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Congenital uterine anomalies (CUAs) are deviations from normal anatomy that result from embryological maldevelopment of the Müllerian ducts. Most are asymptomatic and remain undiagnosed or are diagnosed and treated in adolescence. Some congenital malformations have been linked with adverse pregnancy outcomes such as recurrent miscarriages, infertility, preterm labour and malpresentation. Antenatally, some CUAs may indicate the use of cervical length scanning or growth scans. Intrapartum care for women with CUAs is comparable to the general population but there may be an increased risk of Caesarean section and other complications including vaginal dystocia and lacerations. Women who have been diagnosed with a CUA during pregnancy or parturition need to have additional investigations and treatment tailored to their individual anomaly post-natally.
The incidence of congenital uterine anomalies in the general population is between 0. 4% and 3. 2%. This chapter describes the principles of ultrasound diagnosis of uterine anomalies and compares the results with other available diagnostic modalities. The gold standard in the diagnosis of congenital uterine anomalies used to be a simultaneous laparotomy/ laparoscopy and hysteroscopy to visualize the serosal surface of the uterus and the endometrial cavity. The real breakthrough in ultrasound assessment of congenital uterine anomalies was the development of three-dimensional transvaginal probes. This technique involves the acquisition and storage of a volume of ultrasound information. Magnetic resonance imaging (MRI) has been shown to be effective for the diagnosis of congenital uterine anomalies with sensitivity and specificity up to 100%. The advent of three-dimensional ultrasound has greatly enhanced the ability to diagnose congenital uterine anomalies in an outpatient setting.
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