3D transvaginal ultrasound diagnosis of uterine septa according to different classifications: are there other measurements that correlate to reproductive outcome in small indentation length?

Abstract

Background: High discrepancy between current classifications was observed in the definition of uterine septa, especially for indentation lengths >5 <10mm. Objectives: To assess the discrepancy between current classifications in the diagnoses of septate uterus and to correlate them with reproductive outcomes; to detect 3D transvaginal ultrasound (TVS) additional measurements, which can better correlate small indentation lengths >5 <10mm to reproductive failures. Material and methods: Observational study enrolling 664 women of reproductive age with 3D ultrasound diagnosis of an indentation length ≥3mm. For each patient a detailed reproductive history was taken before performing 3D transvaginal examination. Patients with previous uterine surgery or metroplasty were excluded. Main Outcome Measure(s): Indentation lengths >5 <10mm showed high discrepancy in the diagnosis of uterine septum between different classifications. For these small indentations additional 3D measurements (indentation angle, septal width and septal length/ fundal myometrial thickness (L/M) ratio) were correlated to infertility and recurrent miscarriage. Results: Among the cohort, 215 patients showed an indentation length >5 <10mm; 136 tried to conceive: 69 (51%) were infertile, 38 (28%) had recurrent miscarriages (≥2) and 5 (4%) had at least one delivery. Recurrent miscarriage significantly correlated to an indentation angle >134°; whereas infertility to an indentation width <32mm and a L/M ratio >75%. Conclusions: Wide discrepancies between different classifications are more evident in indentation lengths >5 <10mm. Additional measurements on 3D coronal section may help to evaluate the risk of infertility or recurrent miscarriage. What is new? Additional 3D TVS measurements, beyond septal lengths, in particular for small fundal indentation, may help in predicting the risk of developing adverse reproductive outcomes.

REPLY to Comment on Correlation between endometriosis and migraine features: Results from a prospective case-control study'': Correlation between endometriosis and migraine features is not based on a broad strokes results

“…Hopefully, this can be confirmed in further studies. In our opinion, according to the literature (3,5,6), the different disease features could be correlated with different types of pelvic pain, such as dyschezia with bowel endometriosis, dysuria with anterior endometriosis, dyspareunia with posterior endometriosis, and dysmenorrhea with endometriosis/adenomyosis, thus being in agreement with the greater prevalence of ultrasound signs of disease in the EM-MG group compared to the EM-O group, we described an increased pain intensity in the EM-MG group.…”

“…The severity of the disease is based not only on the presence of the disease in the pelvis, but also on the type, location, extension in the pelvic organs and symptoms (3,5). All these characteristics have been considered in our study.…”