Congenital Uterine Malformations Research Articles

Diagnostic Concordance and Discrepancies in 3D TVUS and MRI of Congenital Uterine Malformations across the ASRM 2016, ASRM 2021, ESHRE/ESGE 2016, and CUME 2018

Background:: The classification of Congenital Uterine Malformations (CONUTA) relies on coronal imaging of the uterus using 3D TVUS and MRI. In everyday practice, radiologists and gynaecologists often struggle to confidently categorize CONUTA due to varying classification systems and the lack of worldwide consensus. Objectives:: The aim of this study was to evaluate the diagnostic concordance and discrepancies between two imaging techniques within the context of the ASRM, ESHRE/ESGE, and CUME systems. Methods:: Ninety-four patients suspected of having CONUTA underwent evaluation: 67 underwent 3D TVUS, 53 had MRI scans, and 34 were examined using both imaging techniques. An initial cross-listing table of ASRM, ESHRE/ESGE, and CUME was created, and a flowchart schema was used to define the type of congenital uterine anomaly for each system The prevalence of anomalies in each system was calculated, and Fleiss’ Kappa was used to assess and determine the level of agreement. Results:: Class VI arcuate uterus was the most common form in ASRM 2016 and 2021, while the partially septate uterus predominated in the CUME 2018 and ESHRE/ESGE 2016 classification systems. Conclusion:: There is no discordance between classification systems for all fusion defects and complete septate type of absorption defects. In the ESHRE/ESGE system, nearly half of the abnormal uteruses were categorized as partially septate. However, the CUME system proved less effective in distinguishing between normal and arcuate uteruses.

Detection of uterine abnormalities using three-dimensional vaginal ultrasound in infertile women undergoing assisted reproductive techniques

Abstract Background: Uterine shape and cavity abnormalities form a common cause of subfertility, for which thorough assessment is considered as a core part in infertility evaluation. A variety of modalities (invasive and none invasive) such as hysterosalpingography, transvaginal sonography, diagnostic hysteroscopy, two-dimensional hysterosonography, and three-dimensional hysterosonography can be used for the diagnosis of uterine abnormalities. Objectives: To address the detection rate of uterine and endometrial abnormalities in infertile women undergoing assisted reproductive techniques (ART) using three-dimensional vaginal ultrasonography. Materials and Methods: A cross-sectional observational study that involved 211 subfertile women who were arranged to undergo ART for different causes of infertility. After taking their verbal consent for participation in this study, all women examined by 2D vaginal U/S for initial assessment of their pelvic anatomy then followed by three-dimensional U/S with or without saline infusion for further assessment of the uterine and endometrial cavity morphology. Women with ultrasound detected endometrial abnormalities further underwent hysteroscopic assessment, histopathological specimens were taken and were treated as recommended by their gynecologist. Results: Twenty-two percent of the studied group discovered to have uterine and/or endometrial abnormalities including endometrial polyps and uterine myomas are the most commonly detected abnormalities while congenital uterine malformation detected in 3.8% of the total patients using three-dimensional ultrasonography. Conclusion: Uterine and endometrial abnormalities are common in subfertile patients, the prevalence of uterine and endometrial abnormalities (endometrial polyps or irregularities, uterine myomas including submucous one) was 22%, whereas congenitally maldeveloped uteri were detected in 3.8% of women undergoing ART (using 3D U/S) which may have a negative impact on ART outcome.

Congenital Uterine Malformations and Diagnostic Methods: Diagnosis with 2D and 3D Ultrasonography

Congenital Uterine Malformations and Diagnostic Methods: Diagnosis with 2D and 3D Ultrasonography

Comparison of clinical outcomes and second-look hysteroscopy of the complete and incomplete septate uterus after hysteroscopic septoplasty.

