[Clinical value of three-dimensional transvaginal sonography in diagnosis of septate uterus and prediction of adverse pregnancy outcome]

Abstract

Objective: To investigate clinical value of three-dimensional transvaginal sonography (3D-TVS) in the diagnosis of septate uterus and the relationship between its parameters and adverse pregnancy.

Methods: From Mar. 2010 to Sept. 2011, 73 patients (aged 23-35 years) with septate uterus who were diagnosed by 3D-TVS in Fujian Province Maternal and Child Health Hospital were enrolled in this retrospective study. The septum width, septum angle, septum length and the length of remaining uterine cavity were measured among the patients with subseptate uterus, and then, the distortion rate was calculated. The hysteroscopic surgery was used as the gold standard, and the diagnostic titer of 3D-TVS in the diagnosis of septate uterus was determined.Receiver operating characteristic curve (ROC) were plotted to evaluate the diagnostic titer of uterine parameters measured by 3D-TVS in predicting the adverse pregnancy outcome among patients with subseptate uterus.Univariate logistic regression was used to analyze the effectiveness of uterine parameters on adverse pregnancy outcome.

Results: Using hysteroscopic surgery as the gold standard, the coincidence rate of diagnosis of septate uterus by 3D-TVS was 94% (69/73) . Among the patients with septate uterus, 25% (17/69) were complete septate uterus, 75% (52/69) were subseptate uterus. Among patients with subseptate uterus, the septum length[(2.2 ± 0.6) cm] and distortion rate in patients with adverse pregnancy (0.60 ± 0.10) were significantly higher than those without adverse pregnancy [(1.5 ± 0.6) cm,0.43 ± 0.13, both P < 0.05]. However, no significant difference in the width, angle and length of septum were observed between the two groups (P > 0.05). The area under ROC curve (AUC) of septum length and distortion rate in determining adverse pregnancy were 0.833 (95%CI: 0.721-0.944) and 0.800 (95%CI: 0.671-0.929), respectively. The optimal cutoff point of septum length was 1.94 cm, with the sensitivity was 74.3% and the specificity was 76.5%; the optimal cutoff point of distortion rate was 0.48, with the sensitivity was 77.1% and the specificity was 76.5%. The expectation morbidity ratio of adverse pregnancy was 2.717, 3.067 and 0.514 by every adding level of septum length, distortion rate, and length of remaining uterine cavity, respectively.

Conclusions: 3D-TVS showed high accuracy in diagnosis of septate uterus. The septum length and distortion rate may predict the risk of adverse pregnancy, and the value of them can be used for screening adverse pregnancy in clinical practice.