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Septate uterus by updated ESHRE/ESGE, ASRM and CUME definitions: association with infertility, previous miscarriage, and warnings for women and healthcare systems, and associated cost analysis

Artur Ludwin, Inga Ludwin, Marcela A Coelho Neto, Carolina O Nastri, Bala Bhagavath, Steven R Lindheim, Wellington P Martins
Ultrasound in Obstetrics & Gynecology 2019 April 11

OBJECTIVE: To estimate the differences in frequency of septate uterus diagnosis and the association with infertility and previous miscarriage using three different criteria.

METHODS: Secondary data-driven analysis of data from prospective study was performed based on data-set of 261 consecutive women of reproductive age from daily clinical practice in private clinic focused on diagnosis and treatment of congenital uterine malformations. Re-analysis of datasets was performed using following definitions of septate uterus: ASRM-2016, ESHRE/ESGE-2016, and CUME-2018 (Congenital Uterine Malformation by Experts).

RESULT(S): Although 33% (85/261) of the subjects met one of the three definitions of septate uterus, only 2.6% (7/261) of them fulfilled all three definitions of septate uterus. We observed many more cases of septate uterus using ESHRE/ESGE-2016 than ASRM-2016, (RR=6.7, P<0.01) and CUME-2018 (RR=2.6, P<0.01). We also observed frequent cases that cannot be properly classified by ASRM-2016 (grey zone; 6.5%). There were no significant differences (P = 1.0) in the prevalence of septate uteri in women with and without infertility by ASRM-2016 (5% vs 4%), ESHRE/ESGE-2016 (35% vs 28%), and CUME-2018 (11 vs 12%), respectively. Septate uterus was significantly more frequent in women with previous miscarriage by ASRM-2016 (11% vs 3%; P = 0.04) and CUME-2018 (22 vs 11%; P = 0.04); but there were no significant differences in prevalence of septate uteri by ESHRE/ESGE-2016 in women with and without previous miscarriage (42% vs 28%; P = 0.4).

CONCLUSION(S): The prevalence of septate uterus using ESHRE/ESGE-2016, ASRM-2016 and CUME-2018 criteria are very different. The most important limitation of ASRM classification is the high proportion of unclassifiable cases (grey-zone: neither normal/arcuate nor septate) that should be addressed. The high proportion overdiagnosis of septate uterus by ESHRE/ESGE-2016 may lead to unnecessary surgeries and therefore unnecessary risk to women and impose excessive expenditures on healthcare systems. Efforts for the creation of clinically meaningful, and universally applicable/acceptable criteria should be encouraged. This article is protected by copyright. All rights reserved.


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