Three dimensional color Doppler transvaginal ultrasound morphologic features of uterine septum and residual cavity in women with reproductive failure

Midtrimester spontaneous torsion of unruptured gravid rudimentary horn: Presurgical diagnosis on magnetic resonance imaging

“…Criteria for early sonographic diagnosis of RHP have been described as: (i) an asymmetrical bicornuate uterus; (ii) absent visual continuity between the cervical canal and the lumen of the pregnant horn; and (iii) the presence of myometrial tissue surrounding the gestational sac . Three‐dimensional ultrasound represents a valid diagnostic tool in uterine anomalies, because, in addition to its lower cost and better tolerance by patients, it provides images of very similar quality to those yielded by MRI . However, in our case, a proper acoustic window was unavailable.…”

The pathophysiology of the septate uterus: a systematic review

“…When comparing women with a septate uterus and subfertility with women with a septate uterus and RPL, one study demonstrated a lower mean septal vascularity index (amount of vascularised muscle tissue component of the intrauterine septum) in women with subfertility versus women with RPL (11.67 versus 18.39; P = 0.003) . In another study, the intrauterine septa of women with subfertility had a lower myometrial tissue content (13.57 versus 20.74%, P < 0.001) and higher fibrous tissue content (29.31 versus 15.28%, P < 0.001) compared with the septa of women with RPL …”

“…In this review, we included studies on implantation showing that early pregnancies in the septum do occur, but have a higher chance of miscarriage . Two studies found that the intrauterine septa of women with subfertility contain more fibrous tissue and are less vascularised, whereas the intrauterine septa of women with RPL are more vascularised and have a higher muscular component . The clinical relevance and implications of these findings should be further investigated.…”

“…15 When comparing women with a septate uterus and subfertility with women with a septate uterus and RPL, one study demonstrated a lower mean septal vascularity index (amount of vascularised muscle tissue component of the intrauterine septum) in women with subfertility versus women with RPL (11.67 versus 18.39; P = 0.003). 11 In another study, the intrauterine septa of women with subfertility had a lower myometrial tissue content (13.57 versus 20.74%, P < 0.001) and higher fibrous tissue content (29.31 versus 15.28%, P < 0.001) compared with the septa of women with RPL. 16 When we combined, using meta-analysis, the reported proportion in seven studies that investigated the presence of myometrium and fibrous tissue in the intrauterine septum with MRI or TVUS, we found that the intrauterine septum consists of a pooled proportion of 69% (95% CI 49-88, seven studies, 25 women, I 2 0%) myometrium and 19% (95% CI 7-32, seven studies, 129 women, I 2 0%) fibrous tissue.…”

“…10 When comparing women with a septate uterus and RPL with women with a septate uterus and subfertility with three-dimensional ultrasound, one study found that women with RPL had a significantly wider (30.1 versus 23.30 mm; P = 0.004) and longer (23.2 versus 16.7 mm; P = 0.003) septum, without any differences in septum volume, vascularity index or residual cavity. 11 Researchers also investigated whether different uterine parameters change significantly throughout natural and stimulated menstrual cycles. For this, inter-ostial distance (defined as distance between two ostia, at the transition point between the endometrial cavity and the isthmic part of the fallopian tube) and the cavity indentation (defined as the perpendicular distance between the point of maximum cavity indentation and the inter-ostial line) were measured.…”