Abstract：
OBJECTIVE: What is the prevalence of congenital and acquired anomalies of the uterus in women with recurrent pregnancy loss (RPL) of unknown etiology examined using 3D transvaginal ultrasound (US)?
CONCLUSIONS: Depending on the adopted diagnostic criteria, the prevalence of partial septate uterus varies between 7% and 14% and a T-shaped uterus is 3% or 4%, while adenomyosis is 23%, at least one of type 0, type 1 or type 2 myoma is 4%, and at least one endometrial polyp is 4%.
BACKGROUND: ESHRE and the Royal College of Obstetricians and Gynaecologists guidelines on RPL recommend the adoption of the 3D transvaginal US to evaluate the \'uterine factor\'. Nevertheless, there are no published studies reporting the prevalence of both congenital and acquired uterine anomalies as assessed by 3D transvaginal US and diagnosed according to the criteria proposed by the most authoritative panels of experts in a cohort of women with RPL.
METHODS: This was a retrospective cohort study including 442 women with at least two previous first-trimester spontaneous pregnancy losses (i.e. non-viable intrauterine pregnancies), who referred to the obstetrics and gynecology unit of two university hospitals between July 2020 and July 2023.
METHODS: Records of eligible women were reviewed. Women could be included in the study if: they were between 25 and 42 years old; they had no relevant comorbidities; they were not affected by infertility, and they had never undergone ART; they and their partner tested negative to a comprehensive RPL diagnostic work-up; and they had never undergone metroplasty, myomectomy, minimally invasive treatments for uterine fibroids or adenomyomectomy. Expert sonographers independently re-analyzed the stored 2- and 3D transvaginal US images of all included patients. Congenital uterine anomalies (CUAs) were reported according to the American Society for Reproductive Medicine (ASRM) 2021, the ESHRE/European Society for Gynaecological Endoscopy (ESGE) and the Congenital Uterine Malformation by Experts (CUME) criteria. Acquired uterine anomalies were reported according to the International Federation of Gynecology and Obstetrics (FIGO) and the Morphological Uterus Sonographic Assessment (MUSA) criteria.
RESULTS: The partial septate uterus was diagnosed in 60 (14%; 95% CI: 11-17%), 29 (7%; 95% CI: 5-9%), and 47 (11%; 95% CI: 8-14%) subjects, according to the ESHRE/ESGE, the ASRM 2021, and the CUME criteria, respectively. The T-shaped uterus was diagnosed in 19 women (4%; 95% CI: 3-7%) according to the ESHRE/ESGE criteria and in 13 women (3%; 95% CI: 2-5%) according to the CUME criteria. The borderline T-shaped uterus (diagnosed when two out of three CUME criteria for T-shaped uterus were met) was observed in 16 women (4%; 95% CI: 2-6%). At least one of FIGO type 0, type 1, or type 2 myoma was detected in 4% of included subjects (95% CI: 3-6%). Adenomyosis was detected in 100 women (23%; 95% CI: 19-27%) and was significantly more prevalent in women with primary RPL and in those with three or more pregnancy losses. At least one endometrial polyp was detected in 4% of enrolled women (95% CI: 3-7%).
CONCLUSIONS: The absence of a control group prevented us from investigating the presence of an association between both congenital and acquired uterine anomalies and RPL. Second, the presence as well as the absence of both congenital and acquired uterine anomalies detected by 3D US was not confirmed by hysteroscopy. Finally, the results of the present study inevitably suffer from the intrinsic limitations of the adopted classification systems.
CONCLUSIONS: The prevalence of CUAs in women with RPL varies depending on the classification system used. For reasons of clarity, the US reports should always state the name of the uterine anomaly as well as the adopted classification and diagnostic criteria. Adenomyosis seems to be associated with more severe forms of RPL. The prevalence rates estimated by our study as well as the replicability of the adopted diagnostic criteria provide a basis for the design and sample size calculation of prospective studies.
BACKGROUND: No specific funding was used. The authors have no conflicts of interest to declare.
BACKGROUND: N/A.
CONCLUSIONS: Depending on the adopted diagnostic criteria, the prevalence of partial septate uterus varies between 7% and 14% and a T-shaped uterus is 3% or 4%, while adenomyosis is 23%, at least one of type 0, type 1 or type 2 myoma is 4%, and at least one endometrial polyp is 4%.
BACKGROUND: ESHRE and the Royal College of Obstetricians and Gynaecologists guidelines on RPL recommend the adoption of the 3D transvaginal US to evaluate the \'uterine factor\'. Nevertheless, there are no published studies reporting the prevalence of both congenital and acquired uterine anomalies as assessed by 3D transvaginal US and diagnosed according to the criteria proposed by the most authoritative panels of experts in a cohort of women with RPL.
