The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion,tubalocclusion secondary to tubal ligation, tubal pregnancies, MOlierian anomalies and intrauterine adhesions, Ferril Steril 1988 Jun;49(6):944-55.l
Uncorrected complete agenesis is incompatible with pregnancy, and in vitro ferrilization with gestational surrogacy is an option. Surgical correction by uterovaginal anastomosis has resulted in successful pregnancy (Kriplani, 201e2). Significant complications accompany this correcrive surgery, and rhe need for clear preoperative anatomy delineation has been emphasized by Rock (2010) and Roberrs (2011) and their colleagues. For this reason, they recommend hysterecromy for complete cervi� cal agenesis and reserve reconsrruction attemprs for carefully selected patients with cervical dysgenesis.
From a large variery, a few of the more common congenital urerine malformations are shown in Table 3-3. An accurate population prevalence of these is diicult to assess because the best diagnostiC techniques are invasive. That said, the prevalence found with imaging ranges from 0.4 to 10 percent, and rates in women with recurrent miscarriage are signiicantly higher (Byrne. 2000; Dreisler. 2014; Saravclos. 2008). In a general population, the mOSt common inding is arcuare urerus, followed in descending order by septate, bicornuate, didelphic, and unicornuate classes (Chan, 2011b).
ination, cesarean delivery, rubal sterilization, or infertility evaluation. Depending on clinical presenrarion, diagnostic tools may include sonography, hysterosalpingography, magnetic� resonance imaging, laparoscopy, and hysteroscopy. Each has limitations, and rhese may be used in combination ro completely deine anatomy. In women undergoing fertiliry evaluation, hysterosalpingography (HSG) is commonly selected for uterine cavity and tubal patency assessment. It is contraindi� cared during pregnancy. HSG poorly deines the external urerine contour and can delineate only patent cavities. Regarding patency, remember that some uniconuate rudimentary horns lack a caviry. Also, ourlet Obstructions will preclude dye illing.
In most clinical senings, rwo-dimensional transvaginal sonography (2-D VS) is initially performed. For this indication, the pooled accuracy for VS is 90 to 92 percent (Pellerito. 1992). Saline infusion sonography (SIS) improves delineation of the endome[fium and intenal merine morphology, bur only with a patent endometrial cavity. It also is contraindicated in pregnancy. Three-dimensional (3-D) sonography is more accurate than 2·D sonography because it provides uterine images from virtually any angle. Thus, coronal images can be constructed as shown in Figure 3-6, and these are essential in evaluating borh
FIGURE 3-6 Three-dimensional transvaginal sonographic images. A. Bicornuate uterus with an 8-week gestation. The external fundal contour (red doted ine) dips centrally below the intercornual line, and the endometrial cavities communicate. B. Septate uterus with a S-week gestation. The external fundal contour is normal and convex 'elow dotted ine), and the long septum (asterisk) extends caudad in the midline. C. Arcuate uterus with an 8-week gestation. The external fundal contour is normal and convex (red dotted line), but the fundal endometrial cavity is slightly indented (arrow).
internal and exrernaJ uterine contours (Grimbizis, 2016). Both 2-D and 3-D sonography arc suirable for use in pregnancy.