Uterine Shape Research Articles

Echo-Anatomy of the Uterus of Pubescent Girls in Lomé (Togo) and its Correlation with the Occurrence of Dysmenorrhea

Introduction: This study aimed to examine the echo morphometry of the uterus in pubescent girls in Lomé and its potential relationship with essential dysmenorrhoea. Essential dysmenorrhoea, characterized by menstrual pain without identifiable causes, affects a significant portion of young women. Methodology: This was a preliminary, prospective, cross-sectional, descriptive, and analytical study performed over six months in the anatomy laboratory of the University of Lomé (Togo), at a teaching hospital Campus and in a school in Lomé. The study was based on a convenience sample of 100 pubescent, nulligravid pupils aged between 13 and 18 years with no pelvic surgery history. Results: Dysmenorrhea was noted in 60% of cases. No abnormality of uterine shape or structure was observed. In seven percent of cases, uterine malposition’s such as retroflection and retroversion were noted. There was a statistically significant correlation between uterine retroflection and the occurrence of dysmenorrhoea. The values of the biometric parameters tended to increase in girls with dysmenorrhoea. Conclusion: To corroborate the results of the aforementioned preliminary work, a subsequent study on the same sample using a more objective means of exploration than ultrasound is necessary. KEYWORDS: Echo-Anatomy, Uterus, Dysmenorrhoea, Lomé (Togo).

The Need for Gynecological Ultrasound Examination on IUD Acceptors

Maternal Mortality Rate (MMR) signifies the number of women who perish due to pregnancy-related complications or their treatment per 100,000 live births, with septic shock emerging as a notable contributor. One such complication linked to septic shock is the rare but perilous translocation of intrauterine devices (IUDs), leading to potential uterine perforation. A recent case of maternal death underscored the urgency of prompt intervention in intraabdominal IUD translocations, with the delay stemming from the refusal of necessary surgical procedures. This tragic incident emphasizes the critical need for timely detection and management of IUD translocations to avert life-threatening complications. Integrating routine gynecological ultrasound examinations to assess uterine shape for prospective IUD acceptors and promoting informed consent through engagement with family members, community leaders, and policymakers is essential in mitigating the risk of maternal mortality associated with such complications.

Parametric Solid Models of the At-Term Uterus From Magnetic Resonance Images.

Birthing mechanics are poorly understood, though many injuries during childbirth are mechanical, like fetal and maternal tissue damage. Several biomechanical simulation models of parturition have been proposed to investigate birth, but many do not include the uterus. Additionally, most solid models rely on segmenting anatomical structures from clinical images to generate patient geometry, which can be time-consuming. This work presents two new parametric solid modeling methods for generating patient-specific, at-term uterine three-dimensional geometry. Building from an established method of modeling the sagittal uterine shape, this work improves the uterine coronal shape, especially where the fetal head joins the lower uterine wall. Solid models of the uterus and cervix were built from five at-term patients' magnetic resonance imaging (MRI) sets. Using anatomy measurements from MRI-segmented models, two parametric models were created-one that employs an averaged coronal uterine shape and one with multiple axial measurements of the coronal uterus. Through finite element analysis, the two new parametric methods were compared to the MRI-segmented high-fidelity method and a previously published elliptical low-fidelity method. A clear improvement in the at-term uterine shape was found using the two new parametric methods, and agreement in principal Lagrange strain directions was observed across all modeling methods. These methods provide an effective and efficient way to generate three-dimensional solid models of patient-specific maternal uterine anatomy, advancing possibilities for future research in computational birthing biomechanics.

Association of congenital uterine anomaly with abnormal placental cord insertion and adverse pregnancy complications: a retrospective cohort study

