Quantitative ultrasound measurement of uterine contractility in septate uterus vs. normal uteri: a multicenter prospective study

Abstract

Objective: To study the differences in uterine contractility in women with septate uterus compared with those with a normal uterus throughout the menstrual cycle using a quantitative two-dimensional transvaginal ultrasound speckle tracking method.

Design: A multicenter prospective observational study was performed from February 2023 to July 2024.

Subjects: Fifty-seven patients with a diagnosis of septate uterus and seventy-one patients with a normal uterus, all of reproductive age, were enrolled at the Gynecology Departments of the University of Naples Federico II (Italy) and the Catharina Hospital in Eindhoven (Netherlands).

Exposure: A four-minute two-dimensional transvaginal ultrasound video in a median sagittal section of the uterus was performed throughout the various phases of the menstrual cycle to evaluate uterine contractility features, using a speckle tracking algorithm.

Main outcome measures: Uterine contractility features were analyzed in all patients diagnosed with a septate uterus, including contraction frequency (in contractions per minute), amplitude, direction, median velocity (mm/sec), and coordination measured in mean squared error.

Results: Regardless of the cycle phase, patients with a septate uterus exhibited statistically significant trends of decreased contraction frequency, velocity, and amplitude, along with poorer contraction coordination, compared with patients with normal uterus. In the luteal phase, when contractions are typically quiescent to facilitate embryo implantation, an increase in contraction frequency (1.27 ± 0.21 vs. 1.10 ± 0.12), contraction velocity in posterior wall from cervix to fundus (0.90 ± 0.23 vs. 0.70 ± 0.09), contraction velocity in posterior wall from fundus to cervix (0.91 ± 0.23 vs. 0.71 ± 0.08) and a decrease in contraction coordination (0.41 ± 0.16 vs. 0.20 ± 0.08) were reported in septate uteri. Furthermore, when considering two subgroups-partial and complete septate uteri compared with normal uteri-data indicated a greater impairment of uterine contractility in partial septate uteri when compared with normal uteri.

Conclusion: The presence of uterine pathologies, such as a septate uterus, may alter uterine peristalsis. A deeper understanding of uterine peristalsis in congenital anomalies could illuminate the link between the septate uterus and infertility.

Trial registration: number NL52466.100.15.

Keywords: Uterine contractility; septate uterus; ultrasound.