Uterine Contour Research Articles

Is There a Difference in Sonographic Estimation of Amniotic Fluid Volume When Measuring With the Probe Perpendicular to the Floor Compared With Perpendicular to the Uterine Contour?

This study sought to determine whether there is a significant difference in amniotic fluid measurements when measuring perpendicular to the floor compared with perpendicular to the uterine contour using both amniotic fluid index and single deepest pocket. This was a single-centre, prospective study of women with singleton gestation who were undergoing fetal ultrasound examination. A total of 240 women were enrolled, and single deepest pocket and amniotic fluid index were measured with both techniques. Correlation coefficient and intraclass correlation coefficient were used to assess the agreement between the values using the two methods of measurement (Canadian Task Force Classification II-2). A strong correlation was found between amniotic fluid index measurements (correlation coefficient 0.82; intraclass correlation coefficient 0.7). A strong correlation also was found between single deepest pocket measurements (correlation coefficient 0.7; intraclass correlation coefficient 0.6). The measurement of amniotic fluid index and single deepest pocket can be performed either perpendicular to the floor or perpendicular to the uterine contour. There is no significant difference between these measurements and they correlate well.

Combined Ultrasound and Cone Beam CT Improves Target Segmentation for Image Guided Radiation Therapy in Uterine Cervix Cancer

PurposeAdaptive radiation therapy strategies could account for interfractional uterine motion observed in patients with cervix cancer, but the current cone beam computed tomography (CBCT)-based treatment workflow is limited by poor soft-tissue contrast. The goal of the present study was to determine if ultrasound (US) could be used to improve visualization of the uterus, either as a single modality or in combination with CBCT.Methods and MaterialsInterobserver uterine contour agreement and confidence were compared on 40 corresponding CBCT, US, and CBCT-US-fused images from 11 patients with cervix cancer. Contour agreement was measured using the Dice similarity coefficient (DSC) and mean contour-to-contour distance (MCCD). Observers rated their contour confidence on a scale from 1 to 10. Pairwise Wilcoxon signed-rank tests were used to measure differences in contour agreement and confidence.ResultsCBCT-US fused images had significantly better contour agreement and confidence than either individual modality (P < .05), with median (interquartile range [IQR]) values of 0.84 (0.11), 1.26 (0.23) mm, and 7 (2) for the DSC, MCCD, and observer confidence ratings, respectively. Contour agreement was similar between US and CBCT, with median (IQR) DSCs of 0.81 (0.17) and 0.82 (0.14) and MCCDs of 1.75 (1.15) mm and 1.62 (0.74) mm. Observers were significantly more confident in their US-based contours than in their CBCT-based contours (P < .05), with median (IQR) confidence ratings of 7 (2.75) versus 5 (4).ConclusionsCBCT and US are complementary and improve uterine segmentation precision when combined. Observers could localize the uterus with a similar precision on independent US and CBCT images.

A Study of Maternal Outcome in Uterine Rupture in Pregnancy at a Tertiary Care Institute

Aim and Objective: The present research was carried out with an objective to determine the incidence, etiology, trend, and management, maternal and fetal outcome of ruptured uterus and to identify the preventive measures. Material and Methods: A prospective observational study was conducted over a period of 2 years from Nov 2012 – Nov 2014 in a tertiary care hospital of Mumbai, India. A total of 40 patients who came with rupture of uterus in pregnancy were studied. These cases were analyzed based on clinical features, etiology and risk factors of rupture uterus, the mode of management and the foetal and maternal outcome. Results: There were 40 cases of uterine rupture out of 32,200 deliveries giving an incidence of 1 in 805 i.e. 0.12%. Most common clinical features were those of classical signs of rupture with ill defined uterine contour, superficially felt foetal parts and absent foetal heart sounds. The commonest cause of rupture was due to separation of previous cesarean scar rupture (72.5%). The lower uterine segment was the commonest site of rupture. Rent repair was the commonest procedure done in the cases of ruptured uterus. Perinatal mortality of 77.5% and maternal mortality of 10% was observed in this study. Conclusion: Skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.

Preimplantation 3D ultrasound: current uses and challenges.