METHODS: This was a retrospective cohort study including 442 women with at least two previous first-trimester spontaneous pregnancy losses (i.e. non-viable intrauterine pregnancies), who referred to the obstetrics and gynecology unit of two university hospitals between July 2020 and July 2023.
METHODS: Records of eligible women were reviewed. Women could be included in the study if: they were between 25 and 42 years old; they had no relevant comorbidities; they were not affected by infertility, and they had never undergone ART; they and their partner tested negative to a comprehensive RPL diagnostic work-up; and they had never undergone metroplasty, myomectomy, minimally invasive treatments for uterine fibroids or adenomyomectomy. Expert sonographers independently re-analyzed the stored 2- and 3D transvaginal US images of all included patients. Congenital uterine anomalies (CUAs) were reported according to the American Society for Reproductive Medicine (ASRM) 2021, the ESHRE/European Society for Gynaecological Endoscopy (ESGE) and the Congenital Uterine Malformation by Experts (CUME) criteria. Acquired uterine anomalies were reported according to the International Federation of Gynecology and Obstetrics (FIGO) and the Morphological Uterus Sonographic Assessment (MUSA) criteria.
RESULTS: The partial septate uterus was diagnosed in 60 (14%; 95% CI: 11-17%), 29 (7%; 95% CI: 5-9%), and 47 (11%; 95% CI: 8-14%) subjects, according to the ESHRE/ESGE, the ASRM 2021, and the CUME criteria, respectively. The T-shaped uterus was diagnosed in 19 women (4%; 95% CI: 3-7%) according to the ESHRE/ESGE criteria and in 13 women (3%; 95% CI: 2-5%) according to the CUME criteria. The borderline T-shaped uterus (diagnosed when two out of three CUME criteria for T-shaped uterus were met) was observed in 16 women (4%; 95% CI: 2-6%). At least one of FIGO type 0, type 1, or type 2 myoma was detected in 4% of included subjects (95% CI: 3-6%). Adenomyosis was detected in 100 women (23%; 95% CI: 19-27%) and was significantly more prevalent in women with primary RPL and in those with three or more pregnancy losses. At least one endometrial polyp was detected in 4% of enrolled women (95% CI: 3-7%).
CONCLUSIONS: The absence of a control group prevented us from investigating the presence of an association between both congenital and acquired uterine anomalies and RPL. Second, the presence as well as the absence of both congenital and acquired uterine anomalies detected by 3D US was not confirmed by hysteroscopy. Finally, the results of the present study inevitably suffer from the intrinsic limitations of the adopted classification systems.
CONCLUSIONS: The prevalence of CUAs in women with RPL varies depending on the classification system used. For reasons of clarity, the US reports should always state the name of the uterine anomaly as well as the adopted classification and diagnostic criteria. Adenomyosis seems to be associated with more severe forms of RPL. The prevalence rates estimated by our study as well as the replicability of the adopted diagnostic criteria provide a basis for the design and sample size calculation of prospective studies.
BACKGROUND: No specific funding was used. The authors have no conflicts of interest to declare.
BACKGROUND: N/A.
摘要：
目的：使用3D阴道超声（US）检查病因不明的复发性妊娠丢失（RPL）妇女的先天性和获得性子宫异常的患病率是多少？
结论：根据所采用的诊断标准，部分纵隔子宫的患病率在7%到14%之间，T形子宫为3%或4%，子宫腺肌病占23%，0型、1型或2型肌瘤中至少有一种为4%，至少一个子宫内膜息肉占4%。
背景：ESHRE和皇家妇产科学院关于RPL的指南建议采用3D经阴道US来评估“子宫因子”。然而，没有发表的研究报告通过3D经阴道US评估并根据最权威的专家小组在RPL女性队列中提出的标准诊断先天性和获得性子宫异常的患病率.