Septate uterus is the most common congenital uterine malformation. This retrospective cohort study compared clinical outcomes and second-look hysteroscopy findings in patients with complete and incomplete septate uteri after septoplasty. We reviewed the medical records of patients with a septate uterus who underwent hysteroscopic septoplasty and second-look hysteroscopy at the West China Second University Hospital between September 2013 and September 2021. Information regarding pregnancy outcomes was collected through telephone interviews. The independent samples t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test were used to explore the differences between the complete and incomplete septate uterus groups. A total of 64 patients were enrolled in this study. There was no significant difference in intrauterine adhesion (IUA) rates (16.7% and 32.1%), pregnancy rates (44.1% and 42.9%), term delivery rates (35.3% and 32.1%), premature delivery rates (2.9% and 0), placenta previa rates (2.9% and 3.6%), placenta implantation/adhesion rates (5.9% and 3.6%), and premature rupture of membranes rates (2.9% and 0) between the complete and the incomplete group after hysteroscopic septoplasty (P > 0.05). Endometrial polyps in the septate uterus were common, with an incidence of 33.3% and 25% in the complete and incomplete groups, respectively (P > 0.05). The pregnancy outcomes of complete and incomplete septate uteri after hysteroscopic septoplasty were similar. There was no statistical difference in IUAs after surgery. Different treatment strategies may not be required for complete or incomplete septate uteri.

P-671 Comparing clomiphene citrate/ flexible GnRH antagonist vs ultrashort flare GnRH agonist protocols for controlled ovarian stimulation in poor ovarian reserve patients

Abstract Study question How do Clomiphene citrate (CC)/ flexible GnRH antagonist and ultrashort flare GnRH agonist protocols compare in poor ovarian reserve patients (POSEIDON groups 3 & 4)? Summary answer In poor ovarian reserve patients, irrespective of age, use of CC / flexible antagonist vs ultrashort flare protocol significantly reduces gonadotrophin consumption and stimulation duration. What is known already Poor responders constitute 47% of ART patients and up to 65% of these have diminished ovarian reserve. Despite the various treatment options available, lack of good quality evidence to enable recommendation of a particular protocol or adjuvant continues to pose a challenge to their effective management. The need for multiple stimulations for pooling up embryos also makes effective cost of treatment an added concern in them. Study design, size, duration An open label, multi centric, randomized controlled study was conducted over a period of 1 year recruiting 116 women having AMH <1.2ng/dl and antral follicle count (AFC) <5 who were further analysed in POSEIDON 3 and 4 subgroups. Patients were randomized to 1 of 2 groups for controlled ovarian stimulation. Those with severe endometriosis, adenomyosis, autoimmune or metabolic disorders, sustained hyperprolactinaemia, congenital uterine malformations and with male partners having severe oligoasthenoteratozoospermia were excluded. Participants/materials, setting, methods Group A (55 women) received CC 100mg from D1-D5 with 300 IU human menopausal gonadotrophin (hMG) in a flexible GnRH antagonist protocol. Group B (61 women) underwent ultrashort flare protocol. 1mg leuprolide was administered from D1-D4 and 300 IU hMG given D2 onwards followed by flexible GnRH antagonist administration. Dual trigger with triptorelin and recombinant hCG was administered 35-36 hours before oocyte retrieval. Embryos cultured till D5 were vitrified for transfer at a later stage. Main results and the role of chance The two groups were well matched for baseline characteristics like age, BMI, AMH, duration of infertility, D2 AFC, estradiol and FSH levels. The mean total gonadotrophin consumption (3387.29 + 1082.5 vs 4407 + 1224.2, p value <0.01) and the duration of stimulation (10.71 + 2.52 vs 11.95 + 2.43, p value <0.01) were significantly lower in group A vs group B. The primary outcomes of median number of oocytes retrieved (4 vs 4, p value- 0.71) , M2 rate (3 vs 3, p value-0.91), fertilisation rate were similar in the two groups. The secondary outcomes of oocyte retrieval rate (103.05 + 42.97 vs 97.14 + 42.96, p value- 0.63), FORT (0.81 +0.68 vs 0.96 + 0.48, p value- 0.37) FOI (0.91 + 0.55 vs 0.92+ 0.54, p value 0.92), top quality embryo rate (0.53 + 1.1 vs 0.41 + 0.84, p value 0.61), cycle cancellation rate (26.22% vs 29.09%), implantation rate (23.63% vs 24.59%) and clinical pregnancy rate (21.31% vs 20%) were also similar in group A vs B respectively. A subgroup analysis of POSEIDON 3 versus POSEIDON 4 patients revealed similar outcomes with both the protocols in the two groups. Limitations, reasons for caution Small sample size of the cases limits the current statistical power of the study. Wider implications of the findings CC /flexible GnRH antagonist protocol is an effective alternative to ultrashort flare protocol in patients with poor ovarian reserve irrespective of their age. The lower gonadotrophin dosage required and shorter duration of stimulation observed make it a viable option in patients who might need multiple stimulations for pooling up embryos. Trial registration number Not applicable

