Assessment of Uterine Cavity Size and Shape: A Systematic Review Addressing Relevance to Intrauterine Procedures and Events

Norman Goldstuck

Abstract

Uterine cavity measurement began with evaluation of post-mortem and surgical specimens. It has been extended in vivo by use of mechanical instruments and visualization techniques. This is a systematic review of the range of values for the uterine cavity and the practical implications of these measurements, Following a review of multiple data bases & a QUORUM analysis. Only articles with clearly defined quantitative measurements were included. Mechanical cavity measurements with a variety of instruments gave a mean endometrial cavity length (ECL) of 33.73mm (18-22.1) and a mean endometrial cavity width (ECW) of 25.1mm (17.8-32.2) for nulliparae. The values for multiparae were mean ECL 38.6mm(20.61-40.3) and mean ECW 34.9mm (23.4-53).Imaging measurements for the uterine cavity by hysterography and ultrasound were mean ECL 44.3mm (29-64) for multiparae and ECL 37mm for nulliparae. Mean ECW was 28.2mm (21-33) for nulliparae and 32.1mm (26-38) for multiparae. There were wide variations due to parity, ethnicity and gestational states. Accurate measurement of intrauterine parameters is valuable for improving and enhancing many intrauterine procedures including IUD insertion, endometrial ablation, embryo placement in IVF and management of spontaneous and therapeutic abortion.  (Afr J Reprod Health 2012; 16[3]: 129-138).

 

Résumé

 

La mesure de la cavité utérine a commencé avec l'évaluation des échantillons post-mortem et chirurgicaux.  Il a été prolongé in vivo par l'utilisation  des instruments mécaniques et des techniques de visualisation. Il s'agit d'une revue systématique de l’étendue de valeurs pour la cavité utérine et les implications pratiques de ces mesures,  suite d'un examen des bases de données multiples et quelques articles et d’analyse  de Quorum.  Seuls les articles dont les mesures quantitatives étaient bien définies ont été retenus.  Les mesures de la cavité mécanique  réalisées à l’aide des divers instruments ont donné une longueur de cavité endométriale moyenne(LCE)  de 33.73mm (18 à 22,1) et une largeur de cavité endométriale moyenne de la cavité endométriale  (LgCE) de 25.1mm (17,8 à 32,2) pour  les nullipares. Les valeurs pour les multipares étaient LCE 38.6mm (20,61 à 40,3) et la moyenne pour LgCE était 34.9mm (23.4 à 53).   Les mesures d'imagerie pour la cavité utérine à l’aide de l’hystérographie et l'échographie LCE 44.3mm (29-64) pour les multipares et LCE 37mm pour nullipares.  La LgCE moyenne était 28.2mm (21-33) pour les nullipares et 32.1mm (26-38) pour les multipares. Il y avait de grandes variations en raison de la parité, l'appartenance ethnique et les états gestationnels.  Une mesure exacte des paramètres intra-utérins est importante pour  l’amélioration et le renforcement de nombreuses procédures intra-utérines, y compris l'insertion du DIU, l’ablation de l'endomètre, la mise en place d'embryons dans la FIV et du traitement de l'avortement spontané et thérapeutique (Afr J Reprod Health 2012; 16[3]: 129-138).

 

  Keywords: intrauterine, uterine cavity, measurement, endometrial

Full Text:

PDF

References

Mohor D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Lancet 1999;354: 1896-1900

Dickson RL. Human Sex anatomy. Robert E. Krieger Publishing Co., 1971: 20-3.

Lewis RB, Zuspan IP. A method for determining contour volume of the uterine cavity. Contraception 1970; 2: 249-57.

Canteiro R, Bahamondes MV, Fernandes ADS, et al. Length of the endometrial cavity as measured by uterine sounding and ultrasonography in women of different parities. Contraception 2010; 81: 515-9.

Goldstuck ND. The Mark-7 sound- an accurate determinant of uterine axial length. Contraception 1979; 20:359-65.

Gibor Y, Deysack L, Nissen CH. Uterine length: a prognostic indicator for the successful use of the Copper 7 intrauterine device. J Reprod Med 1973; 11: 205-8.

Hasson HM. Differential uterine measurement recorded in vivo Obstet Gynecol 1974; 43: 40-12.

Reynoso L, Zamora G, Gonzalez-Didi M, Lozano M, Aznar R Uterine metrology in Mexican women. In Hasson H, Hafez ES, van Os WA eds Biomedical aspects of IUDs. Hingham, Mass. MTP Press, 1985: 119-24.

Kurz KH. Cavimeter uterine measurements and IUD clinical correlation. In Zatuchni GI, Goldsmith A, Sciarra JJ, eds. Intrauterine contraception: Advances and future prospects. Philadelphia, Harper and Row, 1984: 126-41.

Wang JG. Development of a new method of insertion of IUDS. Contraception 1982; 25: 405-20.

Hasson HM. Clinical Studies of the Wing sound II metrology device. In Zatuchni GI, Goldsmith A, Sciarra JJ, eds.Intrauterine contraception: Advances and future prospects. Philadelphia, PA. Harper and Row, 1984:126-41.

Sharp HT. Assessment of new technology in the management of idiopathic menorrhagia and uterine leiomyomata. Obstet Gynecol 2006; 108:990-1003.

Theron F, Wessels PH. Uterine measurement in the fitting of intrauterine devices. S Afr Med J 1984; 65: 1054-6.

Ismail AAA, ANSWER SM, Keshk SM, et al. Uterine geometry by Wing sound and hysterography versus

direct measurements. Adv Contracept 1987; 3: 23743.

de Castro A. Assessment of uterine shape and size using Kurz’s Cavimeter. Adv Contracept 1988; 4: 115-23.

