Uterine malformations consist of a group of miscellaneous congenital anomalies of the female genital system. Their mean prevalence in the general population and in the population of fertile women is approximately 4.3%, in infertile patients approximately 3.5% and in patients with recurrent pregnancy losses approximately 13%. Septate uterus is the commonest uterine anomaly with a mean incidence of approximately 35% followed by bicornuate uterus (approximately 25%) and arcuate uterus (approximately 20%). It seems that malformed uterus and especially septate uterus is not an infertility factor in itself. However, it may have a part in the delayed natural conception of women with mainly secondary infertility. On the other hand, patients with uterine malformations seem to have an impaired pregnancy outcome even as early as their first pregnancy. Overall term delivery rates in patients with untreated uterine malformations are only approximately 50% and obstetric complications are more frequent. Unicornuate and didelphys uterus have term delivery rates of approximately 45%, and the pregnancy outcome of patients with untreated bicornuate and septate uterus is also poor with term delivery rates of only approximately 40%. Arcuate uterus is associated with a slightly better but still impaired pregnancy outcome with term delivery rates of approximately 65%. Women who have undergone hysteroscopic septum resection and have been reported in the different series comprise a highly selected group of symptomatic patients with term delivery and live birth rates of only approximately 5%. Hysteroscopic treatment seems to restore an almost normal prognosis for the outcome of their pregnancies with term delivery rates of approximately 75% and live birth rates of approximately 85%. It seems, therefore, that hysteroscopic septum resection can be applied as a therapeutic procedure in cases of symptomatic patients but also as a prophylactic procedure in asymptomatic patients in order to improve their chances for a successful delivery.

/pdf/clinical-implications-of-uterine-malformations-and-2v1xwhj24x.pdf

Clinical implications of uterine malformations and hysteroscopic treatment results

Context.—Postmenopausal vaginal bleeding is a common clinical problem. Endovaginal
ultrasound (EVUS) is a noninvasive diagnostic test that may help determine
which women should undergo endometrial biopsy.Objective.—To determine the accuracy of EVUS in detecting endometrial disease in
postmenopausal women with vaginal bleeding according to hormone replacement
use.Data Sources.—Literature search of English-language and non–English-language
articles published from 1966 through November 1996 using MEDLINE and by a
manual search of bibliographies of published articles.Study Selection.—Studies were included if they prospectively collected EVUS measurements
of endometrial thickness prior to obtaining endometrial tissue for histologic
evaluation in postmenopausal women with vaginal bleeding. Of 85 studies that
included data on EVUS and endometrial histology, 35 were included in the meta-analysis
and included 5892 women.Data Extraction.—Articles were reviewed and independently selected and abstracted by
2 reviewers. Disagreement was resolved by consensus.Data Synthesis.—The overall summary mean weighted estimates of sensitivity and specificity
were calculated for thresholds of endometrial thickness from 3 to 10 mm. Using
a 5-mm threshold to define abnormal endometrial thickening, 96% (95% confidence
interval [CI], 94%-98%) of women with cancer had an abnormal EVUS result,
whereas 92% (95% CI, 90%-93%) of women with endometrial disease (cancer, polyp,
or atypical hyperplasia) had an abnormal result. This did not vary by hormone
replacement use. However, the number of women with normal histology who had
an abnormal EVUS result did vary by hormone replacement use. In women who
were not using hormone replacement therapy, 593 (8%) with normal histological
findings had an abnormal EVUS result (specificity, 92%; 95% CI, 90%-94%),
whereas 1544 (23%) using hormone replacement therapy had an abnormal EVUS
result (specificity, 77%; 95% CI, 75%-79%). For a postmenopausal woman with
vaginal bleeding with a 10% pretest probability of endometrial cancer, her
probability of cancer is 1% following a normal EVUS result.Conclusion.—Endovaginal ultrasound has a high sensitivity for detecting endometrial
cancer and other endometrial disease and can reliably identify postmenopausal
women with vaginal bleeding who are highly unlikely to have significant endometrial
disease so that endometrial sampling may be unnecessary.

