Congenital Uterine Anomalies

Abstract

Congenital uterine anomalies are the most common anomaly of the female reproductive tract, affecting 3–8 % of fertile and infertile women. Uterine anomalies are traditionally classified as hypoplasia or agenesis, unicornuate, didelphys, bicornuate, septate and arcuate, and diethylstilbestrol exposed. These anomalies are associated with normal reproductive outcomes and adverse reproductive outcomes such as pregnancy loss and preterm delivery and are not typically associated with infertility. Although females with obstructive uterine anomalies tend to present during adolescence due to pelvic pain or dysmenorrhea, nonobstructive uterine anomalies may not be identified until a woman presents for evaluation of first or second trimester pregnancy loss, preterm delivery, or infertility. Imaging modalities commonly employed to evaluate congenital uterine anomalies include two-dimensional ultrasonography (2DUS), three-dimensional ultrasonography (3DUS), hysterosalpingography, saline-infusion ultrasonography, and magnetic resonance imaging (MRI). As 3DUS is increasingly utilized in pelvic imaging, this modality is becoming the next level of testing after 2DUS when a uterine anomaly is suspected. For more complex congenital anomalies, additional imaging such as MRI may be warranted. Detailed imaging of the reproductive tract is essential to make the correct diagnosis of a uterine anomaly, determine if surgical intervention is recommended, and educate the patient about the reproductive implications of the diagnosis.