Gullinat A. NovaSure impedance controlled system for endometrial ablation: three years follow up on 107 patients. Am J Obstet Gynecol 2004; 191: 1585-9.

Fulop T, Rakozi I, Barna I. NovaSure impedance controlled endometrial ablation: Long term follow up results. J Min Invasive Gynecol 2007: 14; 85-90.

Burnhill MS, Birnberg CH. The size and shape of the uterine cavity determined by hysterography with an intrauterine contraceptive marker. Int J Fertil 1966; 11: 187-93.

Tejuja S, Malkani PK. Clinical significance of correlation between size of the uterine cavity and IUCD: a planimeter hysterogram technique. Am J Obstet Gynecol 1969; 105: 620-7.

Bromer JG, Sanguenetti M, Tal P, Patrizio P.

Assessment of the uterine cavity and the intraostial distance using hysteosalpingography. Fertil Steril 2007; 88 (Suppl 1): S202.

Castellotti DS, Cambioghi AS. Comparing measurements of endometrial cavity length by performed at hysteroscopy with transvaginal and pelvic ultrasound before in-vitro fertilization. Fertil Steril 2007; 88 (Suppl 1): S145.

Sher G, Fisch JD. Measuring uterine depth with colpohydroscopy. Reprod Med 2003; 48: 325-9.

Benacerraf BR, Shipp TD, Lyons JG, Bromley B. Width of the normal uterine cavity in premenopausal women and effect of parity. Obstet Gynecol 2010; 116: 305-10.

Haines CJ, Shaund KL, Leung DYL. Transvaginal sonography of the uterine cavity following curettage for early pregnancy failure. Ultrasound Obstet Gynecol 1991; 1: 417-9.

Sokol ER, Casele H, Haney EI. Ultrasound Examination of the postpartum uterus: what is normal? J of MatFetal Neonat Med 2010;15:95-9.

Bourne TH, Hagstrom HG, Granberg S, et al. Ultrasound studies of vascular and morphological changes in the human uterus after a positive self-test for the urinary luteinizing hormone surge. Human Reproduction 1996; 11: 369-75.

Madani T, Ashrati M, Abandi AB, et al. Appropriate timing of uterine cavity length measurement positively affects assisted reproduction cycle cutcome. Reprod Biomed online 2009; 19: 734-6.

Kurz KH, Tadese E, Haspels AA. In vivo measurement of uterine cavities in 795 women of fertile age. Contraception 1984; 29: 495-510.

Goldstuck ND. Insertion forces with intrauterine devices: implications for uterine perforation. Eur J Obstet Gynecol Reprod Biol 1987: 25: 315-23.

Egbase PE, Al-Sharhan M, Grudzinskas JG. Influence of position and length of uterus on implantation and clinical pregnancy rates in IVF and embryo transfer treatment cycles. Human Reproduction 2000; 15: 1943-6.

Wildermeersch D, Janssens D, Andrade A. The Femilis LNG-IUS: Contraceptive performance- an interim analysis. Eur J Cont Reprod Health Care 2009; 14: 103-110.

Adel SK, Ghonheim MA, Sobrero AJ. Hysterography study of long term effects of intrauterine contraceptive devices. Fertil Steril 1971; 22: 651-2.

Hasson HM, Berger GS, Edelman DA. Factors affecting intrauterine contraceptive device performance. Am J Obstet Gynecol 1976; 126: 973-81.

Kurz KH. Avoidance of the dimensional incompatibility as the main reason for side effects in intrauterine contraception. Contracept Deliv Syst 1981; 2: 21-9.

Toppazada M, Ismail AA, Bakry MA. Uterine geometry and IUD induced pain. Adv Contracept 1986;2: 169-175.

O’Brien P, Marfleet CC. Frameless versus classical intrauterine device for contraception. Cochrane Database Syst Reviews 2005; 1: Art no. CDOO3282.

Tadesse E, Van Brandenburg WJA, Exalto N.

Intrauterine devices: results of a separate clinical and ultrasound follow-up study. Eur J Obstet Gynecol Reprod Biol 1985; 19: 289-95.

Tiras B, Polot M, Korucuogla U, Zeyneloglu B, Yarali H. Impact of embryo replacement on in vitro fertilization and embryo transfer outcomes. Fertil Steril 2010; 94: 1341-5.

Corolen B, Barri PN, Carreras O, et al. The influence of the depth of embryo replacement into the uterine cavity on implantation rates after IVF: a controlled, ultrasound –guided study. Human Reproduction 2002; 17: 341-6.

Pole CS, Cook EKD, Arny M, Novak A, Grow DR. Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes. Fertil Steril 2004; 81: 51-8.

Gergely RZ, De Ugarte CM, Danzer H, et al. Three dimensional four dimensional ultrasound-guided embryo transfer using the maximal implantation potential point. Fertil Steril 2005; 84: 500-3.

Sun Y, Fang L, Su Y, Guo Y. Uterine cavity shape and the best site for embryo transfer. Int J. Gynecol Obstet 2009; 105: 140-4.

van Bogaert LJ, Misra A. Sonography of uterine cavity contents after medical abortion. Int J Obstet Gynecol 2009; 104: 150-1.

Conde-Agudelo A, Romero R, Hassan S, Yeo L. Transvaginal sonographic cervical length for the production of spontaneous preterm birth in twin pregnancies: a systematic review and meta-analysis. Am J Obstet Gynecol 2010; 203: 128e 1-12.

Yoshizato T, Inoue Y, Fukami T, Sanui A, Miyamato S, Kawarabayashi T. Longitudinal changes in canal length at 16-35 weeks in normal twin pregnancies with preterm labor and delivery. J Obstet Gynecol

Refbacks

  • There are currently no refbacks.