Objective Congenital uterine anomalies during pregnancy increase the risk of pregnancy complications such as miscarriage, preterm delivery, fetal malpresentation, cesarean delivery, and fetal growth restriction. However, few studies have examined uterine anomalies in relation to perinatal complications other than those mentioned above. We investigated the association between pregnancies complicated by congenital uterine anomalies and various perinatal outcomes at our institution. Methods This retrospective cohort study was conducted from January 2009 to May 2021. We included cases of uterine anomalies, such as septate, bicornuate, unicornuate, and didelphic uterus. First, the perinatal complications and neonatal outcomes were compared between pregnancies complicated by uterine anomalies and those with normal uteri. Second, we conducted an analysis based on the type of uterine anomalies classified into two groups: the minor anomaly group consisted of anomalies limited to the uterine cavity, such as the septate uterus, whereas the major anomaly group included anomalies affecting the uterine shape, such as bicornuate, unicornuate, and didelphic uterus. We compared the incidence of perinatal complications among the major anomaly, minor anomaly, and normal uterus groups. Results During the study period, 45 pregnancies were complicated with uterine anomalies. The minor anomaly group included 11 patients and the major anomaly group included 34 patients. The incidence of fetal malpresentation was significantly higher in the uterine anomaly group than in the normal uterus group (18% vs. 3.7%, p = .04). Furthermore, the frequency of abnormal placental cord insertion was significantly higher in the uterine anomaly group (16% vs. 3.7%, p = .01). Examination based on the type of uterine anomaly revealed significant differences in cervical incompetence, malpresentation, cesarean section, and abnormal placental cord insertion. Cervical incompetence was more likely in patients with minor anomalies. In contrast, fetal malpresentation, cesarean section, and abnormal placental cord insertion were more likely in the major anomaly group. Conclusions In addition to the findings reported in previous studies, abnormal placental cord insertion was more frequent in pregnancies complicated by uterine anomalies.

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.

ODP421 Patterning the Antero-posterior and Dorso-ventral Axes of the Female Reproductive Tract is Dependent on Amhr2+ Mesenchyme in Mice

Abstract The functional properties of the female reproductive tract organs are dependent on establishing the correct organ-specific epithelial morphologies and differentiation. At the early stage, XX embryos possess the progenitors for both male and female reproductive tracts, also known as the Wolffian and Müllerian ducts. The two ducts are surrounded by their own distinct mesenchymes. During sexual differentiation, the XX embryo eliminates the Wolffian duct and maintains the Müllerian duct, which eventually gives rise to the oviduct, uterus, cervix, and vagina in an antero-posterior fashion. Our previous study revealed that the Wolffian duct mesenchyme was not eliminated in the XX embryo. Instead, it becomes a unique mesenchymal population localized at the mesometrial (dorsal) side of the uterus, contrary to the residence of the Müllerian duct mesenchyme-derived cells at the anti-mesometrial (ventral) side. It has been well-established that epithelial morphogenesis is regulated by its surrounding mesenchyme. Therefore, a subsequent question is how the two different mesenchymes contribute to the morphogenesis of the female reproductive tract. The Müllerian duct mesenchyme uniquely expresses Amhr2. To investigate the functional significance of the Müllerian duct mesenchyme in vivo, we designed the Amhr2-Cre; Rosa-DTA genetic cellular ablation model to partially remove Amhr2+ Müllerian duct mesenchyme in the female reproductive tract. After partially ablating the Amhr2+ Müllerian duct mesenchyme, the oviduct became shorter and lost its characteristic coiling. Oviductal epithelial proliferation was significantly reduced, which contributed to the defective oviductal elongation and coiling. Surprisingly, the regionalization of the oviduct into the infundibulum, ampulla, and isthmus was not affected in the ablation group, suggesting that oviductal coiling and regionalization are two uncoupled events. The uterus looked shorter in the ablation group. Histology analysis further revealed the disorganization of the lumen shape. Normally, the lumen shape of the neonatal uterus forms an ellipse with the long axis parallel to the dorso-ventral axis. In the ablation group, however, the uterine shape was irregular and the long axis of the lumen became perpendicular to the dorso-ventral axis. These results demonstrate that Amhr2+ mesenchyme is indispensable for the morphological patterning of the female reproductive tract along both the antero-posterior and dorso-ventral axes. To investigate the mechanisms underlying the morphological defects in the ablation group, we are in the process of investigating cellular events that have been implicated in the female reproductive tract patterning: cellular apoptosis, proliferation, and orientation of cell division. Taken together, our study provides a novel model to understand how the mesenchyme patterns the female reproductive tract in place. This work was supported by NIH grant R00 HD096051. Presentation: No date and time listed

