Ultrasound screening for congenital uterine anomalies

Abstract

The aim of this study was to investigate the prevalence of congenital uterine anomalies in 1046 women attending gynaecological ultrasound clinics for a variety of indications. Using three-dimensional ultrasound, anomalies were found in 55 women (5.4%), including 32 (3.1%) with an arcuate uterus and 23 (2.3%) with major anomalies. The prevalence of uterine anomalies was similar to the findings in women undergoing elective sterilisation, but lower than in studies of women with recurrent miscamage.The true prevalence of congenital uterine anomalies in the general population is not known; previous studies reporting on uterine anomalies examined women with a history of infertility or recurrent miscarriage. One of the reasons for this pre-selection of study populations was the invasive nature of the tests for the examination of the uterus including hysterosalpingography, hysteroscopy and laparoscopy. Three-dimensional ultrasound, that has recently been introduced into clinical practice, enables noninvasive and accurate diagnosis of congenital uterine anomalies'. We used this new technique to determine the prevalence of congenital anomalies in women attending gynaecological ultrasound unit for a variety of indications. MethodsThis was a prospective observational study involving pelvic ultrasound examination in 1046 women attending our gynaecological ultrasound unit. The women were either self-referred for ovarian cancer screening or they were referred for a scan by their consultant gynaecologists or general practitioners because of suspected pelvic abnormalities (Table 1). Exclusion criteria were pregnancy, previous hysterectomy or myomectomy, and referral for investigation of infertility or recurrent miscarriages.Each woman first underwent a conventional B-mode transvaginal ultrasound examination using a 7.5 MHz mechanical probe (Combison 530 3D Voluson, Kretztechnik, Zipf, Austria). The longitudinal axis of the uterus, from the isthmus to the fundus, was first defined and then a series of transverse sections were obtained. When there was any duplication or splitting of the endometrial echo, fusion anomalies were suspected and in these women a three-dimensional ultrasound scan was used to determine the diagnosis. In the three-dimensional ultrasound examination the uterus was visualised in a longitudinal plane and a three-dimensional volume was generated by the automatic rotation of the mechanical transducer through 360". The volumes, in the shape of truncated cones with a depth of 4.3-8.6 cm and a vertical angle of 90", were analysed on-line using the technique of computer-generated planar reformatted sections. Although the images were similar to those of conventional two-dimensional sonography, with this technique it is possible to obtain an unlimited number of sections through the uterus which cannot be seen on routine scans. The acquisition of three-dimensional volumes is about 10 s, but complete analysis is achieved in 3 to 10 minutes.Congenital uterine anomalies were classified according to the criteria of the Am...

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