Septate vs bicornuate is decided on the external fundal contour in the true coronal plane of the uterus: an indentation of the fundus means bicornuate; a flat or convex fundus with an internal septum means septate (hysteroscopically treatable).
Orient first
- Classifications: ASRM 2021 or ESHRE/ESGE (verify the one your gynaecologists use).
- Renal agenesis or ectopia travels with unicornuate and didelphys uteri.
- Obstructed hemivagina (OHVIRA) presents with pain at menarche.
Acquire the study
- 3D transvaginal ultrasound with a reconstructed coronal plane of the uterus, in the secretory phase.
The manoeuvre
- Coronal 3D view: external fundal contour — indentation depth in mm.
- Internal cavity: septum length in mm from the interostial line.
- Two cervices or one; vagina if visible.
- Kidneys: presence and position of both.
What confirms it
- Anomaly class named from the fundal contour, cavity shape, cervix and vagina in the true coronal plane.
What licenses you to exclude it
- A normal fundal contour and triangular cavity in the true coronal plane exclude a major anomaly; an arcuate indentation is a normal variant.
The classic misread
- Judging the fundus on an oblique plane that manufactures an indentation.
- Forgetting the kidneys.