Falloposcopic tuboplasty: an easy, quick, and safe technique

To describe our simplified technique for falloposcopic tuboplasty (FT) and demonstrate its principle and results. A step-by-step description of the technique and demonstration of its principle using a clay model. Private infertility clinics in Osaka and Tokyo operated by 10 physicians. A total of 431 infertile women with a diagnosis of unilateral or bilateral proximal tubal occlusion (6 cm from the uterotubal ostia), between October 2013 and February 2019 were included. These patients underwent routine work-ups for infertility, including a semen analysis, hysterosalpingography, antimüllerian hormone, basal luteinizing hormone/follicle-stimulating hormone and prolactin concentrations during menstruation, postcoital test in the periovulatory period, and estradiol and progesterone concentrations in the middle of the luteal phase. Physicians performed hysterosalpingography to evaluate tubal patency and uterine shape. Saline infusion sonography was not conducted because it does not accurately identify regions of tubal occlusion and/or stenosis. The principle of our simplified technique for FT is that a hole is located at the side of the FT catheter tip. Therefore, the balloon and fiberscope move away from the catheter line (Fig.1). The uterotubal ostium is located at the tip-end of the triangle of the uterine cavity. When a balloon is inserted while visualizing the uterotubal ostium at the nearest position to the ostium, the balloon hits the uterine wall. When a balloon is inserted 5-10 mm from the uterotubal ostium without visualization, the balloon may be easily placed in the ostium through its convex angle, allowing it to slide into the uterine wall (Figs. 2 and 3). Step 1: Confirm anteflexion or retroflexion of the uterus by ultrasound. Step 2: Confirm the direction of the uterotubal ostia by hysteroscopy. Step 3: Adjust the angle of the FT catheter according to steps 1 and 2, insert the catheter into the end of the uterus, pull it back 5-10 mm (without visualizing the uterotubal ostia), and then fix it to the forceps. Catheter placement away from the tubal ostium is confirmed by the residual length of the moving part of the catheter. An attending instructor should ask the operator about the feeling of rigidity when the catheter does not advance and then suggest whether to proceed or stop. In the latter case, the catheter is not moved, saline is infused for 1 minute for lubrication, the balloon is pulled back using the fiberscope to remove the bunching of the balloon, and balloon pressure is changed as follows: 6→8→6→10→6 mmHg. Our institutional review board stated that approval was not required because the video describes the technique of our routine procedure. A description of the FT technique using a clay model and a demonstration of its application in our clinic. The average operative time was 15.4 minutes, and the clinical pregnancy rate was 24.4% (natural conception and intrauterine insemination without invitro fertilization). No significant differences were observed in the operative time or pregnancy rate among physicians. Approximately 17 FT procedures may be performed using one fiberscope. Our simplified technique, which was described and demonstrated in this video article, is a feasible and practical approach for performing FT. It provides excellent cost performance by saving fiberscopes. The most important point is "Introduce the balloon and fiberscope 5-10 mm away from the uterotubal ostia without visualizing it." To facilitate learning this technique, we recommend watching the video and then practicing FT without searching for the uterotubal ostia. Physicians master FT without any assistance by an attending instructor in ≤3 attempts.

Relation between uterine morphology and severity of primary dysmenorrhea.

Objective:This study aimed to evaluate whether uterine dimensions including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness measurements have a role in the severity of primary dysmenorrhea in virgin girls.Materials and Methods:Enrollment included 90 virgin girls suffering from primary dysmenorrhea. The girls were divided into three groups according to the severity of dysmenorrhea, which was determined by the visual analog scale (VAS). Patients with VAS scores of 8-10 comprised the severe primary dysmenorrhea group (n=30), 4-7 the moderate primary dysmenorrhea group (n=30), and 1-3 the mild primary dysmenorrhea group (n=30). Uterine characteristics including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness were measured by a high-resolution four-dimensional ultrasound device with real-time capacity. They were recorded to determine if they can be predictors of dysmenorrhea severity.Results:Girls with severe primary dysmenorrhea were more likely to complain of midline pain as opposed to mild and moderate cases with lateral or diffuse pain. None of the uterine characteristics on ultrasonography examination were significant for predicting the severity of primary dysmenorrhea. There were no significant positive correlations between the dysmenorrhea severity and uterine corpus length, cervix length, and uterine volume degree. Any combination of the measured uterine features was not predictive for determining the severity of dysmenorrhea.Conclusion:Ultrasonographic measurements of uterine dimensions in virgins have low accuracy for predicting the severity of pain in primary dysmenorrhea.