O-057 Prevalence of T-shaped uterus among women undergoing fertility treatments based on ESHRE/ESGE and Congenital Uterine Malformation by Experts (CUME) criteria.

Abstract Study question What is the prevalence of a T-shaped uterus among women undergoing fertility treatments based on ESHRE/ESGE (Grimbizis et al.,2013) and CUME (Ludwin et al.,2020)? Summary answer The prevalence of T-shaped uterus was 4.1% according to the ESHRE/ESGE, and according to the CUME, 1.1% T-shaped uterus and 0.9% borderline T-shaped uterus. What is known already The definition of a T-shaped uterus by the ESHRE/ESGE consensus (Grimbizis et al., 2013) was based on three-dimensional ultrasound (3D-US) images, defining it as a narrow uterine cavity caused by thickened lateral walls with a ratio of two-thirds uterine body and one-third cervix. This definition is subjective and therefore makes giving an objective diagnosis difficult. The CUME group (Ludwin et al., 2020) described practical diagnostic criteria for a T-shaped uterus according to 3D-US images. As there is no consensus regarding the definition, the overall prevalence according to different studies varied from 0.2 to 10.0%. Study design, size, duration A retrospective cohort study with prospective analysis of 3D-US images was conducted. All women who were admitted to our unit for fertility treatments and underwent 3D-US between 12/2017-12/2021 were included. Women were grouped according to infertility type. All 3D-US images of uteri suspected to be T-shaped according to ESHRE/ESGE were assessed according to the CUME criteria, based on the following three measurements: lateral indentation angle ≤130°, lateral indentation depth ≥7 mm, and T-angle ≤40°. Participants/materials, setting, methods The study was conducted in a single university-affiliated hospital. Women who underwent fertility treatments due to various indications were included. The exclusion criteria were women undergoing fertility preservation, egg donation and oocyte recipients. All 3D-US were performed by well-trained ultrasound technicians. We first screened all images and calculated the prevalence of T-shaped uteri in our population based on the ESHRE/ESGE consensus. Next, we performed the three measurements according to the CUME criteria. Main results and the role of chance Altogether 451 women were admitted to our fertility unit. Nine cases were excluded due to unsatisfactory 3D-US images because of technical difficulties. Finally, 442 women were included in the study and divided into in the following groups: anovulation 10.6% (n = 47), mechanical factor 11.1% (n = 49), male factor 38.7% (n = 171), and unexplained infertility 39.6% (n = 175). The prevalence of T-shaped uterus according to the ESHRE/ESGE was 4.1% (n = 18). Among them, 3.2% (n = 3) were from the female factor groups (anovulation + mechanical), 4.1% (n = 7) from the male factor group, and 4.6% (n = 8) from the unexplained infertility group. Afterwards, the 3D-US images were analyzed according to the CUME criteria. T-shaped uterus was defined when all three criteria were met, and borderline T-shaped uterus was defined when two out of three criteria were met. According to CUME criteria, the prevalence of T-shaped uterus was only 1.1% (n = 5), three being from the male factor group and two from the unexplained infertility group. No T-shaped uteri were found in the female factor groups. Additionally, 0.9% (n = 4) were considered borderline T-shaped. Limitations, reasons for caution The ESHRE/ESGE consensus is subjective and may lead to either under- or over-diagnosis. On the other hand, the CUME criteria are objective and well-defined, but due to their strictness, dysmorphic uteri with very narrow uterine cavities and thickened lateral walls may not be diagnosed as T-shaped uteri. Wider implications of the findings Diagnosis and management of women with T-shaped uteri are very controversial topics. Therefore, making the diagnosis more precise and objective can help us to screen for the most significant cases and tailor the management accordingly. The similar prevalence among different infertility groups reflects the incidental nature of this diagnosis. Trial registration number Not applicable.

