The informative value of ultrasound examination of patients with intrauterine adhesions


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Abstract

Objective: To improve intrauterine adhesions (IUA) diagnosis accuracy and integrate three-dimensional echography into the algorithm for examining patients with IUA. Materials and methods: The study comprised 79 patients with suspected IUA. We analyzed various functions and modes of three-dimensional echography, including multiplanar reconstruction mode, Vocal, OmniView mode, frontal section (using HI, SRI CRI functions or Render Mode automatic versions, surface scanning mode with a combination of minimum/maximum intensity), ultrasound tomography mode. The examination was performed on the Canon Aplio 500 ultrasound system to assess the degree of obliteration and septal architectonics. The role of three-dimensional hydrohysteroscopy in navigation during endoscopic adhesiolysis was determined. Results: Echographic criteria for assessing uterine cavity obliteration by three-dimensional echography were developed. Echographic features of the three-dimensional uterine model, including "muscular invagination" (frontal section, OmniView mode, ultrasound imaging), hourglass and discontinuous M-echo character (frontal section, OmniView mode), allowed for a detailed evaluation of uterine cavity obliteration, its architectonics, and determine the intraoperative strategy for IUA destruction. Conclusion: The developed three-dimensional criteria enabled developing a unified strategy to guide pre-surgical planning, reduce the risk of intraoperative complications and disease recurrence. To reduce the risk of uterine perforation and surgical trauma in patients with IUA, it was suggested to form a surgical team consisting of an endoscopy specialist and a diagnostic medical sonographer.

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About the authors

Irina A. Esipova

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia

Email: esipova.ira@inbox.ru
PhD, Associate Professor at the Department of Obstetrics and Gynecology, Faculty of Pediatrics 119415, Russia, Moscow, Lobachevskogo str., 42

Irina A. Krasnova

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia

Email: krasnovairina@mailru
Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology, Faculty of Pediatrics 119415, Russia, Moscow, Lobachevskogo str., 42

Valentina G. Breusenko

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia

Email: breusenkovg@yandexru
Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology, Faculty of Pediatrics 119415, Russia, Moscow, Lobachevskogo str., 42

Viktoria B. Aksenova

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia

Email: viktoriya-aksenova@yandexru
PhD, Department of Obstetrics and Gynecology, Faculty of Pediatrics 117997, Russia, Moscow, Ostrovytianova str., 1

Elena G. Timofeeva

N.I. Pirogov Russian National Research Medical University Ministry of Health of Russia

Email: sonadormonroe@gmail.com
PhD. student at the Department of Obstetrics and Gynecology, Faculty of Pediatrics 119415, Russia, Moscow, Lobachevskogo str., 42

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