Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between normal/arcuate and septate uterus?

Martins

Ultrasound in Obstet & Gyne

2019

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The uterine scare after caesarean section and "niche" also called "isthmocoele" and their specific morphologic features may be associated with specific further gynecological and obstetrical complications . Abnormal uterine bleeding, subfertility, risk of scar pregnancy and uterine rupture during pregnancy and delivery are considered as potential indications for hysteroscopic or laparoscopic correction of cesarean scar; however, there is a lack of robust evidence that surgery is justified by specific niche morphology, symptoms, and risks. Despite of the lack of appropriate studies with control of untreated patients, a significant barrier to build evidence is the lack of reliable diagnostics. Recently, a step for standardization of the nomenclature and ultrasound measurements has been made . Some researchers agreed that there is not a preference for a specific ultrasound technique to be used, and transvaginal ultrasound with the sagittal and transversal view for specific niche measurements are suggested. The experts also agree that using contrast agents during the scan (normally gel or saline) have added value in the assessment of niche if fluid is not present naturally in niche . Role of three-dimensional ultrasound were not a subject of this consensus, probably because it was focused on basic niche assessment. Recently, the use of three-dimensional saline contrast sonohysterography and SonoHysteroAVC technique was described as promising in assessment of uterus and uterine cavity . We here are sharing our initial experience with three-dimensional sonohysterography and SonoHysteroAVC for niche assessment in clinical practice and research. This article is protected by copyright. All rights reserved.

Section: Techniquementioning

confidence: 99%

Evaluation of uterine niche by three‐dimensional sonohysterography and volumetric quantification: techniques and scoring classification system

Martins

Ultrasound in Obstet & Gyne

2019

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“…Although the ESHRE/ESGE classification attempted to address all the previous shortcomings, with more objective definitions of CUAs, particularly for septate uterus, it has received criticism, as some authors have observed an increase in the diagnosis of septate uterus compared with former classifications . The Congenital Uterine Malformation Experts (CUME) group has recently criticised ESHRE/ESGE criteria as overestimating and ASRM criteria as underestimating the prevalence of septate uterus, based on a reproducibility and diagnostic accuracy study using 3D ultrasound. The proportion of septate uteri using the ESHRE/ESHE classification was demonstrated to be much higher than using the ASRM criteria (RR 13.9; 95% CI 5.9–32.7, P ≤ 0.01) .…”

Section: Classificationmentioning

confidence: 99%

Reproductive Implications and Management of Congenital Uterine Anomalies

Akhtar¹,

Saravelos²,

Li³

et al. 2019

BJOG

Plain language summary Congenital uterine anomalies (CUAs) are malformations of the womb that develop during fetal life. When a baby girl is in her mother’s womb, her womb develops as two separate halves from two tubular structures called ‘müllerian ducts’, which fuse together before she is born. Abnormalities that occur during the baby’s development can be variable from complete absence of a womb through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good in screening for CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex womb abnormality is suspected, MRI scanning may also be used, with a combination of laparoscopy in which a camera is inserted into the cavity of the abdomen, and hysteroscopy, when the camera is placed in the womb cavity. As there can be a link between CUAs and abnormalities of the kidney and bladder, scans of these organs are also usually requested. Although CUAs are present at birth, adult women typically do not have any symptoms, although some may experience painful periods. Most cases of CUA do not cause a woman to have difficulty in becoming pregnant and the outcome of pregnancy is good. However, these womb anomalies are often discovered during investigations for infertility or miscarriage. Moreover, depending upon the type and severity of CUA, there may be increased risk of first and second trimester miscarriages, preterm birth, poor growth of the baby in the mother’s womb (fetal growth restriction), pre‐eclampsia and difficult positioning of the baby for birth (fetal malpresentation). Surgical treatment is only recommended to a woman who has had recurrent miscarriages and has a septate uterus, i.e., the womb cavity is divided by a partition. In this case, surgery may improve her chances for a successful pregnancy, although the risks of surgery, especially scarring of the womb should be considered. However, further evidence from randomised controlled trials are required to provide conclusive evidence‐based recommendations for surgical treatment for septate uterus. Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These women, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up using an appropriate protocol for preterm birth as outlined in UK Preterm Birth Clinical Network Guidance.1>

“…However, these criteria, similarly to those recommended recently by the American Society for Reproductive Medicine (ASRM) and those by the common working group of the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy (ESHRE‐ESGE), were derived arbitrarily and without being validated. Now, however, validation of these criteria has been performed, allowing assessment of the results, limitations and implications of this study from a wider perspective.…”

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confidence: 99%

“…In the Congenital Uterine Malformation by Experts (CUME) study, published in this issue of UOG, the subjective judgments of 15 experts, comprising clinicians, surgeons and sonologists, in distinguishing between septate and normal/arcuate uterus were quantified. The final CUME definitions with the best cut‐offs are a reasonable reference standard for validation of currently used criteria of normal/arcuate and septate uterus.…”

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confidence: 99%

“…Therefore, the ‘arcuate’ uterus in this study was actually not a ‘benign’ anomaly according to the AFS definition, and any negative outcome in this group should not be interpreted as attributable to the arcuate uterus, but rather, that a considerable proportion of uteri classified as arcuate using the criteria of Salim et al . should actually be classified as septate, as recommended by the CUME definition.…”

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confidence: 99%

See 1 more Smart Citation

Re: Outcome of assisted reproduction in women with congenital uterine anomalies: a prospective observational study. M. Prior, A. Richardson, S. Asif, L. Polanski, M. Parris‐Larkin, J. Chandler, L. Fogg, P. Jassal, J. G. Thornton, N. J. Raine‐Fenning. Ultrasound Obstet Gynecol 2018; 51: 110–117.

Ultrasound in Obstet & Gyne

2018

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