P-531 Effectiveness and safety of uterine septum division: An updated systematic review and meta-analysis

Abstract Study question To evaluate whether division of uterine septum improves reproductive outcome as compared to no intervention and is a safe procedure. Summary answer While septal division doesn’t seem to improve live birth and clinical pregnancy rates or reduce miscarriage rates, it has improved preterm birth and malpresentation rates. What is known already Septate uteri are common congenital uterine malformations and are seen in about 1% of women. While most women with septate uterus have normal reproductive outcome, studies have reported increased risk of adverse reproductive outcome including miscarriages in women with septate uterus. Hysteroscopic metroplasty or hysteroscopic transcervical division of the uterine septum has been regularly done with an intention to improve the outcome, although evidence on its effectiveness is conflicting. A systematic review of controlled studies done in 2014 has shown a potential benefit, but later studies including a recent randomized controlled trial (RCT) has shown no benefit. Study design, size, duration In this systematic review and meta-analysis, Medline and Cochrane Library databases were searched from commencement to December 2022. We identified 13 eligible studies of which 12 were non-randomised controlled studies and one RCT, comprising 1855 women. Participants/materials, setting, methods We included comparative studies of septal division versus non-intervention in women having septate uterus with a history of infertility or recurrent miscarriage. The outcomes assessed were live birth, clinical pregnancy, miscarriage, preterm birth, malpresentation and complications. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Statistical analysis was performed using Review Manager 5.4.1 software. Pooled odds ratios (OR) with 95% confidence intervals (CI) were computed using random effects models. Main results and the role of chance The live birth rates were similar for the septal division and non-intervention groups (OR: 1.48; 95% CI 0.86-2.56). The clinical pregnancy rates (OR: 1.24; 95% CI 0.64-2.39) and miscarriage rates (OR: 0.61; 95% CI 0.35-1.06) were also similar. The preterm birth rates (OR: 0.67; 95% CI 0.47-0.95) and malpresentation at birth (OR: 0.34; 95% CI 0.23-0.53) were lower in patients managed surgically. The complication rates were reported in four studies and were ranging between 2.6% and 9.4% with the main reported complication being uterine perforation. Limitations, reasons for caution While the review included comparative studies, only one was RCT. High level of heterogeneity between studies was observed. Many had different inclusion and/ or exclusion criteria and used different diagnostic modalities and criteria. Wider implications of the findings The findings of our review help in counselling women seeking septal division, particularly of lack of benefit in improving live birth rates or reducing miscarriage, but may reduce preterm births and malpresentation. Due to the heterogeneity of the included studies and low-quality evidence, large multicentre RCTs are warranted. Trial registration number not applicable

