Currently, the most significant non-invasive method of research in obstetrics and gynecology is ultrasound.
For the visualization of congenital malformations of the uterus, the second phase of the menstrual cycle is more informative, when the endometrium in the phase of secretion clearly delineates the contours of the uterine cavity.
A double-breasted uterus is transversally scanned by two formations connected to each other at a greater or lesser angle of the homogeneous structure. Intrauterine septum with ultrasound is not always clearly visualized, and the uterus appears as a single entity with the presence of 2 M-ECHO. Defect M-ECHO depends on the degree of severity of the septum, if the defect was all over, then the septum was complete, with a partial defect - incomplete. The saddle-shaped uterus is not always detected with ultrasound outside of pregnancy, it usually looks like a single formation with a small deeper contour in the bottom area of the uterus body.
Significant differences were obtained on the following parameters: the thickness of the myometrium in congenital malformations and uterine hypoplasia was reduced by 25-40% compared to normal indices.
When uterine hypoplasia, the uterine body length significantly decreased by 15-26.6% and the cervix by 31-34%. Reduction of these parameters can not but affect the functional abilities of the uterus and determines the high degree of risk of complications in pregnancy.
The informativity of the echography, according to our data, was from 50 to 100%: the lowest with intrauterine synechiae, the largest - with uterine myoma. When echography, you can identify organic istmiko-cervical insufficiency in the event that the width of the cervical canal exceeds 0.5 cm, which is significantly higher than the normative parameters.
According to research, the width of the cervix over 1.9 cm indicates the presence of ischemic-cervical insufficiency.
Using the method of echography, chronic endometritis is revealed, especially when using a transvaginal sensor - the uterine cavity is expanded to 0.3-0.7 cm and a small amount of fluid is noted.
The use of transvaginal ultrasound allows to assess the state of the endometrium, its readiness for implantation, dynamics of changes in the structure and thickness of the endometrium during the menstrual cycle.
Extremely interesting for practical use is the assessment of the biophysical profile of the uterus according to the data of echography and Dopplerometry, developed in the Women's Healts Center in Chicago.
Further examination is carried out taking into account those parameters that were identified at the first stage and relate mainly to the clarification of pathogenetic mechanisms, selection of therapy and evaluation of the effectiveness of the therapy and is carried out individually for patients. For example, if the main genesis of miscarriage is infectious, the second stage involves evaluating the immune status, interferon status, and the level of proinflammatory cytokines.
When detecting changes on the hemostasiogram, the cause of the thrombophilic condition is clarified: lupus anticoagulant, congenital hemostatic disorders, etc. These studies will be reflected when considering the tactics of managing patients with various causative factors of miscarriage.
A major role in the etiology of habitual miscarriage is played by malformations of the uterus, especially in the termination of pregnancy of the second and third trimesters. The incidence of malformations of the uterus in the population is only 0.5-...
If there is an ischemic-cervical insufficiency, the treatment should be etiological. Thus, with gross anatomical changes in the cervix due to old ruptures (if this is the only reason for miscarriage), surgical treatment outside of pregnancy (...
Among the factors of abortion, complications of pregnancy take a big place: gestations of the second half of pregnancy, anomalies of placenta attachment, premature detachment of the placenta, improper position of the fetus.
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