ABSTRACT
Objective To discuss the accuracy of three-dimensional (3D) sonography in diagnosing arcuate uterus and septate uterus and propose a quantitative indicator in distinguishing arcuate uterus and septate uterus.Methods Ninety-six patients with suspected congenital uterine malformation underwent 3D sonography to assess uterine anomalies at Obstetrics and Gynecology Hospital of Fudan University from August 2011 to March 2013.Uterine coronal section was reconstructed and measured in onmi view imaging mode of 3D sonography.Then qualitative diagnosis and categorization was done.The results were compared with diagnosis of hysteroscopy,hysteroscopy combined with laparoscope to determine the sensitivity,specificity,positive predictive values,negative predictive values and total accuracy of 3D sonography in diagnosing arcuate uterus,partial and complete septate uterus respectively.The variable was created in coronal section of uterus constructed through 3D imaging mode to differentiate arcuate uterus from septate uterus.Results There were 33 cases (34.4％,33/96) of arcuate uterus,54 cases (56.2％,54/96) of partial septate uterus and 9 cases (9.4％,9/96) of complete uterus in 96 cases diagnosed by 3D sonography.The accuracy of 3D sonography in diagnosing arcuate uterus and septate uterus was 86.5％.We concluded that 3D sonography had 100％ sensitivity,82.9％ specificity,60.6％ positive predictive value and 100％negative predictive value in the diagnosis of arcuate uterus.The sensitivity of 3D sonography for diagnosis of partial septate uterus was 80.6％,the specificity was 100％,the positive predictive value was 100％,and the negative predictive value was 69.1％.The sensitivity,specificity,positive and negative predictive values of 3D sonography for detecting complete septate uterus were all 100％.The ratio of depth of uterine internal indentation and depth from uterine fundus to the top of intemal indentation was more than 50％ for septate uterus,while less than 50％ for most of the arcuate uterus.Conclusions The diagnostic efficiency of 3D sonography in specific uterine malformation is different.The new quantitative indicator maybe helpful in improving the accuracy of 3D sonography in diagnosing arcuate uterus and septate uterus.
ABSTRACT
Background: The anatomical variations of uterus particularly those concerning the body of uterus are well known in medical literature. Knowledge of these variations is important in reproductive periods of life, as well as in deciding the surgical procedures involving caesarean section delivery. However there are some exceptional variations in the body of uterus thatmay puzzle the obstetrician and gynaecologist dealingwith gynaecological patients. Normal development of the female reproductive tract requires a complex series of events. Failure of any part of this process can result in congenital anomaly. Careful sonography and an awareness of the sonographic findings of early pregnancy in anomalous uteri should improve the detection of these anomalies. Recognition of such anomalies will also allow differentiation of those patients requiring repeat dilatation and curettage from those requiring laparotomy, as in the presence of a blind uterine horn or ectopic gestation. 3D ultrasonography permits the obtaining of planar reformatted sections through the uterus, which allow precise evaluation of fundal indentation& length of the septum. AimThis studywas undertaken to assess themorphology of uterus and evaluate the anomalies. Materials: 1500 subjects within the age of 15-45 were assessed using ultrasound scan and the anomalies were analyzed. Results: 5-7% cases involving the variations ofmorphology of the uterus were reported in this study, that 3DUS has recently become the only mandatory step in the initial investigation. Conclusion:With timely and accurate diagnosis, appropriatemanagement is likely to provide the best possible outcome for all such patients.
ABSTRACT
A uterine malformation is the result of an abnormal development of the Mullerian duct(s) during embryogenesis. The arcuate uterus is a type of congenital uterine malformation where the uterine fundus displays a small midline indentation towards the uterine cavity. A 25 years old woman with history of two abortions was diagnosed as a case of arcuate uterus during her first caesarean section. With proper antenatal care and counseling she has been able to give birth to 2nd baby successfully. No correctable surgery was essential for her. The literature regarding the diagnosis, management, and reproductive outcomes for arcuate uterus is limited and conflicting. A woman with an arcuate uterus can carry a baby to full term pregnancy. However, this condition is associated with a higher risk for miscarriage and premature births. Arcuate uterus is usually managed similarly to septate uterus, and only selected patients who fulfill poor reproductive performance criteria are recommended for surgical correction.
ABSTRACT
Este trabalho de revisão foi idealizado para analisar as malformações dos ductos de Müller, que, devido à sua frequência de 3 a 7,3% na população em geral, justificam uma análise mais profunda do tema. O objetivo foi avaliar, de acordo com a literatura por meio de metodologia adequada? Os aspectos mais relevantes dessas anomalias, com destaque para a etiopatogenia, classificação, diagnóstico e tratamento. Os resultados obtidos nesta revisão apontaram as melhores evidências, até o momento, de como conduzir as mulheres portadoras dessas malformações.
This review paper was organized in order to analyse Müllerian anomalies, because their frequency from 3 to 7,3% in people in general justify a better evaluation about these malformations. The objective of the study was to evaluate, according to literature - by a proper methodology - the main aspects of these malformations, with special attention to etiology, classification, diagnostic and treatment. The results of this review showed the best evidences up till now of how to manage women with these genital malformations.