require special training rather than hysteroscopy, but hysteroscopy is still the valuable gold standard for detecting high-probability patients, even asymptomatic.

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