# Four-Dimensional Transvaginal Ultrasonography as a First-Line Non-Invasive Follow-Up After Hysteroscopic Metroplasty in Dysmorphic Uterus Cases

## TL;DR

This study shows that 4D transvaginal ultrasonography is a non-invasive, cost-effective way to monitor uterine recovery after surgery for a dysmorphic uterus.

## Contribution

This is the first study comparing the cost-effectiveness of 4D-TVUSG, HSG, and HS for postoperative uterine evaluation.

## Key findings

- 4D-TVUSG was found to be non-invasive, easy to use, and less costly than HSG and HS.
- 45.2% of patients achieved pregnancy after surgery, with 78.6% resulting in ongoing pregnancies or live births.
- All patients showed a normalised uterine cavity with a 100% surgical success rate.

## Abstract

Background/Objectives: This study compared the cost-effectiveness of 4D transvaginal ultrasonography (TVUSG), hysterosalpingography (HSG), and hysteroscopy (HS) in evaluating postoperative uterine correction among patients who underwent hysteroscopic metroplasty for a dysmorphic uterus. Additionally, pregnancy outcomes following surgery were assessed. Materials and Methods: Thirty-one patients who underwent hysteroscopic metroplasty due to a dysmorphic uterus between July 2023 and June 2024 were retrospectively analysed. Postoperative uterine cavity evaluations were performed exclusively using 4D transvaginal ultrasonography (4D-TVUSG). The characteristics of alternative imaging modalities (HSG and HS) were evaluated conceptually in terms of invasiveness, feasibility, and cost based on official Ministry of Health data and previously published literature, rather than through direct patient-based comparison. One-year postoperative pregnancy outcomes were also recorded. Results: Notably, 4D-TVUSG was considered preferable to HSG and HS due to its non-invasive nature, ease of use, lack of anaesthesia requirement, and lower cost. Postoperatively, 14 patients (45.2%) achieved pregnancy, of whom 3 (21.4%) experienced miscarriages and 11 (78.6%) had ongoing pregnancies or live births. All patients demonstrated a normalised uterine cavity on follow-up and a 100% surgical success rate. Conclusions: It was found that 4D-TVUSG is a reliable, cost-effective, and non-invasive method for postoperative assessment in patients with a dysmorphic uterus undergoing hysteroscopic metroplasty. This is the first study to compare the cost-effectiveness of these three imaging methods, highlighting 4D-TVUSG as a potential first-line follow-up tool in clinical practice.