Menstrual pattern of severe intrauterine adhesion following hysteroscopy adhesiolysis

Objective: The purpose of this study was to evaluate the menstrual and uterine shape in patients diagnosed with severe intrauterine adhesion (IUA) on hysteroscopy and to assess the outcome following hysteroscopic adhesiolysis.
 Materials and methods: It is a retrospective study of patients with severe intrauterine adhesion who attended with complain of infertility, abortion , and repeated dilatation and curettage to our institution from January 2017 and December 2017. Post hysteroscopic adhesiolysis the inserted of urinary balloon catheter and intrauterine device (IUD). The sodium hyaluronate gel was administered inside the uterus and oral cyclical hormonal treatment was initiated after the surgery to all patients to prevent reformationof adhesion, and promote endometrial regeneration respectively. The outcome of menstrual pattern and uterine shape were retrospectively analyzed. Data analyzed was performed with SPSS for Windows, version 20.0). Statistically significant level was set at p<0.05.
 Results: In a total number of 64 patients with severe intrauterine adhesion and mean age of 30.1 years old were participated in this study. No identification of any complication around the hysteroscopy adhesiolysis. Out of 64 severe IUA patients, 59 (92.1%) patients had second, 42 (65.6%) had the third hysteroscopic adhesiolysis procedure required. After 3 months follow-up, restore of uterine shape and 95 % of patients in progress to normal menstruation, which was considered as significant (p<0.05).
 Conclusion: The patients with severe intrauterine adhesion (IUAs) have found significant progress of normal pattern of menstruation with normal shape of the uterine cavity following hysteroscopic adhesiolysis. The repeat procedure and strategies are necessary for prevention of adhesions.
 Bangladesh Journal of Medical Science Vol.19(3) 2020 p.475-479

Prospective validation of craniocaudal tumour size on MR imaging compared to histoPAthology in patients with uterine cervical cancer: The MPAC study

PurposeTo determine the accuracy of MRI in detecting craniocaudal tumour extension, compared to histopathology, of the hysterectomy specimen in patients with early-stage uterine cervical cancer. Three complementary methods were investigated. Materials and methodsThirty-four patients with early-stage cervical cancer had pre-operative MRI, followed by radical hysterectomy or trachelectomy. 1) craniocaudal tumour extension was measured on MRI by two radiologists and compared to microscopy by a pathologist, 2) to compensate for changes in uterine shape between pre-operative MRI and the surgical specimen, craniocaudal tumour extensions were directly compared and appreciated as being a part of a 3-dimensional tumour by a radiation oncologist and resident, and 3) tumour size on MRI was compared macroscopically after digital non-rigid registration of the uterus, uterine cavity and tumour of both modalities. ResultsThe craniocaudal tumour extension measured on histopathology minus MRI gives: 1) on average +3 mm difference when measured by a radiologist compared to the microscopic extension (range −13 to +15 mm), 2) −0.2 mm (range −11 to +6.0 mm) when evaluated on MRI by a radiation oncologist compared to the macroscopic tumour; 3) after non-rigid organ registration, a margin of 10 mm around the tumour on MRI would be needed to cover 95% of the tumour in 90% of the patients. ConclusionsResults indicate that microscopic tumour extension towards the uterine fundus is within a margin of 10 mm around the visible tumour on MRI. The major source of measurement uncertainty is post-surgical change of organ shape and form.

Validation of whole-body radiographs for examining uterine disorders in sexually intact female rabbits.