The preimplantation ultrasound (US) refers to targeted imaging of the uterus and adnexa prior to assisted reproductive techniques (ART) to optimize the infertility treatment outcomes. After a thorough evidence based literature review, we propose the use of transvaginal three-dimensional (3D) US during the early follicular phase. A systematic approach for 3D US examination consists of a detailed examination of the uterine shape, size and contour, evaluation of the endometrial thickness, volume, pattern and vascularity, and assessment of the junctional zone regularity, echogenicity and thickness. Uterine anatomy is explored in the coronal plane by simultaneous visualization of the uterine cavity, the external surface of the fundus and cervix. Saline infusion sonogram (SIS) is recommended for patients with increased endometrial volume, abnormal endometrial pattern and irregular uterine cavity shape suggestive of Müllerian duct anomalies or acquired intracavitary abnormalities. Myometrial lesions should be recognized and proper dimensions and locations should be ascertained. Ovarian dimensions and volume are measured and the antral follicle count is recorded. Adnexa are carefully assessed for masses, endometriosis and dilated tubes. Color power Doppler US may be applied to evaluate vascularity of the ovaries and pelvic lesions. Hysterosalpingo-contrast-sonography (Hy-Co-Sy) should be optimally utilized for assessment of tubal patency. Accessibility and mobility of the ovaries should be checked in real time for better planning of the ultrasound-guided oocyte retrieval. The cul-de-sac is assessed for the presence of free fluid or masses.

Successful term delivery after Khairy’s modified B-lynch suture technique: First case report

Abstract Postpartum hemorrhage (PPH) is a life-threatening obstetric complication. Uterine atony is the most common cause presenting in approximately 80% of cases. As regards management options, B-lynch brace suture, and its modifications have been used for more than a decade with a great success as a substitution for hysterectomy. Their efficiency in preserving future fertility is not well-established. This case reports the first successful pregnancy and delivery after one of the recent B-lynch suture modifications “Khairy’s modification” for control of atonic PPH during cesarean delivery. The patient got pregnant two months after the surgery. The course of pregnancy was smooth and she was delivered by Repeat cesarean section with no deformities of uterine cavity or contour. Khairy’s modified B-lynch suture is an effective technique that has no reported complications of the classic B-lynch suture or affection of subsequent fertility.

Metroplasty to treat chronic pelvic pain resulting from outflow tract müllerian anomalies

Chronic pelvic pain can result from noncommunicating uterine cavities in patients with müllerian anomalies. Traditional management has been to resect the noncommunicating uterine horn. Two cases are described. One had a unicornuate uterus with noncommunicating left uterine horn (American Fertility Society [AFS] classification IIb) and the other had a normal external uterine contour with noncommunicating left uterine cavity that did not fit any category of the AFS classification of müllerian anomalies. Attempts at connecting the noncommunicating cavities hysteroscopically failed in both cases. Successful unification of the cavities was subsequently achieved in the first case using the classic Strassman metroplasty with the assistance of the robot. The unification of uterine cavities was achieved using a modified Strassman metroplasty in the second patient, as there was no uterine horn for landmark. Robot assistance was utilized in this case as well. Both patients are symptom free after surgery. We conclude that laparoscopic Strassman metroplasty, with or without robot assistance, is a viable alternative to resection of uterine horns in patients with hematometra, chronic pelvic pain, and noncommunicating uterine cavities.

Natural history of early first-trimester pregnancies implanted in Cesarean scars.

To describe the ultrasound findings and natural history of pregnancies implanted within or on Cesarean section scars in the first trimester of pregnancy. This was a prospective observational study of 10 women diagnosed with a pregnancy implanted in or on a Cesarean section scar in the first trimester, who declined medical intervention because of their desire to continue the pregnancy. The study population comprised women at < 12 weeks' gestation who were seen in our early pregnancy unit between January 2011 and September 2013. Nine women were followed up by serial ultrasound examinations and had detailed care plans for delivery at King's College Hospital (KCH). One woman was followed up and delivered at another teaching hospital. The first-trimester ultrasound findings were compared with the clinical outcome of the pregnancy. The nine patients who were followed up at KCH developed ultrasound findings of morbidly adherent placenta (MAP) in the second and third trimesters. All 10 patients were diagnosed with MAP at the time of delivery by Cesarean section. The gestational age at delivery ranged from 26 to 38 weeks. The uterus was conserved in five patients, and Cesarean hysterectomy was performed in the remaining five. All three women with complete implantation of the gestational sac within the scar and two of three cases with placental lakes in the first trimester had hysterectomies. The two cases with bulging of the gestational sac out of the uterine contour had a preterm emergency hysterectomy due to placenta percreta. Histology confirmed placenta accreta in the five hysterectomy specimens. There were no fetal or neonatal complications. Implantation of a pregnancy on or in a Cesarean section scar is a precursor of MAP; however, the degree of morbidity associated with this implantation is variable and difficult to predict based on first-trimester ultrasound findings only. The assessment of ongoing pregnancies implanted in Cesarean scars is most beneficial when performed between 7 and 9 weeks' gestation. Complete implantation within the myometrial defect, bulging of the trophoblast from the uterine contour and large placental lakes in the first trimester are ultrasound findings that may predict severe placenta accreta or percreta and consequently a poor outcome.

