Three-dimensional Ultrasound versus Hysteroscopy in Diagnosis of Cesarean Scar Defect

Article information Background: As there is increase in cesarean section mode of delivery, growing concerns related to its negative consequences are raised and reliable diagnostic tools are of crucial importance in order to diagnose caesarean scar defect. Aim of the work: The aim of this study was to compare the efficacy of 3D ultrasound versus Hysteroscopy in diagnosis of caesarean scar defect. Patients and Methods: Three hundred cases of female patients 6-12 months after undergoing cesarean section were recruited and assessed for eligibility at the outpatient Gynecology Clinic in Al-Azhar University Hospital [Damietta]. The study cases were examined using 3D trans-vaginal ultrasound for detecting the presence of caesarean scar defect [niche] and assessing its site, depth, shape and volume and measuring the residual myometrium. Diagnostic hysteroscopy was carried out to all patients under anesthesia and compared blindly to the ultrasound findings. Results: The mean scar thickness of the study group by trans-vaginal ultrasound was 1.94±0.89 with range 0.65-3.2 cm. There was significant difference between using the trans-vaginal ultrasound and hysteroscopy regarding detecting scar ballooning, it was detected in 74 cases [24.7%] using trans-vaginal ultrasound in compare with 38 cases [12.7%] diagnosed by hysteroscopy [P<0.001]. There was no significant difference between using the trans-vaginal ultrasound and hysteroscopy regarding detecting the site of the scar [P=0.52], the continuity of scar [P= 0.24] and the vascularity of scar [P=0.33]. Conclusion: Ultrasound is of greater value in evaluating scar thickness and detecting scar defect originated after cesarean section than hysteroscopy.