Comparison Between Scissors and Resectoscope in Resection of Uterine Septum

Background: Septate uterus is a common congenital uterine malformation. It is due to abnormal resorption of the Mullerian canal in embryonic life. Poor reproductive outcomes (e.g., abortion and preterm births) are associated with septate uterus.
 Aim of the work: The present study aimed to compare scissors and resectoscope regarding the efficacy and safety in resection of uterine septum.
 Patients and Methods: This study was conducted in the outpatient clinic of Al-Azhar University Hospital (New Damietta) from December 2017 to October 2020. Women were assigned into one of the two groups. The first included fifteen women, who underwent septoplasty by scissor and the Group II included fifteen women who were submitted to septoplasty by bipolar resectoscope.
 Results: Group (I) had a higher pain score in group I than group II with a significant difference. Mild pain was reported in 10 cases (66.7%) in group I and 4 (26.7%) in group II. However, moderate pain was reported for 5 cases (33.3%) and 11 cases (73.3%) in groups I and II, respectively, with a statistically significant difference. However, both groups were comparable regarding patient characteristics, operative data, postoperative complications and postoperative results of hysteroscopy, three months after the resection of the uterine septum.
 Conclusion: Scissor is preferred over the bipolar resectoscope especially in thin septum. It is associated with comparable outcome to the bipolar resectoscope. However, bipolar resectoscope was associated with significantly higher pain scores than scissors.

High level of thyroid peroxidase antibodies as a detrimental risk of pregnancy outcomes in euthyroid women undergoing ART: A meta-analysis.

Thyroid autoimmunity (TAI) triggered by genetic and epigenetic variation occurs mostly in women of reproductive age. TAI is described mainly by positivity of anti-thyroid peroxidase antibody (TPO-Ab) and/or thyroglobulin antibody (TG-Ab). TPO-Ab, but not TG-Ab, was suggested to be associated with pregnancy outcome in euthyroid women undergoing assisted reproductive technology (ART), but their results are conflicting. This meta-analysis was performed to decide whether the presence of TPO-Ab-in a concentration dependent manner-correlates with the success of ART. A systematic literature search was performed in the PubMed, Web of Science, and EMBASE databases for relevant articles published from January 1999 to April 2022, and these studies focused on the effect of TAI on pregnancy outcomes of women who underwent in vitro fertilization, intracytoplasmic sperm injection and intrauterine insemination and met the inclusion criteria: (i) the studies were prospective or retrospective study; (ii) all patients undergoing ART were tested for thyroid-related antibodies; (iii) the assessed ART outcomes included miscarriage rate (MR) or delivery rate (DR). The exclusion criteria were: (i) female congenital uterine malformation, chromosomal diseases and other infectious diseases; (ii) overt hypothyroidism or pre-existing thyroid disease; (iii) thrombus tendency. We divided the included patients into three groups according to the TPO-Ab threshold they defined: (i) TPO-Ab (-), threshold <34 IU/mL; (ii) TPO-Ab-34, threshold >34 IU/mL; (iii) TPO-Ab-100, threshold >100 IU/mL. We then extracted necessary relevant data, including MR and DR. Egger's test was used to evaluate the risk of publication bias. This meta-analysis included a total of 7 literatures involving 7466 patients with TAI (-) and 965 patients with TAI (+) and revealed that there was no significant difference between group TPO-Ab-34 and group TPO-Ab (-) in MR [risk ratio (RR): 0.61 (0.35, 1.08), p = 0.09] and DR [RR: 0.97 (0.83, 1.13), p = 0.69]. By contrast, compared to TPO-Ab (-) group, TPO-Ab-100 patients showed markedly higher MR [RR: 2.12 (1.52, 2.96), p = 0.0046], and lower DR [RR: 0.66 (0.49, 0.88), p < 0.0001] with high degree of statistical significance. This meta-analysis suggests that, for euthyroid patients, high level of TPO-Ab (>100 IU/mL) could adversely influence the pregnancy outcome of ART.

Rudimentary horn pregnancy

Rudimentary horn is an anatomic variant of unicornuate uterus which is a mullerian duct anomaly resulting from the incomplete fusion of the ducts. The prevalence of congenital uterine malformations is about 3.2%Pregnancy in the rudimentary horn is an extremely rare condition occurring in 1 in 76,000 to 1 in 1,40,000 pregnancies. Unicornuate uterus with rudimentary horn maybe associated with gynecological and obstetric complications like infertility, endometriosis, hematometra, abortions and preterm deliveries. Despite advances in ultrasound and other diagnostic modalities, prenatal diagnosis remains elusive, with confirmatory diagnosis being laparotomy.

