Use of 3-Dimensional Sonography to Assess Uterine Anomalies

Abstract

Female genital tract malformations are frequent but are not always detected because many are asymptomatic. Therefore, their true prevalence is unknown.1 They can range from up to 7% in the general population2 to 8% to 10% in women with recurrent pregnancy loss.3 Uterine anomalies are associated with an increased risk of infertility, miscarriage, premature birth, fetal loss, malpresentation, and cesarean delivery.4,5 Their accurate diagnosis is essential to minimize complications such as hydronephrosis, endometriosis, and infertility and to prevent unnecessary and, occasionally, inadequate surgery. Precise classification of a uterine anomaly is of clinical importance because the need for intervention and the type of intervention depends on this distinction. Furthermore, accurate classification of uterine anomalies has prognostic importance with respect to obstetric and gynecologic complications. The American Fertility Society’s 1988 classification6 has been adopted as the main classification system for almost 2 decades. It consists of 7 basic groups that were essentially analyzed on the basis of mullerian development and its relationship to fertility: (1) agenesis and hypoplasias, (2) unicornuate uteri, (3) didelphys uteri, (4) bicornuate uteri, (5) septate uteri, (6) arcuate uteri, and (7) anomalies related to diethylstilbestrol exposure syndrome. This classification, however, does not specify the diagnostic methods or criteria that should be used to diagnose uterine anomalies. The diagnosis is thus solely based on the subjective impression of the clinician performing the test. Additional findings referring to the vagina, cervix, fallopian tubes, ovaries, and urinary system must be addressed separately. However, many congenital uterovaginal anomalies and complex genitourinary anomalies are not encompassed in this system. In fact, Jones7 had already reported the independence of duplication anomalies of the uterus, cervix, and vagina. In some of these cases, two volumes, one to study the fundus and cavity and another to study the cervix and cervical canal, are needed to clearly evaluate the anomaly. Three-dimensional (3D) sonography enables the clinician to assess uterine morphologic characteristics completely, thus alleviating the need for invasive tests. Silvina M. Bocca, MD, PhD, Alfred Z. Abuhamad, MD