The present study evaluated whole-body radiographs of female rabbits regarding uterine disorders. Based on radiographs of 143 rabbits, visibility, size, shape and density of the uterus, nutritional status of the animal and possible metastasis in other organs were examined. A suspected diagnosis was deduced. The radiological findings were compared with the results of the histopathological examination. Especially the nutritional status was important regarding the visibility of the genital tract. In 99 of the 130 visible uteri (76.2 %), a pathological alteration was detected. Thereof, endometrial hyperplasia was most frequently seen (63.6 %), followed by neoplasia (altogether 42.4 %, 39.4 % of these with adenocarcinoma), endometritis (35.4 %) and other diseases (18.2 %). Forty-six rabbits showed only one disease, 42 rabbits had two, 10 rabbits three and one rabbit four different diseases. Among 13 of the 143 uteri that were not visible in the radiograph four were altered pathologically. In 31 of the 130 rabbits with a visible uterine region (21.7 %) the uterus was unaltered. Visualising the uterus proved impossible in two of four skinny rabbits (2.8 %), whereas in all 39 obese rabbits the uterus was visible. Only in one of the four skinny rabbits was the uterus without pathological findings and six of the 39 obese rabbits showed no pathological alteration, visibility notwithstanding. Calcification indicated a tumourous occurrence in 23 of 53 cases. Except for one rabbit, the mineralised neoplasia was an adenocarcinoma (n = 22). Five animals with calcification in the uterine region showed no abnormalities. Of these, the calcification of four animals was no longer existent in the radiograph after ovariohysterectomy. Neoplastic changes in the uterus did not always show calcification. In 20 of the 44 patients with uterine neoplasia no calcification was seen. Changes in uterine size occurred in 118 of the 143 rabbits (82.5 %) and alteration of the uterine shape in 109 of the 143 rabbits (67.1 %). Thus, the above presented parameters - especially size, shape and mineralisation - are very important regarding uterine diseases.

Uterine dimensions in gravida 0 phase according to age, body mass index, and height in Chinese infertile women.

The aim of this study was to describe the size and the shape of gravida-0 uteri in infertile Chinese Han women according to age, height, and body mass index (BMI).Registered data obtained from the Department of Reproductive Medicine, Xiangya Hospital of Central South University, were collected and analyzed. The length, width, and anteroposterior diameter of the uteri of nonpregnant women aged 20 to 45 years were measured by transvaginal ultrasonography. Statistical analyses among different populations were conducted using a 1-way analysis of variance analysis or a Kruskal–Wallis H test.A total of 5726 primary infertile women were enrolled. The mean age of the sample group was 29.18 ± 4.22 years, and the mean BMI and the mean height of them were 21.51 ± 2.91 kg/m2 and 158.13 ± 4.71 cm, respectively. The mean uterine length, width, anteroposterior diameter, and L/W ratio were 49.33 ± 7.00 mm, 39.94 ± 7.23 mm, 44.95 ± 8.11 mm, and 1.2662 ± 0.2465, respectively. There were a statistically significant positive correlations between uterine length, width, anteroposterior diameter, and age in infertile women (all P < .001). Uterine L/W ratio gradually decreased with age, which was statistically significant (P < .001). The correlations between uterine length, width, anteroposterior diameter, and height were also considered statistically significant (all P < .001), while there was no correlation between L/W ratio and height. The results showed that uterine size and BMI had no statistical significance.The uterine length, width, and anteroposterior diameter gradually increased with increased age and height, but the increasing extents was different, and the uterine shape became rounder with age and had not changed with height in primary infertile women.

Application of uterine lower part breakwater-like suture operation in placenta previa

Objective: To explore the efficacy and safety of uterine lower posterior wall breakwater-like suture technique in controlling the intraoperative bleeding of placenta previa. Methods: From June 2016 to June 2017, 47 patients were diagnosed placenta previa in Union Hospital, Tongji Medical College of Huazhong University of Science and Technology. Posterior wall breakwater-like suture technique was used preferentially, as for cases with poor myometrium layer, lower anterior wall stitch suture was used at the same time. Bilateral descending branches of uterine artery ligation and Cook balloon compression of uterine lower segment was conducted when necessary. The clinic data of the 47 cases were analyzed. Results: Thirty cases (63.8, 30/47) were diagnosed placenta inccreta or percreta by ultrasound or MRI preoperatively. Senventeen cases were diagnosed as placenta accreta (36.2%, 17/47) . Thirty-four cases had the previous history of cesarean section. The average cervical canal length of 47 patients was (2.8±0.9) cm. There were 19 cases (40.4%,19/47) with 1 time posterior wall breakwater-like sutured and 16 cases (34.0%,16/47) with 2 or 3 times posterior wall breakwater-like sutured; 12 cases (25.5%,12/47) were treated with anterior wall stitch suture simultaneously.Ten cases (21.3%, 10/47) underwent uterine artery ligation, 17 cases (36.2%, 17/47) underwent COOK balloon compression on the staxis surface of lower segment. None of them had postpartum hemorrhage or performed internal iliac artery embolization. The median blood loss in the operation was 700 ml, the percentiles 25 was 500 ml, and the percentiles 75 was 1 200 ml. The blood loss ≥1 000 ml in 18 (38.3%, 18/47) patients,and the most serious one was 2 500 ml. The median blood transfusion volume (including allogenetic transfusion and autotransfusion) was 450 ml, the percentiles 25 was 228 ml, and the percentiles 75 was 675 ml. The average vaginal bleeding volume was (150±63) ml first day after operation. The mean hospitalization time was (4.7±1.0) days. The mean gestational weeks of pregnancy termination was (36.1±1.5) weeks, and the mean birth weight of newborns was (2 817±492) g. Apgar score:1-minute 7.8±1.1, 5-minute 8.9±0.8. No neonatal death, 16 cases were transferred to neonatal ICU (34.0%, 16/47) mainly for premature delivery and low birth weight. No complication was found in 6 months post-operation. Conclusions: Uterine posterior wall breakwater-like suture technique is a simple, safe and effective way in controlling intraoperative bleeding of placental previa.Lower anterior wall stitch suture could effectively stop bleeding and restore the normal uterine shape. Combined application of various methods could significantly reduce the incidence of postpartum hemorrhage and hysterectomy, and improve maternal and fetal prognosis.

