Transvaginal 3-D Ultrasonic Sonohysterography For Clinical Evaluation Of Septate Uterus

ObjectiveSeptate Uterus is the most common of congenital uterine malformation and closely associated with the poorest reproductive outcome. Surgical operation is the only way to treat septate uterus for patients with clinical symptom. Three -dimensional ultrasound is a new technology which has recently been introduced into clinical practice. The technique overcomes anatomical limitations which restrict the number and orientation of the scanning planes on transvaginal sonogra-phy, particular coronal plane can provide clear image of the whole uterine anatomy, it is crucial for diagnosis and differential diagnosis of septate uterus. This study evaluates the diagnostic value of transvaginal three - dimensional ultrasonic sonohysterography (3D - SHG) on septate uterus through comparing 3D -SHG with transvaginal ultrasonography ( TVS ). To compare differences in the morphology of subseptate uterus and investigate septal vascularity found in patients with recurrent miscarriage symptom and control group in relation to adverse pregnancy in order to provide full information for clinic.MethodsA total of 66 patients ( symptomatic group 36 cases, control group 30 cases )with suspected uterine malformation were first examined by TVS using a 5 -8MHz mechanical sector endoprobe (ACCUVIX XQ; Medison Company) , the result of examination was recorded. After that, the 3D - SHG was performed, the results of diagnosis were recorded on the hard disk. To respectively measure the septum length of subseptate uterus, the length of the unaffected uterine cavi-ty on the coronal plane and calculate the degree of distortion of uterine architecture. Above data were compared between recurrent miscarriage group and control group. Using receiver operating characteristic ( ROC) curve determined the optimal cut - off point of the distort radio of subseptate uterine cavity for predicting miscarriage symptom. Color Doppler examine septal vascularity, the result was compared between two groups. Endoscopic examination was a final result of the diagnosis. Comparisons between groups were made by using a SPSS for Windows computer application (version 12.0).ResultsTo compare the diagnostic result of 3D - SHG and TVS shows that the diagnostic accuracy of 3D - SHG is 100% , TVS is 93. 94%. The result of 3D -SHG was consistent with that of endoscopic examination. There was no significant difference in depth of fundal distortion between the two groups. However , the length of remaining uterine cavity was significantly shorter ( P < 0. 01) and the distortion ratio was significantly higher ( P < 0. 01) in the recurrent miscarriage group. The result of ROC curve shows the cut — off point of the distort radio of subseptate uterine cavity for miscarriage symptom is 51%. Patients with vascularized septa had significantly higher prevalence of pregnancy failure than those with avascularized septa (P<0. 05)Conclusions1. 3 D - SHG technology is higher valuable for assessing septate uterus, especially for differential diagnosis of septate and bicornuate uterus was evidently superior to TVS.2. 3D - SHG provides the ability to describe septate uterus in quantitative terms, confirms that the likelihood of pregnancy failure in patients with sepate u-terus become more liigher when the distortion ratio of uterine cavity is 51 % or surpass 51%.3. Color Doppler imaging has a potential to predict likelihood of pregnancy...