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


  • Selvaraj Ravi Lakshmy Shri Lakshmi Scan Centre, 185/386-A, Govindhachetty Street, NCR Complex, Kaveripattinam - 635112, Krishnagiri, Tamilnadu, India
  • Nity Rose Shri Lakshmi Scan Centre, 185/386-A, Govindhachetty Street, NCR Complex, Kaveripattinam - 635112, Krishnagiri, Tamilnadu, India
  • Meenakshi Ramachandran Shri Lakshmi Scan Centre, 185/386-A, Govindhachetty Street, NCR Complex, Kaveripattinam - 635112, Krishnagiri, Tamilnadu, India



Congenital uterine anomalies, Septate uterus, 3 Dimensional ultrasound, Cervical assessment


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.


El Huseiny AM, Ahmad RA, Sadek SM, Gouhar GK, Dawood HA. Role of three-dimensional ultrasound in the diagnosis of double uterine cavity anomalies and concordance with laparoscopic and hysteroscopic diagnosis. The Egyptian Journal of Radiology and Nuclear Medicine. 2014;45(2):555-60.

Dewan KA, Hefeda MM, ElKholy DG. Septate or bicornuate uterus: Accuracy of three-dimensional trans-vaginal ultrasonography and pelvic magnetic resonance imaging. The Egyptian Journal of Radiology and Nuclear Medicine. 2014;45(3):987-95.

Saravelos SH, Cocksedge KA, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14:415-29.

Ribeiro SC, Yamakami LY, Tormena RA, Pinheiro WD, Almeida JA, Baracat EC. Septate uterus with cervical duplication and longitudinal vaginal septum. Revista da Associação Médica Brasileira. 2010;56(2):254-6.

Troiano RN, McCarthy SM. Mullerian duct anomalies: imaging and clinical issues. Radiology. 2004;233(1):19-34.

Li S, Qayyam A, Coakley FV, Hricak H. Association of renal agenesis and Müllerian duct anomalies. J Comput Assist Tomogr. 2000;6:829-34.

Kimberley N, Hutson JM, Southwell BR, Grover SR. Vaginal agenesis, the hymen, and associated anomalies. J Pediatr Adolesc Gynecol. 2012;25(1):54-8.

Gell JS. Müllerian anomalies. Semin Reprod Med. 2003;21(4):375-88.

American Fertility Society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944-55.

Bocca SM, Abuhamad AZ. Use of 3-dimensional sonography to assess uterine anomalies. Journal of Ultrasound in Medicine. 2013;32(1):1-6.

Devi Wold AS, Pham N, Arici A. Anatomic factors in recurrent pregnancy loss. Semin Reprod Med. 2006;24(1):25-32.

Woelfer B, Salim R, Banerjee S, Elson J, Regan L, Jurkovic D. Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening. Obstet Gynecol. 2001;98:1099-103.

Turkgeldi E, Urman B, Ata B. Role of Three-Dimensional Ultrasound in Gynecology. The Journal of Obstetrics and Gynecology of India. 2015;65(3):146-54.

Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17:761-71.

Ludwin A, Ludwin I, Pityński K, Banas T, Jach R. Differentiating between a double cervix or cervical duplication and a complete septate uterus with longitudinal vaginal septum. Taiwanese Journal of Obstetrics and Gynecology. 2013;52(2):308-10.

Practice Committee of the American Society for Reproductive Medicine. Uterine septum: a guideline. Fertility and sterility. 2016.

Barbanti S, Chiamulera N, Botelho B. Vaginal Septoplasty in Septate Uterus with Double Cervix. Case reports in obstetrics and gynecology. 2014.

Ludwin A, Ludwin I, Pityński K, Banas T, Jach R. Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty. Human Reproduction. 2014;29(7):1420-31.

Jurkovic D, Geipel A, Gruboeck K, et al. Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two dimensional sonography. Ultrasound Obstet Gynecol. 1995;5:233-7.

Salim R, Jurkovic D. Assessing congenital uterine anomalies: the role of thee-dimensional ultrasonography. Best Pract Res Clinical Obstet Gynecol. 2004;18:29-36.

Ghi T, Casadio P, Kuleva M. Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies. Fertil Steril. 2009;92:808-13.

Salim R, Woelfer B, Backos M, Regan L, Jurkovic D. Reproductibility of three-dimensionnal ultrasound diagnosis of congenital uterine anomalies. Ultrasound Obstet Gynecol. 2003;21:578-82.

Armstrong L, Fleischer A, Andreotti R. Three-dimensional volumetric sonography in gynecology: an overview of clinical applications. Radiologic Clinics of North America. 2013;51(6):1035-47.

Faivre E, Fernandez H, Deffieux X, Gervaise A, Frydman R, Levaillant JM. Accuracy of three-dimensional ultrasonography in differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging. Journal of minimally invasive gynecology. 2012;19(1):101-6.

Deutch TD, Abuhamad AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of Müllerian duct anomalies. J Ultrasound Med. 2008;27:413-23.

Bermejo C, Martínez Ten P, Cantarero R, Diaz D, Pérez Pedregosa J, Barrón E. Three‐dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound in Obstetrics and Gynecology. 2010;35(5):593-601.






Original Research Articles