Successful Treatment of Robert’s Uterus by Two Different Ways: Laparotomy or Hysteroscopy: Case Report and Literature Review

Robert’s uterus is unique malformation described as a septate uterus with non-communicating hemicavity; i.e. a blind uterine horn usually with unilateral hematometra, contralateral unicornuate shaped uterine cavity and normal external shape of the uterine fundus. Pelvic pain intensified near the menses in young women is the main symptom and recurrent pregnancy loss and infertility are the main questions when they grow up. In this study, we described two cases of Robert’s uterus: one was Excised of the septum on laparotomy and then successfully became pregnant and gave birth, the other was treated with hysteroscopy and 1 month later, another hysteroscopy showed the uterine cavity shape was closer to the normal. And we also summarized the diagnosis and treatment from the current reports.

P26.08: Screening for congenital uterine anomalies by three‐dimensional transvaginal ultrasound in premenopausal women: the online added information

To establish the feasibility of applying three-dimensional transvaginal ultrasound (3DTVUS) in an unselected population of premenopausal women, in screening for congenital uterine anomalies (CUA). Secondary aims were to estimate the incidence of CUA in this population and to determine the on-line added information of 3DTVUS. The prospective study used 3DTVUS as a screening tool for CUA, after 2D gynecological scanning. Two observers were involved in the study, interpreted on-line the acquired volumes of the uterus, and classified them using the ASRM (American Society for Reproductive Medicine) classification system, with a further division, in major and minor anomalies. The study included 3155 volume datasets for interpretation, from which 3004 (95.21%) were declared as interpretable. We had an incidence of 2.25% major CUA and 6.75% - minor ones. Age range was 16 to 53 and mean age was 31.4. 2902 (91.9%) women were Caucasian. The main indication for imaging was routine medical examination. The most common reason for inadequate assessment of uterine shape was the poor visibility of the endometrium, related to the menstrual cycle day. Associated pathology (like fibroids, adenomyosis, polyps and endometriosis) rarely interfered the proper visualisation of the internal contour. In a subset of 145 cases with CUA with corporeal distortion only, magnetic resonance imaging (MRI) offered no additional information. The 3DTVUS modified the 2D classification in 21 (29.5%) cases of major CUA and excluded 54 minor CUA. In our unselected patient population the 3DTVUS assessment of the shape of the uterus was possible in 95.21% of cases. This study demonstrates the feasibility of incorporating the on-line 3D sonographic evaluation of corpus uterine anatomy in routine gynecology scanning. This simple and low time consuming examination may serve as a screening tool to identify patients in need of increase surveillance in pregnancy or in those undergoing endouterine manoeuvres.