方法：这是一项回顾性队列研究，包括442名妇女，这些妇女至少有两次早孕自然流产（即无存活的宫内妊娠），他在2020年7月至2023年7月期间提到了两家大学医院的妇产科部门。
方法：回顾了符合条件的妇女的记录。如果妇女年龄在25至42岁之间;他们没有相关的合并症;他们没有受到不孕症的影响，他们从未接受过ART；他们和他们的伴侣对全面的RPL诊断检查呈阴性；他们从未接受过计量学成形术，子宫肌瘤切除术,子宫肌瘤或腺肌瘤切除术的微创治疗。专家超声检查者独立地重新分析所有纳入患者的存储的2-和3D经阴道US图像。根据美国生殖医学学会（ASRM）2021，ESHRE/欧洲妇科内窥镜学会（ESGE）和专家先天性子宫畸形（CUME）标准报告了先天性子宫异常（CUA）。根据国际妇产科联合会（FIGO）和形态学子宫超声检查（MUSA）标准报告了获得的子宫异常。
结果：在60岁时诊断出部分纵隔子宫（14％；95％CI：11-17％），29（7%；95%CI：5-9%），47名（11%；95%CI：8-14%）受试者，根据ESHRE/ESGE的说法，2021年ASRM和CUME标准，分别。根据ESHRE/ESGE标准，19名女性（4％；95％CI：3-7％）诊断为T形子宫，根据CUME标准，13名女性（3％；95％CI：2-5％）诊断为T形子宫。在16名女性（4％;95％CI：2-6％）中观察到边界T形子宫（当满足三个CUME标准中的两个时被诊断为T形子宫）。在4%的纳入受试者中检测到0型、1型或2型肌瘤中的至少一种(95%CI:3-6%)。在100名妇女中检测到子宫腺肌病（23％；95％CI：19-27％），并且在原发性RPL的妇女和有三个或更多妊娠损失的妇女中更为普遍。在4％的入选妇女中检测到至少一个子宫内膜息肉（95％CI：3-7％）。
结论：对照组的缺失使我们无法研究先天性和获得性子宫异常与RPL之间是否存在关联。第二,宫腔镜检查未证实3DUS检测到的先天性和获得性子宫异常的存在和不存在.最后,本研究的结果不可避免地受到所采用分类系统的内在局限性。
结论：患有RPL的女性中CUA的患病率因使用的分类系统而异。为了清楚起见,美国报告应始终说明子宫异常的名称以及采用的分类和诊断标准.子宫腺肌病似乎与更严重的RPL形式有关。我们研究估计的患病率以及所采用诊断标准的可重复性为前瞻性研究的设计和样本量计算提供了基础。
背景：没有使用特定的资金。作者没有利益冲突要声明。
背景：不适用。
结论：根据所采用的诊断标准，部分纵隔子宫的患病率在7%到14%之间，T形子宫为3%或4%，子宫腺肌病占23%，0型、1型或2型肌瘤中至少有一种为4%，至少一个子宫内膜息肉占4%。
背景：ESHRE和皇家妇产科学院关于RPL的指南建议采用3D经阴道US来评估“子宫因子”。然而，没有发表的研究报告通过3D经阴道US评估并根据最权威的专家小组在RPL女性队列中提出的标准诊断先天性和获得性子宫异常的患病率.
方法：这是一项回顾性队列研究，包括442名妇女，这些妇女至少有两次早孕自然流产（即无存活的宫内妊娠），他在2020年7月至2023年7月期间提到了两家大学医院的妇产科部门。
方法：回顾了符合条件的妇女的记录。如果妇女年龄在25至42岁之间;他们没有相关的合并症;他们没有受到不孕症的影响，他们从未接受过ART；他们和他们的伴侣对全面的RPL诊断检查呈阴性；他们从未接受过计量学成形术，子宫肌瘤切除术,子宫肌瘤或腺肌瘤切除术的微创治疗。专家超声检查者独立地重新分析所有纳入患者的存储的2-和3D经阴道US图像。根据美国生殖医学学会（ASRM）2021，ESHRE/欧洲妇科内窥镜学会（ESGE）和专家先天性子宫畸形（CUME）标准报告了先天性子宫异常（CUA）。根据国际妇产科联合会（FIGO）和形态学子宫超声检查（MUSA）标准报告了获得的子宫异常。
结果：在60岁时诊断出部分纵隔子宫（14％；95％CI：11-17％），29（7%；95%CI：5-9%），47名（11%；95%CI：8-14%）受试者，根据ESHRE/ESGE的说法，2021年ASRM和CUME标准，分别。根据ESHRE/ESGE标准，19名女性（4％；95％CI：3-7％）诊断为T形子宫，根据CUME标准，13名女性（3％；95％CI：2-5％）诊断为T形子宫。在16名女性（4％;95％CI：2-6％）中观察到边界T形子宫（当满足三个CUME标准中的两个时被诊断为T形子宫）。在4%的纳入受试者中检测到0型、1型或2型肌瘤中的至少一种(95%CI:3-6%)。在100名妇女中检测到子宫腺肌病（23％；95％CI：19-27％），并且在原发性RPL的妇女和有三个或更多妊娠损失的妇女中更为普遍。在4％的入选妇女中检测到至少一个子宫内膜息肉（95％CI：3-7％）。
结论：对照组的缺失使我们无法研究先天性和获得性子宫异常与RPL之间是否存在关联。第二,宫腔镜检查未证实3DUS检测到的先天性和获得性子宫异常的存在和不存在.最后,本研究的结果不可避免地受到所采用分类系统的内在局限性。
结论：患有RPL的女性中CUA的患病率因使用的分类系统而异。为了清楚起见,美国报告应始终说明子宫异常的名称以及采用的分类和诊断标准.子宫腺肌病似乎与更严重的RPL形式有关。我们研究估计的患病率以及所采用诊断标准的可重复性为前瞻性研究的设计和样本量计算提供了基础。
背景：没有使用特定的资金。作者没有利益冲突要声明。
背景：不适用。
