Objectives: To compare the accuracy of hydrosonography and hysterosalpingography in diagnosis of niche and to evaluate the correlation between niche and sub-infertility. Study Design: A prospective observational cross-sectional comparative study Patients and Methods: The study was carried out on 50 women underwent at least one caesarean section with unexplained secondary infertility presented at the outpatient obstetric clinic at Fayoum university hospital. Assessment of uterine scar in each woman was performed using 2D transvaginal with Saline Infusion hydrosonography (SHG) followed by hysterosalpingography.
Results:The prevalence of niche among our studied women was (62%, 31 cases) as diagnosed by Hydrosonography, while by Hysterosalpingography, the prevalence was (56%, 28 cases). Hydrosonography and hysterosalpingography showed strong substantial agreement regarding niche with kappa (κ) 0.712. Using hysterosalpingography can diagnose post-CS niche as compared with hydrosonography with 83.9% sensitivity 89.5% specificity, 92.9% PPV, 77.3% NPP and 86% accuracy. Conclusions: We detected a strong substantial agreement between hydrosonography and hysterosalpingography in diagnosis of niche.
Objectives:To study the incidence of associated anomalies and assess the possibility of spontaneous resolution according to the longitudinal bladder diameter (LBD) in fetuses with megacystis. Methods: This is a retrospective study of prospectively collected data in fetuses diagnosed to have megacystis in the first trimester in a tertiary referral centre in South India. 84 fetuses with megacystis were assessed for presence of associated anomalies, rate of spontaneous resolution and immediate postnatal outcome during the study period from January 2007 till December 2021. All scans were performed by FMF certified operators and data was maintained on Astraia database software. Results: Of the 84 fetuses, 15 (17.8%) fetuses were part of a multiple pregnancy. 34 (40.5%) had a longitudinal bladder diameter (LBD) between 7-15 mm (G1) and 50 (59.5%) had an LBD of equal or more than 16 mm (G2). 2/34 (5.9%) and 3/50 (6%) in G1 and G2 respectively had an aneuploidy and hence terminated. 13/34 (38.2%) and 14/50 (28%) in G1 and G2 respectively had associated anomalies, mainly affecting the skeletal system and cardia. Of the 11 continuing pregnancies, 8 (72.8%) and none in G1 and G2 respectively showed spontaneous resolution before 20 weeks. Conclusions: Megacystis is an easily identifiable anomaly in the first trimester. There is nearly 6% incidence of aneuploidies, irrespective of the LBD. In our study, the incidence of spontaneous resolution in the 7-15 mm group was over 70%. However, none in the more than 16 mm group resolved spontaneously. All fetuses with diagnosis of 1st trimester megacystis must be categorised according to the LBD and offered karyotyping. In the isolated group, when LBD is less than 15 mm, the prognosis appears to be favourable in most fetuses.
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