A Rare Uterine Malformation: Asymmetric Septate Uterus

Study ObjectiveTo demonstrate a step by step surgical hysteroscopy technique in a patient with asymmetric uterine septum and transverse uterine septum that was not previously described in the literature. DesignResection of an asymmetric uterine septum by laparoscopy and ultrasound-guided hysteroscopy (Canadian Task Force classification III). The video was assumed exempt from official review by our institutional review board. SettingA septate uterus is defined as the uterus in which the uterine cavity is longitudinally divided by the septum [1]. The most common uterine anomaly, septate uterus has a spectrum of configurations ranging from complete septate to incomplete septate uterus. Asymmetric uterine septum was reported only as case reports in the literature and is described as Robert's uterus [2]. This unique malformation is described as a septate uterus with a noncommunicating hemicavity, composed of a blind uterine horn usually with unilateral hematometra, and a contralateral unicornuate uterine cavity. The external uterine shape is normal. The asymmetric septum with transverse uterine septum in the present case has not yet been reported in the literature. PatientA 29-year-old woman presented to our clinic with primary amenorrhea, cyclic pelvic pain, and the desire to have pregnancy. She previously had failed 2 laparoscopy and hysteroscopy procedures for fertility treatments. Hysterosalpingography previously had been failed. The patient previously underwent magnetic resonance imaging. The magnetic resonance imaging report states there was no connection between the uterus and cervix. On external genital organs assessment, there was no abnormal sign. Ultrasonography revealed 2 uterine cavities and hematometra. Both ovaries were in normal view. InterventionsIn view of her examination findings, the patient was scheduled for laparoscopy and hysteroscopy. Laparoscopy revealed extensive adhesions on both the pelvis and upper abdomen. Initially, the uterus and ovaries were not visualized. Adhesiolysis was performed, and normal anatomy was restored. After this step, the operation was continued by laparoscopy and ultrasound-guided hysteroscopy. Under ultrasound and laparoscopy guidance, the transverse uterine septum at the level of uterine isthmus was incised and the left endometrial cavity was observed with hysteroscopy. The asymmetric uterine septum was then incised, and the right-sided endometrial cavity was then accessed. Finally, the uterine septum was completely incised and both sides of the endometrial cavities were merged. The patient had an uncomplicated postoperative course and was discharged 24 hours after surgery. She returned for follow-up examination in the second month after surgery. She had regular menstrual cycles, and her pain was cured. ConclusionHysteroscopy and laparoscopy combined with ultrasound is a useful method for the diagnosis and treatment of asymmetric uterine septum. The skill and experience of the laparoscopic surgeon is another important factor to identify and manage unusual uterine malformations.

Towards ultrasound-guided adaptive radiotherapy for cervical cancer: Evaluation of Elekta's semiautomated uterine segmentation method on 3D ultrasound images

Purpose3D ultrasound (US) images of the uterus may be used to adapt radiotherapy (RT) for cervical cancer patients based on changes in daily anatomy. This requires accurate on‐line segmentation of the uterus. The aim of this work was to assess the accuracy of Elekta's “Assisted Gyne Segmentation” (AGS) algorithm in semi‐automatically segmenting the uterus on 3D transabdominal ultrasound images by comparison with manual contours.Materials & methodsNine patients receiving RT for cervical cancer were imaged with the 3D Clarity® transabdominal probe at RT planning, and 1 to 7 times during treatment. Image quality was rated from unusable (0)–excellent (3). Four experts segmented the uterus (defined as the uterine body and cervix) manually and using AGS on images with a ranking > 0. Pairwise analysis between manual contours was evaluated to determine interobserver variability. The accuracy of the AGS method was assessed by measuring its agreement with manual contours via pairwise analysis.Results35/44 images acquired (79.5%) received a ranking > 0. For the manual contour variation, the median [interquartile range (IQR)] distance between centroids (DC) was 5.41 [5.0] mm, the Dice similarity coefficient (DSC) was 0.78 [0.11], the mean surface‐to‐surface distance (MSSD) was 3.20 [1.8] mm, and the uniform margin of 95% (UM95) was 4.04 [5.8] mm. There was no correlation between image quality and manual contour agreement. AGS failed to give a result in 19.3% of cases. For the remaining cases, the level of agreement between AGS contours and manual contours depended on image quality. There were no significant differences between the AGS segmentations and the manual segmentations on the images that received a quality rating of 3. However, the AGS algorithm had significantly worse agreement with manual contours on images with quality ratings of 1 and 2 compared with the corresponding interobserver manual variation. The overall median [IQR] DC, DSC, MSSD, and UM95 between AGS and manual contours was 5.48 [5.45] mm, 0.77 [0.14], 3.62 [2.7] mm, and 5.19 [8.1] mm, respectively.ConclusionsThe AGS tool was able to represent uterine shape of cervical cancer patients in agreement with manual contouring in cases where the image quality was excellent, but not in cases where image quality was degraded by common artifacts such as shadowing and signal attenuation. The AGS tool should be used with caution for adaptive RT purposes, as it is not reliable in accurately segmenting the uterus on ‘good’ or ‘poor’ quality images. The interobserver agreement between manual contours of the uterus drawn on 3D US was consistent with results of similar studies performed on CT and MRI images.

