The Rule of 10: a simple 3D ultrasonographic method for the diagnosis of T-shaped uterus.

PURPOSE: To investigate and propose a new simple tridimensional (3D) ultrasonographic method to diagnose a T-shaped uterus (Class U1a). METHODS: A multicenter non-experimental case-control diagnostic accuracy study was conducted between January 2018 and December 2019, including 50 women (cases) diagnosed with T-shaped uterus (U1a class) and 50 women with a "normal uterus" (controls). All the enrolled women underwent 3D ultrasound, drawing four lines and recording the length of three of them as follow: draw and measure the interostial line (R0); draw from the midpoint of R0 a perpendicular line length 20 mm; draw and measure in the uterine cavity a line parallel to R0 at 10 mm below R0 (R10) and a second line parallel to R0 at 20 mm below R0 (R20). The diagnostic performance of all sonographic parameters statistically significantly different between T-shaped and normal uteri was estimated using the receiver operator characteristic (ROC) curve analysis. RESULTS: R10 and R20 were statistically significantly shorter in the T-shaped than the normal uterus. R10 reported the highest diagnostic accuracy with an area under the ROC curve of 0.973 (95% CI 0.940-1.000). R10 length maximizing the Youden's J statistic was 10.5 mm. Assuming R10 length equal to or shorter than 10 mm as the cut off value for defining a woman as having a T-shaped uterus, the new ultrasonographic method following the proposed protocol (R0, R10, and R20) reported sensitivity for T-shaped uterus of 91.1% (95% CI 0.78-0.97%) and a specificity of 100% (95% CI 0.89-100%). The positive likelihood ratio was higher than 30, and the negative likelihood ratio was 0.09 (95% CI 0.04-0.26). CONCLUSIONS: Measuring the length of the intracavitary line parallel to the interostial line at 10 mm from it and using a length ≤ of 10 mm as cut off value (the "Rule of 10") appears a simple and accurate 3D ultrasonographic method for the diagnosis of a T-shaped uterus.

Subtypes of T-shaped uterus.

OBJECTIVE: To present three different subtypes of T-shaped uterus with the use of three-dimensional (3D) ultrasound imaging and hysteroscopy. DESIGN: Video article. SETTING: Fertility center. PATIENT(S): Three cases showing the different subtypes of T-shaped uterus. INTERVENTION(S): 3D ultrasound imaging and hysteroscopy. MAIN OUTCOME MEASURE(S): Distance between the interostial line and external uterine profile at the midcoronal plane of the uterus obtained with the use of transvaginal 3D ultrasound; delineation of the external uterine contour and the length of any existing internal indentation (defined as the distance between the interostial line and the indentation's edge at the cavity). RESULT(S): It is possible to identify three different subtypes of T-shaped uterus: the most common type of T-shaped uterus, with thick lateral walls and normal fundus (without septum or subseptum appereance) and interostial distance; the Y-shaped uterus, with thick lateral walls, fundal septum or subseptum, and reduced interostial distance; and the I-shaped uterus, with very thick lateral walls (even above the isthmus) and severe reduction of the interostial distance (tubular appearance of the whole uterus). CONCLUSION(S): We solicit to investigate the occurrence of different T-shaped uterus subtypes in large cohorts, to evaluate whether they may have different reproductive outcomes and whether they may need different approaches for surgical correction through hysteroscopic metroplasty.

Thyroid hormone resistance syndrome during pregnancy / Síndrome de resistencia a hormonas tiroideas durante el embarazo

La resistencia a la hormona tiroidea representa un síndrome heredado genéticamente, causado por mutaciones en el gen del receptor de la hormona tiroidea beta, con un amplio espectro de expresión clínica. Durante el embarazo, el conocimiento de la mutación en el feto es importante para decidir sobre el tratamiento. En este artículo, revisamos el caso de una mujer embarazada diagnosticada con resistencia a la hormona tiroidea durante el embarazo

Resistance to thyroid hormone represents a genetically inherited syndrome, caused by mutations in the thyroid hormone beta receptor gene, with a wide spectrum of clinical expressiveness. During pregnancy, the knowledge of the mutation status in the fetus is important in order to decide over the treatment. In this paper we report the case of a pregnant woman diagnosed with resistance to thyroid hormone during the pregnancy