Congenital Uterine Malformation by Experts (CUME): diagnostic criteria for T‐shaped uterus

Abstract

CONTRIBUTIONWhat are the novel findings of this work? The prevalence, clinical relevance and appropriateness of management of T-shaped uterus is not fully understood, due to the lack of objective criteria for its diagnosis. This study developed an objective definition of T-shaped uterus based on the diagnosis made most often by representative expert clinicians, surgeons and sonologists. We identified three uterine morphometric measurements in the coronal plane, with cut-offs (lateral internal indentation depth ≥ 7 mm, lateral indentation angle ≤ 130 • and T-angle ≤ 40 • ) that have good diagnostic test accuracy and fair-to-moderate reliability for the diagnosis of T-shaped uterus.What are the clinical implications of this work? These three measurements, with cut-offs, can be used to confirm the diagnosis when there is suspicion of T-shaped uterus on subjective assessment of the uterine cavity. When these CUME definitions and criteria are used, doctors and patients can be confident that the diagnosis Correspondence to: Prof. A. Ludwin, of T-shaped uterus has high probability of being correct. Using these criteria will allow elucidation in future studies of the prevalence, clinical relevance and management of T-shaped uterus. ABSTRACT Objectives To identify uterine measurements that are reliable and accurate to distinguish between T-shaped and normal/arcuate uterus, and define T-shaped uterus, using Congenital Uterine Malformation by Experts (CUME) methodology, which uses as reference standard the decision made most often by several independent experts.Methods This was a prospectively planned multirater reliability/agreement and diagnostic accuracy study, performed between November 2017 and December 2018, using a sample of 100 three-dimensional (3D) datasets of different uteri with lateral uterine cavity indentations, acquired from consecutive women between 2014 and 2016. Fifteen representative experts (five clinicians, five

Septate uterus according to ESHRE/ESGE, ASRM and CUME definitions: association with infertility and miscarriage, cost and warnings for women and healthcare systems

“…The current focus of societies of reproductive medicine and gynecological imaging should be on the creation of universally accepted criteria and a better international classification system than the existing options, based on truly objective and clinically relevant criteria. There is as yet no consensus regarding appropriate and objective criteria for classification of congenital anomalies, which would both facilitate patient management and limit unnecessary surgical procedures. There is a concerning possibility of unnecessary stigmatization of and surgery in healthy women with normal uterus, having been diagnosed with septate or dysmorphic uterus, associated in particular with development of the ESHRE/ESGE classification.…”

“…performed an updated analysis of the stored 3D ultrasound datasets for offline measurement of internal indentation angle, using the same type of machine (Voluson E8 Expert, with updated software (BT13)) as had been used for the real‐time evaluation in the primary study. The indentation angle was measured by tracing two lines close to the indentation apex.…”

Tubal Flushing Treatment for Unexplained Infertility

“…Although it is not recommended by any guidelines, there is a tendency to use operative hysteroscopy for the correction of uterine cavity shape in such debatable entities like arcuate, and T-shaped/dysmorphic uterus in infertile women. 58 Some authors perform correction of the normal uterus under the name of abnormal uterus according to confusing classification systems. 58 Interestingly, all these procedures are reported as beneficial in uncontrolled before/after studies in infertile women.…”

“…58 Some authors perform correction of the normal uterus under the name of abnormal uterus according to confusing classification systems. 58 Interestingly, all these procedures are reported as beneficial in uncontrolled before/after studies in infertile women. Sometimes, endometrial scratching is performed by hysteroscopy.…”

Cutaneous small‐vessel vasculitis following hysterosalpingo‐foam sonography (HyFoSy)

“…A sterile plastic 5‐Fr balloon catheter was inserted into the cervical canal and inflated with 1.0 mL of saline. Three‐dimensional (3D) sonohysterography with automatic volume calculation (SonoHysteroAVC, GE Healthcare, Zipf, Austria) showed a normal/arcuate uterus according to the Congenital Uterine Malformation by Experts (CUME) criteria with a small uterine cavity < 1 mL in volume. During infusion of saline/air (10 mL of saline and 10 mL of air), the right tube was found to be patent but findings were inconclusive on the left side.…”