https://jamanetwork.com/journals/jama/articlepdf/188122/jma80013.pdf

Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities

https://www.fertstert.org/article/S0015-0282(99)00480-X/pdf

The septate uterus: a review of management and reproductive outcome

BACKGROUND
The prevalence of congenital uterine anomalies in high-risk women is unclear, as several different diagnostic approaches have been applied to different groups of patients. This review aims to evaluate the prevalence of such anomalies in unselected populations and in women with infertility, including those undergoing IVF treatment, women with a history of miscarriage, women with infertility and recurrent miscarriage combined, and women with a history of preterm delivery.

The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review

BACKGROUND: The prevalence of congenital uterine anomalies in women with reproductive failure remains unclear, largely due to methodological bias The aim of this review is to assess the diagnostic accuracy of different methodologies and estimate the prevalence of congenital uterine anomalies in women with infertility and recurrent miscarriage (RM) METHODS: Studies from 1950 to 2007 were identified through a MEDLINE search; all relevant references were further reviewed RESULTS: The most accurate diagnostic procedures are combined hysteroscopy and laparoscopy, sonohysterography (SHG) and possibly three-dimensional ultrasound (3D US) Two-dimensional ultrasound (2D US) and hysterosalpingography (HSG) are less accurate and are thus inadequate for diagnostic purposes Preliminary studies (n= 24) suggest magnetic resonance imaging (MRI) is a relatively sensitive tool A critical analysis of studies suggests that the prevalence of congenital uterine anomalies is 67% [95% confidence interval (CI), 60‐74] in the general population, 73% (95% CI, 67‐79) in the infertile population and 167% (95% CI, 148‐186) in the RM population The arcuate uterus is the commonest anomaly in the general and RM population In contrast, the septate uterus is the commonest anomaly in the infertile population, suggesting a possible association CONCLUSIONS: Women with RM have a high prevalence of congenital uterine anomalies and should be thoroughly investigated HSG and/or 2D US can be used as an initial screening tool Combined hysteroscopy and laparoscopy, SHG and 3D US can be used for a definitive diagnosis The accuracy and practicality of MRI remains unclear

/pdf/prevalence-and-diagnosis-of-congenital-uterine-anomalies-in-17vgk19og8.pdf

Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal

The role of vaginal scan in measurement of endometrial thickness in postmenopausal women

The thickness of the endometrium was measured in postmenopausal women by both the transvaginal and transabdominal ultrasound approaches in two separate groups of patients. The first group consisted of 90 women who received a transabdominal scan of the endometrium before dilatation and curettage or hysterectomy for either postmenopausal bleeding or uterine prolapse. The second group consisted of 111 women who underwent a transvaginal scan of the endometrium for similar postmenopausal conditions. Both methods suggested that an endometrial thickness of 5 mm may be used as a cut-off level in the conservative management of patients with postmenopausal bleeding or in a screening program for endometrial carcinoma. Patient acceptance and image quality were better in the group examined transvaginally. The proximity of the transvaginal probe to the endometrium, in the absence of a full bladder compressing the endometrium, revealed a unique group of patients with atrophic endometrium but thick endometrial cavity caused by intracavity fluid. In the presence of uterine fibroids distorting the uterine cavity, transvaginal scanning was better than transabdominal scanning for visualizing the endometrium. The transabdominal full-bladder technique can be of value in detecting asymptomatic bladder pathology.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1046/j.1469-0705.1991.01040279.x

M. N. Nasri

Papers

The role of vaginal scan in measurement of endometrial thickness in postmenopausal women

Sonographic depiction of postmenopausal endometrium with transabdominal and transvaginal scanning.

91180913 The role of vaginal scan in measurement of endometrial thickness in postmenopausal women

Transvaginal ultrasound for diagnosis of uterine malformations.

The role of vaginal scan in measurement of endometrial thickness in postmenopausal women