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Uterine Cavity Assessment (Saline Hysterosonography)
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Arcuate uterus, a condition that is sometimes associated with subfertility [46,47], can be classified as either a normal or a dysmorphic uterus with minor deformity. The most common uterine anomalies of infertile women are those with septa of differing lengths. These are also the most common anomalies in patients with miscarriage (up to 18%) [48] (Figure 5.14).
Uterine Anomalies and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Daniel S. Seidman, Mordechai Goldenberg
An arcuate uterus (intrauterine indentation of <1 cm) is found in 17% in women with recurrent miscarriage [9] compared to 3.2% in the general population. The diagnosis is difficult when conventional diagnostic methods are used such as hysteroscopy or laparoscopy [10]. Consequently, little is known about the prevalence and clinical significance. Although many believe that the arcuate uterus has little or no impact on reproduction and obstetrical outcomes [11], some studies have reported an increase in adverse reproductive outcomes, mostly second trimester loss [10,12,13]. Gergolet et al. [13] followed women with at least one early miscarriage and a subseptate or arcuate uterus undergoing hysteroscopic metroplasty. The miscarriage rates after metroplasty were similar between the women with subseptate and arcuate uterus (14.0% and 11.1%, respectively). Before metroplasty, the miscarriage rates were significantly higher in subseptate uterus group as well as in the arcuate uterus group. The authors therefore concluded that the arcuate uterus had a similar effect on reproductive outcome as the subseptate uterus both before and after surgical correction [13].
Congenital anomalies of the reproductive tract
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Maggie Dwiggins, Veronica Gomez-Lobo
Many other uterine anomalies have been categorized and described by the AFS/ASRM, VCUAM, Acien, and ESHRE-ESGE and include bicornuate or septate uterus and uterine didelphys, and have an incidence of 4.3% in the general population.3,6,8,9 These anomalies, while important to be cognizant of, often do not need treatment from the pediatric and adolescent gynecologist. Diagnosis is usually made by hysteroscopy or hysterosalpingogram in the adult patient, often due to infertility. A uterine septum may cause implantation failure or recurrent miscarriage, and in these cases, septoplasty by operative hysteroscopy is indicated.6 Pregnancy rates are unchanged in patients with bicornuate or didelphic uterus, patients have increased rates of abnormal fetal lie, and preterm deliveries have been described.7 The arcuate uterus does not have any implications related to pregnancy and does not need treatment. Rarely, a Thompkins or Jones metroplasty may be indicated for complex intrauterine anomalies; however, these are difficult surgeries to perform and are associated with increased risk of uterine rupture.
The accuracy of three-dimensional ultrasonography in the diagnosis of Müllerian duct anomalies and its concordance with magnetic resonance imaging
Published in Journal of Obstetrics and Gynaecology, 2022
Yasin Ertug Cekdemir, Uygar Mutlu, Demet Acar, Canan Altay, Mustafa Secil, Omer Erbil Dogan
An overview of 3D US and MRI findings classified according to ESHRE/ESGE and ASRM criteria in our series are presented in Table 3. Based on ESHRE-ESGE classification, there was a discrepancy for only one patient (case no. 21, Table 3) between US and MRI. Therefore, we suggest that the concordance of 3D-US and MRI are 26/27 (96.3%) in terms of detection of MDAs. With respect to ASRM classification, there was a disagreement between MRI and 3D-US in three patients (cases nos. 20, 21 and 26; Table 3). In other words, concordance between MRI and 3D-US was 24/27 (88.9%) in terms of visualisation of MDAs. One patient (1/27, 3.7%), misdiagnosed as class 6 arcuate uterus by 3D-US turned out to be normal by MRI (Table 3, case no.21). Another patient (1/27, 3.7%) misdiagnosed as class 6 arcuate uterus by 3D-US turned out to be class 5b-partial septate by MRI (Table 3, case no. 20). In another patient, diagnoses made by 3D-US and MRI were consistent with each other according to ESHRE-ESGE classification. However, there was a discrepancy between MRI and 3D-US with respect to ASRM classification (Table 3, case no. 26). This patient was misdiagnosed as class 7-DES drug-related uterine anomaly under 3D-US, while MRI yielded a class 1 uterus. A patient misdiagnosed as class 5A-complete septate in 3D-US was found to have a class 5B-partial septate uterus in MRI.
Aetiology of recurrent miscarriage and the role of adjuvant treatment in its management: a retrospective cohort review
Published in Journal of Obstetrics and Gynaecology, 2018
Samuel James Alexander Dobson, Kanna Mannadiar Jayaprakasan
Uterine malformations may be more common in women with miscarriage compared to a control population (13.3% vs. 5.5%) (Chan et al. 2011). Septate uteri is the most common abnormality associated with recurrent miscarriage, and as such surgical correction can be considered in these women (Jaslow and Kutteh 2013). Arcuate uteri are not associated with early pregnancy loss (Chan et al. 2011).