Diagnostic role of magnetic resonance hysterosalpingography in the evaluation of female infertility

BackgroundIn the evaluation of female infertility, hysterosalpingography (HSG) with fluoroscopy provides limited evaluation of congenital uterine malformation and extrauterine disease. Transvaginal ultrasonography (TVS) is though commonly used, has its limitations in assessment of tubes. Addition of sonosalpingography can help assess tubal patency but may be inconclusive in cases of unilateral or bilateral obstruction and is grossly operator dependent. Recent past has seen evolution of magnetic resonance imaging (MRI) to evaluate problems associated with female infertility, with unparalleled advantages of having no radiation and being less operator-dependent. The need to assess tubal patency has been addressed by increasing literature on utilization of gadolinium (Gd) in MRI and comparing it with HSG alone or a mixture of HSG and laparoscopy. We aimed to evaluate the sensitivity and specificity of using magnetic resonance imaging (MRI) and magnetic resonance hysterosalpingography (MRHSG) as a screening test for female infertility and to compare accuracy, positive predictive value and efficacy of MRI and MRHSG with laparoscopy.ResultsFifty-four out of 63 patients had bilateral tubal patency (85.7%). Nine patients had tubal pathology (14.3%) out of which one had unilateral and eight had bilateral tubal obstruction. Endometrial cavity abnormality was found in four patients and ovarian abnormalities were detected in 28.5% patients. MRHSG has shown high sensitivity and specificity for tubal patency evaluation when compared to the true gold standard for tubal patency assessment, laparoscopic chromotubation. With laparoscopy as standard, there was 100% sensitivity and specificity for structural abnormality, myometrial abnormalities and endometrial cavity assessment in MRHSG.ConclusionsIn comparison with diagnostic laparoscopy, MRHSG was found to have good sensitivity and specificity for assessment of tubal patency, excellent sensitivity and specificity for the assessment of structural malformation and endometrial cavity lesions. Furthermore MRHSG was good in picking up extra-uterine diseases.

Does uterine septum resection improve IVF treatment success?

Aim: Uterine septum is the most common type of congenital uterine malformation. The septum has also been suggested as a potential cause of infertility. The role of the septum in infertility and whether the septum can be resected is debatable. We aimed to reveal the results of assisted reproductive techniques in patients with septate uterus according to whether or not resection is performed. &#x0D; Material and Method: 7790 patients were scanned retrospectively. 110 patients with the uterine septum and unexplained infertility were included in the study. Patients who underwent uterine septum resection were recorded. The clinical pregnancies of patients were compared according to whether or not resection was performed. In addition, patients with complete septum were evaluated according to whether or not resection was performed, and their clinical pregnancies were evaluated.&#x0D; Results: It was revealed that 79 of the patients with uterine septum underwent septum resection operation. It was determined that 31 patients were not treated. Clinical pregnancy rates were found to be statistically significantly higher in the expectant management group (p=0.02). In addition, comparing the clinical pregnancy rates of the resection and expectant management groups in patients with a complete septum, no significant difference was found between the groups (p=0.134).&#x0D; Conclusion: In our study, the success of treatment with assisted reproductive techniques did not change after septum resection. Although uterine septum resection is a simple and safe method, it has disadvantages such as the development of adhesions and rupture in the uterus. There is insufficient evidence to perform septum resection in patients with uterine septum prior to infertility treatment.

Basic Gynecologic Ultrasound Examination (Level I): DEGUM, ÖGUM, and SGUM Recommendations.

Ultrasound has become an essential diagnostic tool in gynecology, and every practicing gynecologist must be able to differentiate normal from pathologic findings, such as benign or malignant pelvic masses, adnexal torsion, pelvic inflammation disease, endometriosis, ectopic pregnancies, and congenital uterine malformations at least on a basic level. A standardized approach to the correct settings of the ultrasound system, the indications for gynecologic ultrasound investigations, and the sonographic appearance of normal anatomy and common pathologic findings in the standard planes are important prerequisites for safe and confident clinical management of gynecologic patients. Based on current publications and different national and international guidelines, updated DEGUM, ÖGUM, and SGUM recommendations for the performance of basic gynecologic ultrasound examinations were established.

