Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies

Objective: To assess the accuracy of three-dimensional (3D) ultrasound in the diagnosis of congenital uterine anomalies. Design: Prospective study. Setting: University hospital. Patient(s): Nulliparae with three or more consecutive miscarriages. Intervention(s): All women underwent 3D transvaginal ultrasound study of the uterine cavity. Main Outcome Measure(s): Women with negative ultrasound findings subsequently underwent office hysteroscopy, whereas a combined laparoscopic-hysteroscopic assessment was performed in cases of suspected Müllerian anomaly. Result(s): A specific Müllerian malformation was sonographically diagnosed in 54 women of the 284 included in the study group. All negative ultrasound findings were confirmed at office hysteroscopy. Among the women with abnormal ultrasound findings, the presence of a Müllerian anomaly was endoscopically confirmed in all. Concordance between ultrasound and endoscopy around the type of anomaly was verified in 52 cases, including all those with septate uterus and two out of three with bicornuate uterus. Conclusion(s): Volume transvaginal ultrasound appears to be extremely accurate for the diagnosis and classification of congenital uterine anomalies and may conveniently become the only mandatory step in the assessment of the uterine cavity in patients with a history of recurrent miscarriage.