Clinical implications of sonographic detection of uterine anomalies for reproductive outcome

The purpose of this review article was to analyze the literature on the pre valence, diagnosis and treatment of the congenital uterine anomalies and to discuss current dilemmas on their influence on reproductive outcome. Conge nital uterine anomalies are commonly associated with repeated pregnancy fai lure, in particular an increased risk of first- and second-trimester miscar riages and preterm delivery. Recent reports on two-dimensional and three-di mensional transvaginal ultrasound and saline contrast sonohysterography app ear promising for diagnosis and classification of congenital uterine anomal ies. The ability to visualize both the uterine cavity and the fundal uterin e contour on a three-dimensional scan facilitates the diagnosis of uterine anomalies and enables differentiation between septate and bicornuate uteri. Color Doppler ultrasound allows visualization of intraseptal vascularity a nd may help in distinguishing the avascular from the vascular septum. Less connective tissue in the septum may result in poor decidualization and plac entation, while an increased amount of muscle tissue in the septum can caus e miscarriage by the production of local uncoordinated myometrial contracti lity. Hysteroscopic septum excision is an effective procedure which improve s live-birth rates. Because of its simplicity, minimal invasiveness, low mo rbidity and low, cost, a more liberal approach to the treatment of uterine anomalies is being advocated.