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Purpose: To assess the accuracy of hysterosonography (HSG) and its role in diagnostic confidence and therapeutic clinical decision making among referring physicians caring for patients with postmenopausal bleeding (PMB)., Materials and Methods: One hundred twenty-three patients with PMB underwent transvaginal ultrasonography (US) and HSG. They were examined for cancer, polyp, leiomyoma, and hyperplasia. Physicians assessed the effect of the studies on diagnostic confidence and care, including biopsy, dilation and curettage, hysteroscopy, hormone manipulation, and/or patient reassurance. Abnormality was proved with histopathologic evaluation, and normality, with 6-month follow-up., Results: In 10 patients, HSG was unsuccessful, and in 15, follow-up was incomplete; this left 98 patients. Endometrial polyps were seen in 46 (47%) patients; leiomyoma, in 11 (11%); cancer, in four (4%); hyperplasia, in eight (8%); and normal findings, in 29 (30%). Our calculations yielded a sensitivity of 98% and a specificity of 88%. In 86 (88%) patients, US added certainty to the diagnosis; in 78 (80%), it resulted in a change in patient treatment., Conclusion: HSG and transvaginal US in patients with PMB improves diagnostic accuracy, clinical decision making, and the clinician's diagnostic certainty. In patients with benign causes of PMB, the absence of abnormality at HSG and a normal endometrial biopsy result may eliminate the need for further studies.

Fifteen pregnancies occurring in 13 patients with congenital uterine anomalies were analyzed. The anomalies included bicornuate uteri (nine cases), subseptate uteri (two), septated uteri (one), and uterus didelphys (one). Identification of a bilobed uterine contour with an anterior and/or posterior indentation, an eccentrically located gestational sac, and echogenic endometrial debris in the nongravid horn, reliably indicated a coexistent uterine anomaly. Uterine anomalies became difficult or impossible to identify with increasing gestational age. Entities potentially confused with uterine anomalies include cornual leiomyomata, ectopic gestation, placental septations, and uterine scarring. Awareness of the sonographic findings of pregnancies in anomalous uteri should improve their detection and may alter obstetrical management.

Failure of first trimester pregnancy termination is an uncommon, although potentially serious complication of attempted therapeutic abortion. We report our experience in four patients with unsuspected congenital uterine anomalies in whom attempted pregnancy termination procedures failed to completely ablate the products of conception. When dilatation and curettage fails to produce embryonic tissue, sonography is indicated to exclude ectopic gestation or uterine anomaly. In patients who are known to have anomalous uteri, intraoperative real-time guidance may increase the success of pregnancy termination procedures and decrease the incidence of retained products of conception.