OBSTETRICAL PROGNOSIS AFTER UTERINE SEPTUM SECTION BY HYSTEROSCOPYABOUT A CASE REPORT

The septate uterus is the most common congenital uterine malformation resulting from a resorption defect of the inter-mullerian septum. It is frequently associated with conception abnormalities such as early recurrent spontaneous miscarriage (FCS) and late recurrent miscarriage (FCT) but also with fertility abnormalities, without a clear mechanism. The imaging techniques used to diagnose a septate uterus are based on : Endo-vaginal ultrasound, diagnostic hysteroscopy and IRM pelvic . Surgical treatment is based on septum sectioning which is a minimally invasive surgical technique with low risk of complications. This septal section significantly improves the obstetrical prognosis in women with a desire for pregnancy.

334 Three-dimensional ultrasound versus mri in the diagnosis and classification of congenital uterine malformations: A systematic review

Introduction and aims of the study: Congenital uterine malformations are highly associated with infertility and recurrent pregnancy loss, making their accurate diagnosis and classification a necessity. Although hysteroscopy and laparoscopy are considered to be the gold standard methods, 3D-US and MRI are emerging as pioneering diagnostic techniques. The comparison of their efficacy is the main aim of this study. Methods: This study is a systematic review of prospective, retrospective and cross-sectional studies found across 3 databases (PubMed, Scopus and Web of Science) until April 2021.

1 Surgical approach for the non-communicating rudimentary horn of a pregnant unicornuate uterus during c-section

Introduction and aims of the study: Unicornuate uterus with a rudimentary horn is a congenital uterine malformation as a result of fusion defects of the Mullerian ducts and is commonly associated with renal tract anomalies. This pathology relates to poor obstetric outcomes, moreover, since pre- and post-conceptional management of rudimentary horns with functioning endometrium remains indefinite. The aim of this report is to illustrate a different approach to the rudimentary horn at the moment of delivery.

Spontaneous twin pregnancy in uterus bicornis unicollis complicated with preeclampsia: A case report

Introduction and importanceBicornuate uterus is a uterine malformation caused by abnormal Müllerian fusion, often leading to multiple obstetric complications. A twin pregnancy in this condition is extremely rare.Case presentationA 27-year-old patient (Gravida 3, Para 0) with a previous history of two spontaneous early miscarriages was diagnosed with uterus bicornis unicollis (unicervical bicornuate uterus). She presented with spontaneous twin pregnancy complicated with preeclampsia at 34 weeks + 6 days. Thus, she underwent cesarean section with two separate lower-segment incisions. Consequently, healthy twins were delivered successfully.Clinical discussionBicornuate uterus is a rare congenital uterine malformation, and only 16 cases of twin pregnancy associated with uterus bicornis unicollis have been reported worldwide. This uterine malformation can be discovered spontaneously in imaging or during obstetric complications such as spontaneous abortions, premature labor, premature rupture of membranes, malpresentations, and intrauterine growth restriction.In addition, the risk for preeclampsia in twin pregnancies is twice higher than singleton gestations.ConclusionTwin pregnancy in a bicornuate uterus is extremely rare; this phenomenon is yet to have guidelines for monitoring pregnancy and the mode of delivery.

