Publication:

Role of three dimensional ultrasound in uterine anomalies - 3D assessment of cervix in septate uteri

Background Mullerian duct anomalies are associated with higher incidence of infertility, recurrent pregnancy loss and fetal complications. The role of imaging is to distinguish between surgically correctable forms of mullerian duct anomalies from the inoperable forms. HSG and 2D ultrasound does not give a definitive diagnosis in double uterine cavity anomalies and moreover septate uterus with double ostia can be misinterpreted as unicornuate uterus on HSG as the dye passes through only one ostium. The study highlights the usage of transvaginal 3D ultrasound in assessment of the cervix in septate uterus.

Methods Volume acquisition was obtained in the sagittal section of uterus by transvaginal route. Under adequate magnification care was taken to include the cervix and then the volume was acquired. The rendering box was adjusted and the green line placed in the region of cervix to get the satisfactory transverse rendered image of cervix.

Results 3D assessment of cervix in 44 septate uterus revealed single cervical ostium in 36, complete septum with double ostia in 8 cases of which one had a duplicated cervix. There was absolute correlation between 3D assessment of the cervix and clinical evaluation.

Conclusions 3D transvaginal ultrasonography of the uterine cavity is extremely accurate in diagnosing and classifying anomalies. Assessment of double uterine cavity abnormalities is complete with 3D evaluation of cervix. The added advantage of assessing cervix with 3D helps to distinguish between single and double ostia in septate cervix.