Research
Imaging
Ultrasound assessment of uterine cavity remodeling after surgical correction of subseptations

Presented, in part, in oral format at the 2013 annual convention of the American Institute of Ultrasound in Medicine, New York, NY, April 7-10, 2013.
https://doi.org/10.1016/j.ajog.2013.11.008Get rights and content

Objective

To assess the postoperative restoration of a normal uterine cavity, uterine cavity measurements were obtained in patients with arcuate or septate uteri in the periods before and after resection.

Study Design

Twenty-eight women diagnosed with arcuate or septate uteri were evaluated with 3-dimensional ultrasound before and after undergoing surgical resection by hysteroscopic resection, in a university center. In addition to the conventional parameters, measurements of the subseptum's length and width, and cavity width, were obtained on a frozen coronal view of the uterus. Postoperatively, uterine cavity width was measured.

Results

Twelve patients were diagnosed with arcuate uterus and 16 with septate uterus and subsequently underwent surgical correction. Of them, 50% had a retroverted uterus and 61% had a diagnosis of polycystic ovary syndrome (7/28, or 25%, had both). Uterine length, width, and height, before and after resection, were similar between arcuate and septate, as were the subsepti base widths, despite the different lengths. However, cavity width was significantly decreased after resection only in the septate uterus group: 3.6 cm, 95% confidence interval, 3.3–3.9, preoperatively vs 2.8 cm, 95% confidence interval, 2.5–3.1, postoperatively, respectively; P < .001. The postoperative difference in cavity width was directly correlated with the length of the subseptation (r –0.59, P = .05).

Conclusion

Postoperative measurements of the uterine cavity revealed a remarkable uterine remodeling capacity: we speculate this could represent the most important single change to explain improved pregnancy outcomes after surgical correction of subseptations.

Section snippets

Materials and Methods

This was a prospective cohort study. The conduct of this study was approved by the University of Tennessee Health Science Center Human Investigation Committee. Patients signed an informed consent form.

A cohort of women diagnosed with arcuate or septate uteri were evaluated with 3D ultrasound before undergoing surgical resection by hysteroscopic resection. In addition to all the standard measurements including uterine length, height, and width, measurements of the subseptum's length (measured

Results

Twenty-eight patients were diagnosed with either arcuate (n = 12) or septate (n = 16) uterus and underwent surgical correction. Most patients presented to our clinic reporting infertility (27/28, 96%); 1 had experienced 3 consecutive losses after a term pregnancy and was also heterozygous for Factor V of Leiden and of advanced age, being 42 years old. The average age of the patients was 31.4 years (95% CI, 29.1–33.8). Of them, 50% had a retroverted uterus and 61% had a diagnosis of polycystic

Comment

Postoperative measurements of the uterine cavity width were significantly decreased after resection in patients with septate uterus. The postoperative difference in cavity width was directly correlated with the length of the subseptation. Our findings revealed a remarkable uterine remodeling capacity: the cavity regained a normal shape and size after surgical correction. It appears that the uterine fundus is only stretched by the subseptum and that, after its resection, plastic forces reinstate

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This study was supported by an institutional grant from the University of Tennessee Health Science Center.

The author reports no conflict of interest.

Cite this article as: Detti L. Ultrasound assessment of uterine cavity remodeling after surgical correction of subseptations. Am J Obstet Gynecol 2014;210:262.e1-6.

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