The role of diagnostic hysteroscopy in diagnosis of incomplete uterine septum in patients with recurrent pregnancy loss in the era of transvaginal 3D ultrasound scan

Abstract

Purpose: To determine the accuracy of transvaginal 3D ultrasound scan (TV 3D US) in detecting partial septate uterus (PSU) in patients with recurrent pregnancy loss (RPL). Methods: This retrospective study included 113 patients with an initial diagnosis of unexplained RPL, who were subsequently found to have PSU on diagnostic hysteroscopy and who had TV 3D US prior to surgery. The diagnosis of PSU was made at the time of a diagnostic hysteroscopy based on ESHRE-ESGE classification of Müllerian anomalies. Based on hysteroscopic findings, patients were divided into two groups: those with PSU and a central point of indentation at an acute angle < 90° (PSUAA) [30.1%], and those who had PSU and a central point of indentation at an obtuse angle (PSUOA) [69.9%]. We compared the mean internal indentation length at the fundal midline (IILFM) in millimeters on TV 3D US and on diagnostic hysteroscopy. For the purpose of this study, a diagnosis of PSU on hysteroscopy was made if IILFM measured ≥ 10 mm. Results: The mean IILFM (mm) on hysteroscopy was significantly higher than the mean IILFM (mm) measured on TV 3D US in patients with PSUAA (18.5 ± 6.5 vs 4.9 ± 4.4; P < 0.001), in patients with PSUOA (14.1 ± 3.8 vs 4.3 ± 3.4; P < 0.001), and in the overall population (15.3 ± 5.1 vs 4.1 ± 4.4; P < 0.001). Conclusions: The data suggest that mean IILFM in patients with RPL and PSU can be underestimated on TV 3D US. Therefore, its diagnostic accuracy in such patients may need further evaluation.