Pattern of Morphological Anomalies of Uterus as Observed by Modern Investigation Techniques

Abstract Background: Due to the high prevalence and possible impact on the reproductive health of the of woman, congenital uterine malformation of female genital tract is a challenge for the therapeutic decision-making process. The current study aimed to evaluate the morphological anomalies of the uterus as observed by modern investigation techniques. Methods: This cross-sectional observational study was done in Prathima Institute of Medical Sciences, Nagnoor, Karimnagar, Telangana state. Women who were infertile and anxious to conceive and women were subjected to 2D ultrasound Screening followed by Hysterosalpingography. Those women who were fertile and found to have uterine anomalies and needed reconfirmation of the provisional diagnosis were subjected to Hysterosalpingography. Results: Out of n=300 cases studied n=288 (96%) were with normal uterine anatomy and n=12 (4%) cases were detected with uterine malformations as seen by USG. N=5 (40.5%) had a Bicornuate Uterus. While uterus didelphys and unicornuate uterus were seen in n=2 (16.67%) each. Arcuate uterus, uterine septum, uterine Aplasia/Hypoplasia were seen in n=1(8.33%) women each respectively. Conclusion: Due to the psychological consequences associated with infertility, the effects of uterine anomalies on the life of women are very important. It is critical to know the exact nature of the anomaly, to plan for the most appropriate treatment modality. As most of these anomalies cannot be rectified by medical management, they need surgical correction. For optimal results, it is important to know the exact type of anomaly for surgical correction. The 2D USG can be recommended as the basic modality to evaluate uterine anomalies. HSG/MRI may be used to delineate detail of anomalies if initially detected by the 2D scan.

3D ultrasound in the diagnosis of uterine anomalies

Congenital uterine malformations are genital tract anomalies that can arise at different stages in the development of the Müllerian ducts. Their exact epidemiology is unclear. Depending on the type of uterine anomaly, they can be asymptomatic or imply adverse reproductive outcomes (infertility, recurrent miscarriages, preterm labor), thus altering the quality of life. The American Society of Reproductive Medicine (ASRM) most common classification system divides uterine malformations into seven categories. The CONUTA (Congenital Uterine Anomalies) working group set up by the European Society of Human Reproduction and Embryology (ESHRE) together with the European Society for Gynecological Endoscopy (ESGE) developed and published in 2013 the new classification system of congenital uterine malformations which are grouped by classes according to common impairment of the primary embryological process, respectively formation, fusion, resorption. To plan their therapeutic management, one must first determine the exact type of uterine anomaly. Several methods can be used for diagnosing uterine anomalies. Three-dimensional ultrasound (3D-US) represents the essential diagnostic tool and should be used as the first line in most cases where the uterine malformation is suspected.

Diagnosing Septate Uterus Using Three-Dimensional Ultrasound Using Three Different Classifications: An Interobserver and Intraobserver Agreement Study.

Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed. To assess the interobserver agreement of nonexpert sonographers for classifying septate uterus using the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformations by Experts (CUME) classifications. A total of 50 three-dimensional (3D) volumes of a nonconsecutive series of women with suspected uterine malformation were used. Two nonexpert examiners evaluated a single 3D volume of the uterus of each woman, blinded to each other. The following measurements were performed: indentation depth, indentation angle, uterine fundal wall thickness, external fundal indentation, and indentation-to-wall-thickness (I:WT) ratio. Each observer had to assign a diagnosis in each case, according to the three classification systems (ESHRE/ESGE, ASRM, and CUME). The interobserver agreement regarding the ESHRE/ESGE, ASRM, and CUME classifications was assessed using the Cohen weighted kappa index (k). Agreement regarding the three classifications (ASRM versus ESHRE/ESGE, ASRM versus CUME, ESHRE/ESGE versus CUME) was also assessed. The interobserver agreement between the 2 nonexpert examiners was good for the ESHRE/ESGE (k = 0.74; 95% confidence interval [CI]: 0.55-0.92) and very good for the ASRM and CUME classification systems (k = 0.95; 95%CI: 0.86-1.00; and k = 0.91; 95%CI: 0.79-1.00, respectively). Agreement between the ESHRE/ESGE and ASRM classifications was moderate for both examiners. Agreement between the ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2. Agreement between the ASRM and CUME classifications was good for both examiners. The three classifications have good (ESHRE/ESGE) or very good (ASRM and CUME) interobserver agreement. Agreement between the ASRM and CUME classifications was higher than that for the ESHRE/ESGE and ASRM and ESHRE/ESGE and CUME classifications.