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.

Analysis of the diagnostic value of CD138 for chronic endometritis, the risk factors for the pathogenesis of chronic endometritis and the effect of chronic endometritis on pregnancy: a cohort study.

BackgroundTo investigate the role of CD138 immunohistochemistry in the diagnosis of chronic endometritis (CE) and the risk factors for assisted conception patients having CE complications.MethodsNinety-three patients, with normal uterine shape confirmed by examination and who were planning to undergo assisted conception treatments, were selected as research subjects. Endometrial tissue was isolated for routine hematoxylin and eosin (HE) and CD138 immunohistochemical staining. Additionally, the disease histories of patients were collected, and the reproductive prognosis was followed up.Results① CE detection rate: The rate of CD138 immunohistochemical staining was greater than that of HE staining (27.96 % vs. 26.89 %, P <0.05); ② Pregnancy rate: the pregnancy rate of CD138-positive patients (7.7 %) was lower than the pregnancy rate of CD138-negative patients (31.3 %) (p = 0.017 < 0.05); ③ The results from univariate analysis showed that a previous history of prolonged menstrual bleeding episodes, an abortion history, and complications of fallopian tube obstruction were associated with CE (P <0.05). The results of logistic regression analysis confirmed that prolonged menstrual bleeding episodes (P = 0.014, OR = 5.394, 95 % CI 1.405-20.699), a previous abortion history (P = 0.029, OR = 3.194, 95 % CI 1.125-9.073), and fallopian tube obstruction (P = 0.028, OR = 3.274, 95 % CI 1.139-9.415) were independent risk factors for positive CD138 results.ConclusionsCD138 immunohistochemistry can improve the CE diagnosis rate. A previous history of prolonged menstrual bleeding episodes, an abortion history, and a history of fallopian tube obstruction are risk factors for chronic endometritis, and a CD138 immunohistochemical examination should be advised among them.

Modeling Magnetomyograms of Uterine Contractions during Pregnancy Using a Multiscale Forward Electromagnetic Approach.

Understanding the mechanisms of uterine contractions during pregnancy is especially important in predicting the onset of labor and thus in forecasting preterm deliveries. Preterm birth can cause serious health problems in newborns, as well as large financial burdens to society. Various techniques such as electromyography (EMG) and magnetomyography (MMG) have been developed to quantify uterine contractions. However, no widely accepted method to predict labor based on electromagnetic measurement is available. Therefore, developing a biophysical model of EMG and MMG could help better understand uterine contractions, interpret real measurements, and detect labor. In this work, we propose a multiscale realistic model of uterine contractions during pregnancy. At the cellular level, building on bifurcation theory, we apply generalized FitzHugh-Nagumo (FHN) equations that produces both plateau-type and bursting-type action potentials. At the tissue level, we introduce a random fiber orientation model applicable to an arbitrary uterine shape. We also develop an analytical expression for the propagation speed of transmembrane potential. At the organ level, a realistic volume conductor geometry model is provided based on magnetic resonance images of a pregnant woman. To simulate the measurements from the SQUID Array for Reproductive Assessment (SARA) device, we propose a sensor array model. Our model is able to reproduce the characteristics of action potentials. Additionally, we investigate the sensitivity of MMG to model configuration aspects such as volume geometry, fiber orientation, and pacemaker location. Our numerical results show that fiber orientation and pacemaker location are the key aspects that greatly affect the MMG as measured by the SARA device. We conclude that sphere is appropriate as an approximation of the volume geometry. The initial step towards validating the model against real MMG measurement is also presented. Our results show that the model is flexible to mimic the limited-propagation magnetic signature during the emergence and decay of a uterine contraction.