Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Gynecological Surgery
Published in: Gynecological Surgery 1/2019

Open Access 01-12-2019 | Ultrasound | Original Article

The role of diagnostic hysteroscopy in diagnosis of incomplete uterine septum in patients with recurrent pregnancy loss in the era of transvaginal 3D ultrasound scan

Authors: O. Abuzeid, J. LaChance, J. Hebert, M. I. Abuzeid, R. Welch

Published in: Gynecological Surgery | Issue 1/2019

Login to get access

Abstract

Purpose

To determine the accuracy of transvaginal 3D ultrasound scan (TV 3D US) in detecting partial septate uterus (PSU) in patients with recurrent pregnancy loss (RPL).

Methods

This retrospective study included 113 patients with an initial diagnosis of unexplained RPL, who were subsequently found to have PSU on diagnostic hysteroscopy and who had TV 3D US prior to surgery. The diagnosis of PSU was made at the time of a diagnostic hysteroscopy based on ESHRE-ESGE classification of Müllerian anomalies. Based on hysteroscopic findings, patients were divided into two groups: those with PSU and a central point of indentation at an acute angle < 90° (PSUAA) [30.1%], and those who had PSU and a central point of indentation at an obtuse angle (PSUOA) [69.9%]. We compared the mean internal indentation length at the fundal midline (IILFM) in millimeters on TV 3D US and on diagnostic hysteroscopy. For the purpose of this study, a diagnosis of PSU on hysteroscopy was made if IILFM measured ≥ 10 mm.

Results

The mean IILFM (mm) on hysteroscopy was significantly higher than the mean IILFM (mm) measured on TV 3D US in patients with PSUAA (18.5 ± 6.5 vs 4.9 ± 4.4; P < 0.001), in patients with PSUOA (14.1 ± 3.8 vs 4.3 ± 3.4; P < 0.001), and in the overall population (15.3 ± 5.1 vs 4.1 ± 4.4; P < 0.001).