Developing and evaluating an undergraduate radiology teaching programme

Developing and evaluating an undergraduate radiology teaching programme

Rupture of Gravid Non-Communicating Horn with 18 Weeks Pregnancy

We have read with interest the article titled “Rupture of a Gravid Non-Communicating Horn with 18-weeks Pregnancy” by Mithil M. Patil, Girija Wagh, and Y. S. Kulkarni in J Obstet Gynaecol India [1]. It is an interesting case report about how a patient suspected as suffering from ruptured spleen actually turned out to be ruptured non-communicating horn pregnancy. However, the article has raised few concerns in our mind, which are as follows. Firstly, what was the reason to suspect spleen rupture in a pregnant female presenting with shock, when most common differential diagnosis would be ruptured ectopic or abruptio placenta. Was there any reason to suspect spontaneous spleen rupture without any antecedent trauma? Secondly, it would be of great academic value to add ultrasound scan images to publication, since it is interesting to note that ultrasound scan could report fetal bradycardia, normal uterine contour, and no visceral injury in gross hemoperitoneum but missed the fetus lying outside the uterus. How would such images appear. Was it not sufficient to suggest abdominal pregnancy when uterus was looking normal in contour and fetus was not lying in the confines of uterine walls? Thirdly, tachycardia sets in much before fall in blood pressure and in the present case patient has a pulse rate of hundred which is almost the higher side of normal pulse rate in pregnancy. With systolic BP of 70 mmHg we would expect a pulse rate shooting to something like 150 or even beyond. What would be the reason of relative bradycardia in a patient in shock with systolic BP of 70 mm of Hg. In addition, it will be interesting to know what methods were used to achieve homeostasis during the repair of uterus at the site of excision of ruptured non-communicating horn in a highly vascular status of pregnant uterus further complicated with deranged coagulation profile.

Laparoscopically-assisted, Hysteroscopic Removal of an Interstitial Pregnancy With a Fertility-Preserving Technique

Described is a novel surgical management of an unruptured interstitial pregnancy with preservation of the ipsilateral fallopian tube and uterine cornua. The patient was a 34-year-old woman, gravida 3, para 1, with an unruptured left interstitial pregnancy at 9 weeks' gestation, who desired preservation of fertility. The ectopic pregnancy was entirely removed via laparoscopically assisted hysteroscopy with a fertility-preserving surgical technique, with minimal blood loss, preservation of reproductive organs, restoration of anatomy, a patent ipsilateral fallopian tube, and expedient return to normal reproductive function. After the procedure, serial human chorionic gonadotropin levels were obtained until they were <5 mIU/mL. A hysterosalpingogram obtained 2 months after the procedure showed normal uterine and fallopian tube contour and bilateral tubal patency. We conclude that this laparoscopically assisted hysteroscopic technique is a safe and efficient fertility-preserving approach to management of an unruptured interstitial pregnancy.

