Three Dimensional Ultrasound

What is three dimensional ultrasound?

Digital technology has allowed for the latest advance in imaging, namely three-dimensional ultrasound (3DUS). Standard two dimensional transvaginal ultrasound is the modality of choice for evaluation of the female pelvis; however, it is sometimes limited in assessing the shape of the uterus due to the position of the uterus in the pelvis. Three dimensional images can be selected along arbitrary planes, providing the physician a view that can not be obtained with standard ultrasound. Three dimensional ultrasound now provides an alternative to x-ray hysterosalpingography and MRI in the evaluation of the uterus.

What are the indications?

Three dimensional ultrasound is a valuable new technique for examining the shape of the uterus. Three dimensional ultrasound can be used to evaluate the presence of uterine anomalies (birth defects of the uterus) and uterine fibroids. Abnormalities of the uterus are a common cause of pregnancy loss.

Recurrent pregnancy loss is defined as three consecutive miscarriages and occurs in approximately 1 percent of women. About 10-15 percent of women with a history of recurrent pregnancy loss have an abnormality of the uterus. Two uterine causes of recurrent pregnancy loss are congenital anomalies and fibroids. The most common uterine anomaly associated with pregnancy loss is a septate uterus. The uterine septum is a birth defect in which tissue protrudes into the uterine cavity, giving the inside of the uterus a heart shape.  This occurs in about one in four-hundred women. Fibroids are common growths of the muscle of the uterus. Fibroids may cause pregnancy loss when they are located near the inside lining of the uterus. Theoretically, the pregnancy loss occurs because the blood supply is not adequate if the placenta grows on the fibroid or septum. Three dimensional ultrasound can diagnose a septum or fibroid.

Scheduling the test

The three dimensional ultrasound is done in the luteal phase (second half of the menstrual cycle).  The view is best during this time as the lining of the uterus is thick and bright. The shape of the uterus may be difficult to see if the lining is thin, as it normally is early in the cycle or when on hormones (e.g. oral contraceptive pills). The average time of the test is usually less than 20 minutes.

What are the advantages of three dimensional ultrasound?

The main advantages of 3DUS are the absence of radiation or risk of allergic reaction to the x-ray contrast.  Although the radiation exposure with x-ray hysterosalpingogram is minimal, pelvic ultrasound alone has no known risk.  The cost is much less than an MRI and it requires less time.  When an abnormality is found, your physician can determine whether surgery may be indicated.   A three dimensional ultrasound may avoid a purely diagnostic surgical procedure. 

Three dimensional ultrasound is a safe, easy and cost effective way to evaluate the uterus in patients with recurrent pregnancy loss.

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