Conclusions

The data suggest that mean IILFM in patients with RPL and PSU can be underestimated on TV 3D US. Therefore, its diagnostic accuracy in such patients may need further evaluation.
Literature
1.
Stephenson M (1996) Frequency of factors associated with habitual abortion in 197 couples. Fertil Steril. 66:24–29CrossRef
2.
Branch DW, Gibson M, Silver RM (2010) Clinical practice: recurrent miscarriage. N Engl J Med. 363:1740–1747CrossRef
3.
Stephenson M, Kutteh W (2007) Evaluation and management of recurrent early pregnancy loss. Clin Obstet Gynecol. 50:132–145CrossRef
4.
Murugappan G, Shahine LK, Perfetto CO, Hickok LR (2016) Lathi RB (2016). Intent to treat analysis of in vitro fertilization and preimplantation genetic screening versus expectant management in patients with recurrent pregnancy loss. Hum Reprod. 31:1668–1674CrossRef
5.
Sugiura-Ogasawara M, Ozaki Y, Katano K, Suzumori N, Kitaori T, Mizutani E (2012) Abnormal embryonic karyotype is the most frequent cause of recurrent miscarriage. Hum Reprod. 27:2297–2303CrossRef
6.
Hodes-Wertz B, Grifo J, Ghadir S, Kaplan B, Laskin CA, Glassner M, Munne S (2012) Idiopathic recurrent miscarriage is caused mostly by aneuploid embryos. Fertil Steril. 98(3):675–580CrossRef
7.
Chan Y, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A (2011) The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 17(6):761–771CrossRef
8.
Grimbizis G, Camus M, Tarlatzis BC, et. al. Clinical implications of uterine malformation and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161-174.CrossRef
9.
Homer HA, Li TC, Cooke ID (2000) The septate uterus: a review of management and reproductive outcome. Fertil Steril. 73(1):1–14CrossRef
10.
Ghi T, Casadio P, Kuleva M, et. al. Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies. Fertil Steril. 2009;92(2):808-813.CrossRef
11.
Graupera B, Pascual MA, Hereter L et al (2005) Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Mullerian duct anomalies using ESHRE–ESGE consensus on the classification of congenital anomalies of the female genital tract. Ultrasound Obstet Gynecol. 46(5):616–622CrossRef
12.
Kallia N, Abuzeid O, Ashraf M, Abuzeid M. Role of hysteroscopy in diagnosis of subtle uterine anomalies in patients with normal hysterosalpingography. Fertil Steril. 2011;96(3) Supplement, pp S12, O-40.
13.
Abuzeid O, Abdullah A, Moustafa ASZ, Hebert J, Rocha F, Abuzeid MI. Limitations of radiological screening tests in detection of subtle incomplete septum or arcuate uterine anomaly in patients with recurrent pregnancy loss (RPL). Hum Reprod. 2016;Supplement, 23(7):S187.CrossRef
14.
Abuzeid M, Abuzeid O. Three-dimensional ultrasonography of subtle uterine anomalies: correlation with hysterosalpingogram, two-dimensional ultrasonography, and hysteroscopy. In: Ultrasonography in gynecology. Editors: Botros Rizk and Elizabeth Puscheck. Cambridge University Press 2014, Chapter 8, pp 66-79.
15.
Abuzeid O, Zaghmout O, Corrado J, Hebert J, Ashraf M, Abuzeid M. Comparison between the findings on trans-vaginal 3D ultrasound scan and hysteroscopy in patients diagnosed with subtle incomplete uterine septum/arcuate uterine anomaly on hysteroscopy. Fertil Steril. 2015;104(3), Supplement, pp e28, O-70.CrossRef
16.
Abuzeid O, Zaghmout O, Corrado J, Hebert J, Abuzeid M (2016) Three-dimensional ultrasonography with or without saline infusion sonogram in detecting subtle uterine anomalies: correlation with hysteroscopy. JMIG. 23(7):S145
17.
Abuzeid M, Ghourab G, Abuzeid O, Mitwally M, Ashraf M, Diamond M (2014) Reproductive outcome after IVF following hysteroscopic division of incomplete uterine septum/arcuate uterine anomaly in women with primary infertility. Facts Views Vis ObGyn. 6(4):194–202PubMedPubMedCentral
18.
(1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril 49:944–955
19.
Mitwally MFM, Abuzeid M. Operative hysteroscopy for uterine septum. In: Infertility and Assisted Reproduction. Editors: Botros R. M. Rizk, Juan A. Garcia-Velasco, Hassan N. Sallam and Antonis Nakrigiannakis. Cambridge University Press 2008, Part II Infertility Evaluation and Treatment, Chapter 13,115-131.
20.
Grimbizis GF, Gordts S, Di Spiezio SA et al (2013) The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 28(8):2032–2044CrossRef
21.
Heinonen P (2006) Reproductive surgery: complete septate uterus with longitudinal vaginal septum. Fertil Steril. 85(3):700–705CrossRef
22.
Fedele L, Dorta M, Brioschi D, Guidici MN, Candiani GB (1989) Pregnancies in septate uteri: outcome in relation to site of uterine implantation as determined by sonography. AJR. 152:781–784CrossRef
23.
Abuzeid O, Zaghmout O, Herbert J, Rocha F, Abuzeid M (2016) Placental location and reproductive outcome in patients with uterine septum or arcuate uterus. Ob & Gyn 127:64S–19GCrossRef
24.
Jurkovic D, Geipel A, Gruboeck K (1995) Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol. 5(4):233–237CrossRef
25.
Moini A, Mohammadi S, Hosseini R, Eslami B, Ahmadi F (2013) Accuracy of 3-dimensional sonography for diagnosis and classification of congenital uterine anomalies. J Ultrasound Med. 32:923–927CrossRef
26.
Faivre E, Fernandez H, Deffieux X, Gervaise A, Frydman R, Levaillant JM (2012) Accuracy of three-dimensional ultrasonography in differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging. JMIG. 19(1):101–106
27.
Lagana AS, Ciancimino L, Mancuso A, Chiofalo B, Rizzo P, Triolo O (2014) 3D sonohysterography vs hysteroscopy: a cross-sectional study for the evaluation of endouterine diseases. Arch Gynecol Obstet. 290:1173–1178CrossRef
28.
Kasius JC, Broekmans FJM, Veersema S, et. al. Observer agreement in the evaluation of the uterine cavity by hysteroscopy prior to in vitro fertilization. Hum Reprod. 2011;26(4):801-807.CrossRef
29.
Smit JG, Kasius JC, Eijkemans MJC et. al. The international agreement study on the diagnosis of the septate uterus at office hysteroscopy in infertile patients. Fertil Steril. 2013;99(7):2108-2113.CrossRef
30.
Smit JG, Overdijkink S, Mol BW et. al. The impact of diagnostic criteria on the reproducibility of the hysteroscopic diagnosis of the septate uterus: a randomized controlled trial. Hum Reprod. 2015;30(6):1323-1330.CrossRef
31.
Abuzeid O, Raju R, Hebert J, Abuzeid M (2016) Effect of proper uterine distention on the detection rate of subtle uterine anomalies during hysteroscopy. JMIG. 23(7):S134–S135
32.
Ludwin A, Ludwin I, Kudla M, et. al. Diagnostic accuracy of three-dimensional sonohysterography compared with office hysteroscopy and its interrater/intrarater agreement in uterine cavity assessment after hysteroscopic metroplasty. Fertil Steril. 2014;101(5):1392-1399.CrossRef
33.
Ludwin A, Martins WP, Nastri CO et. al. Congenital uterine malformation by experts (CUME): better criteria for distinguishing between normal/arcuate and septate uterus. Ultrasound Obstet Gynecol. 2018;51(1):101-109.CrossRef
34.
The American Society for Reproductive Medicine. Uterine septum: a guideline (2016) Practice Committee of the American Society for Reproductive Medicine. Fertil Steril. 106(3):530–540CrossRef
35.
Di Spiezio SA, Zizolfi B, Bettocchi S et al (2016) Accuracy of hysteroscopic metroplasty with the combination of presurgical 3-dimensional ultrasonography and a novel graduated intrauterine palpator: a randomized controlled trial. JMIG. 23(4):557–566
Metadata
Title
The role of diagnostic hysteroscopy in diagnosis of incomplete uterine septum in patients with recurrent pregnancy loss in the era of transvaginal 3D ultrasound scan
Authors
O. Abuzeid
J. LaChance
J. Hebert
M. I. Abuzeid
R. Welch
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Gynecological Surgery / Issue 1/2019
Print ISSN: 1613-2076
Electronic ISSN: 1613-2084
DOI
https://doi.org/10.1186/s10397-019-1066-8

Other articles of this Issue 1/2019

Gynecological Surgery 1/2019 Go to the issue

Review Article

The diagnosis and management of interstitial ectopic pregnancies: a review

Original Article

Pelvic exenteration in gynecologic cancer: complications and oncological outcome

Original Article

Prediction of unsuccessful endometrial ablation: a retrospective study

Original Article

Laparoscopic lateral suspension: a single-site and single-surgeon experience

Original Article

A value-based evaluation of minimally invasive hysterectomy approaches

Original Article

Effectiveness of ovarian suspension in preventing postoperative ovarian adhesions in patients with severe pelvic endometriosis—a case-control study