Septate uterus: nosographic overview and endoscopic treatment

To comment on the prevalence, diagnosis, and treatment of the septate uterus, with special reference to hysteroscopic metroplasty and its effect on reproductive outcome, we searched publications in PubMed and Embase. Original articles, meta-analysis, reviews, and opinion articles were selected. The studies suggest that the prevalence of the septate uterus is increased in women with repeated pregnancy loss and infertility. Reliable diagnosis depends on accurate assessment of the uterine fundal contour and uterine cavity by means of magnetic resonance and three-dimensional ultrasound. Pertinent published data comparing pregnancy outcome before and after hysteroscopic metroplasty indicated a marked improvement after surgery. Magnetic resonance and three-dimensional ultrasound represent the gold standard for diagnosis of septate uterus. Hysteroscopic metroplasty with its simplicity, minimal postoperative sequelae, and improved reproductive outcome is the gold standard for treatment, not only in patients with recurrent pregnancy loss and premature labor but also in patients with infertility, especially if in vitro fertilization is being contemplated.

Term Viable Abdominal Pregnancy- A Case Report

A lady of 24 years was presented with the complains of 40 weeks pregnancy and abdominal pain for 3 days. Her abdominal examination revealed that abdomen was tense, tender,uterine contour could not be ascertained. A lining foetus of transverse lie was felt in the upper part of abdomen. Liquor was seems to be insufficient. Her USG findings was term pregnancy, oligohydramnions,transvers lie with central placenta previa. Her laperatomy finding was intact shiny amniotic sac was present at the upper part of abdomen, uterus was 12 weeks size and was in normal position that is within the pelvic cavity. Lie of the foetus was transverse,placenta was found to be implanted on the fundus of uterus. Baby was delivered by breech extraction. Subtotal hysterectomy was done due to profuse uncontrolled bleeding from placental implantation site. Her post operative period was uneventful and recovery was good. She was discharged on 8th post operative day.DOI: http://dx.doi.org/10.3329/medtoday.v24i2.15015 Medicine Today 2012 Vol.24(2): 85-86

PM.77 Suspect the Unexpected!: A Rare Case of Uterine Necrosis and Asymptomatic Rupture Following Induced Miscarriage at 20 Weeks Gestation

A 38 year-old parous lady with an unscarred uterus was admitted for induction of medical miscarriage following intrauterine death of a fetus with Edwards syndrome. She was asymptomatic post administration...

False contouring effect of the uterine wall during hysteroscopy a lesson from immediate hydrosonography

A 42 years old woman suffering from repeated events of intensive vaginal bleeding during the week off birth control pills was referred for diagnostic hysteroscopy. The patient underwent hysterohy drosonoscopy, a 3-step procedure, including a transvaginal ultrasound scan, a diagnostic hysteroscopy and immediate hydrosonography. A3 cmintramural myoma was detected by the ultrasound scan without impinging onto the uterine cavity as visualized by diagnostic hysteroscopy. However, continuous hydrosonographic evaluation of the uterus, performed immediately afterwards, unveiled a fibroid with a significant intracavitary portion. A falsely normal cavity could be appreciated by high pressured hysteroscopy, while during the gradual fall of the intracavitary pressure a significant lesion could be revealed encroaching into the lumen. In the absence of an agreed distention pressure range during hysteroscopy, an immediate hydrosonography may serve as an auxiliary tool to follow the uterine wall contour as distention pressure declines during the eventual escape of the distention fluid from the lumen. Uterine wall contour is heavily dependent on the distension pressure and guidelines for intrcavitary pressure during hysteroscopy are evidently needed.

A mullerian anomaly ‘‘without classification’’: Septate uterus with double cervix and longitudinal vaginal septum

The incidence of congenital uterine anomalies in the general population is estimated to be 0.001e10% [1]. The most commonly seen anomalies are septate and arcuate uteri, which represent 75% of all mullerian anomalies. The majority of mullerian duct anomalies are considered to be sporadic or multifactorial in nature; however, polygenic and genetic patterns of inheritance have been described [2,3]. There are two theories to explain the development of mullerian duct anomalies, the classical unidirectional regression theory, and an alternative bidirectional theory in which it is hypothesized that the process proceeds simultaneously in both the cranial and the caudal directions. Anomalies such as a complete septum with a duplicated cervix or an isolated vertical upper vaginal septum could only be explained by the second theory [4,5]. We report the case of a woman with a complete uterine septum, and a double cervix with a longitudinal vaginal septum, and search the available literature for similar cases. A 28-year-old nulligravida woman was admitted to our hospital due to being unable to conceive. She had been married for 2 years and had never used any contraceptive methods. She had regular menses but had dysmenorrhea and sometimes also dyspareunia. A longitudinal vaginal septum from the midportion of the vagina to the cervix, and the presence of two separate cervixes were identified following a speculum examination. Transvaginal ultrasound showed a normal uterine contour, then hysterosalpingography was performed. When a contrast media was injected into the right cervix, the uterine cavity was filled, however, the fallopian tubes were not. When the contrast media was then injected into the left cervix and uterine cavity, the left fallopian tube and pelvic cavity filled with contrast media, but the right fallopian tube was not filled with contrast media. Following

