Sonohysterography: A Formidable Diagnostic Tool in the Evaluation of the Caesarean Scar Defect in Comparison to MRI

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Introduction: The use of the caesarean section (C-section) in obstetric care has exponentially increased in the past few decades. The caesarean scar defect (CSD) is a potential complication of C-section and is associated with a wide range of problems. The purpose of this study was to compare the evaluation of the CSD in non-pregnant women by sonohysterography (SHG) and MRI. Methods: This study was performed in patients having undergone a single C-section more than 6 months prior, presenting with abnormal uterine bleeding, dysmenorrhoea, or pelvic pain. Since ultrasonography and pelvic examination were inconclusive, these patients underwent MRI followed by saline infusion SHG. Measurements and characteristics of the ‘niche’ were acquired from both MRI and SHG and compared for analysis. Results: Patients with a single C-section presenting with prolonged bleeding, spotting, and dysmenorrhoea were included in this prospective study. SHG and MRI were used to measure scar thickness, width, depth, and adjacent myometrial thickness, in which the findings concurred. The mean defect depth was greater in patients with postmenstrual bleeding. Conclusion: SHG is noninferior to MRI, and SHG has the potential to assess the dynamic status of the CSD, with morphological clarity.

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