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Screening Tools for Recurrent Pregnancy Loss
Title: Sonohysterography for screening in recurrent pregnancy loss
Author:M.Keltz et al..
Address:New Haven, Conneticuts
Source: Fertility and Sterility 67:4 641-643 (April)
Synopsis:Up to 15 to 27% of couples experiencing recurrent pregnancy loss have an etiologic factor of a uterine abnormality. Thirtyfour women experiencing two consecutive pregnancy losses were examined using sonohysterography. 50% of these women demonstrated intrauterine abnormalities. 100% of these abnormalities were confirmed at surgery. Traditionally, hysterosalpingography has been used to screen for anatomic abnormalities in recurrent pregnancy loss. But , then laparoscopy has been necessary to differentiate a bicornuate from a septate uterus. Sonohysterography is an attractive alternative to hysterosalpingography, is highly sensitive and specific in identifying uterine abnormalities.
Comment: SonoHSG appears safe, easy, relatively inexpensive and is sometimes particularily useful for a variety of gynecologic and fertility indications. Probably all gynecologic offices with ultrasound capability and infertility centers should have this technology available. It especially useful when traditional scans suggest a endometrial abnormality such a polyp or fibroid. It is reassuring when the uterine cavity is smooth; perhaps surgery can be avoided in some cases. While tubal patency is suggested by accumulation of fluid in the pelvis, it seems the diagnostic value of Sono HSG, in assessing tubal status, to be less than that of the endometrial cavity. With development of new contrast agents, such as micronized albumin, the usefulness of the technique should increase. I would be pleased to discuss the procedure if anyone desires.

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