MRI-based Preplanning Using CT And MRI Data Fusion In Patients With Cervical Cancer Treated With 3D-based Brachytherapy: Feasibility And Accuracy Study

MRI-based Preplanning Using CT And MRI Data Fusion In Patients With Cervical Cancer Treated With 3D-based Brachytherapy: Feasibility And Accuracy Study

Case of the Month #169: Septate Uterus with Cervical Duplication and Vaginal Septum

A septate uterus with a complete septum arising from the midline fundus, 2 separate cervices, longitudinal septum of the vagina, and a flat external uterine fundal contour are shown in Figures 1 and 2. T2-weighted and gadoliniumenhanced fat-saturated 3D T1-weighted images (Figures 3e5) show a enhancing mass within the left cervix, which extends into the upper aspect of the left vaginal canal. It also appears to extend into the vaginal mucosa anteriorly.

MRI of a twin pregnancy in a uterus bicornis unicollis

1At 33 weeks, an emergency caesarean section delivery was performed via two separate classic incisions into each corpus. A spectrum of congenital uterine malformations is attributed to the abnormal fusion of the pair of Mullerian ducts or failure of the absorption of the uterine septum; 2,3 bicornuate uterus is the most common. 3 Spontaneous twin gestation in a case of bicornuate uterus is rare. MRI is a valuable adjunct to sonar, which can be diagnostically limited in the third trimester. MRI assists in delineating external uterine contour, characterising septal composition, endometrial/myometrial ratio and defining the subtype of Mullerian duct anomalies. 3 Deep uterine bifurcation causes myometrial distortion denying each corpus the full complement of musculature,

The role of 3-dimensional ultrasound for the diagnosis of congenital uterine anomalies

Objectives: To demonstrate the value of 3-dimensional (3-D) ultrasound (US) in the diagnosis of congenital uterine anomalies. Methods: Fifty one infertile patients referred to our US unit during 12 years period, with suspected diagnosis of congenital uterine anomalies by previous HSG or 2D US examinations, were evaluated by transvaginal 3-D US. The 3-D US diagnoses were compared to the initial HSG diagnosis, and to hysteroscopic evaluation when performed. Results: 3-D scan confirmed the initial HSG diagnosis in 27 out of 51 (52.9%) women. The concordancy rates between the initial diagnosis by HSG and 3-D US results were 30.4% for bicornuate uterus; 75% for arcuate uterus; 83% for septate uterus; and 80% for unicornuate uterus. Of the 13 cases with normal HSG and suspicious 2-D US, 30.8% were found to be normal by 3D sonography. In cases where hysteroscopy was done, the results were 100% in concordance with the 3-D US evaluations. Conclusions: 3-D US is an accurate test for the assessment of uterine congenital anomalies. Its ability to concomitantly visualized, the external uterine contour with the uterine cavity on the same coronal plan, makes this noninvasive, easy to perform test the procedure of choice for the diagnosis of uterine anomalies.

The Unicornuate Uterus with an Occult Adenomyotic Rudimentary Horn

We report 2 case of an atypical variant of unicornuate uterus in 2 adolescent patients with severe dysmenorrhea. Pelvic ultrasonography and magnetic resonance imaging identified a normal uterine contour. On the right side within the uterine fundus, a nodule was detected with a small hypoechogenic content. At laparoscopy the uterus and adnexae appeared to be normal. No endometriotic lesions were identified. Hysteroscopy identified a single regular cervical canal and a uterine cavity resembling that of a left unicornuate uterus, with a single regular left tubal ostium. Complete resection of the right uterine nodule along with an ipsilateral salpingectomy was performed. The nodule contained a small endometrial cavity and hematometra. Histologic study showed a cavitated adenomyotic uterine rudiment. The patients were discharged on the second postoperative day. No intraoperative or postoperative complications or recurrence of pelvic pain occurred.