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GYN ultrasound

17 studies9 challenges

Describe the uterus, the endometrium and each adnexa before naming anything. Every image opens with how to read it; switch to Practice when you are ready to be tested.

Transabdominal ultrasound of the pelvis showing two separate uterine bodies side by sideTransabdominal, transverse

GYN ultrasound · Uterine anomalies

Two uterine bodies

Diagnosis

Uterus didelphys

Normal against abnormal

The plane, and which way is up

Transvaginal in coronal or three-dimensional reconstruction: the outer fundal contour and the shape of the cavity are read together, best in the secretory phase when the endometrium is bright.

Look for, in order

  1. The outer fundus: a normal convex or flat contour, or a deep notch?
  2. The cavity: one, two, or a septum dividing it; how far the division reaches toward the cervix.
  3. Two cervices or two vaginas; the kidneys, which share an origin and are often abnormal too.

What normal looks like

A single fundus with a convex contour and a triangular cavity. A septate uterus has a normal outer contour with a divided cavity; a bicornuate uterus has a fundal notch over 1 cm; didelphys is two separate horns and usually two cervices.

Trap. Septate and bicornuate look alike on a two-dimensional scan and are managed differently; the outer fundal contour, not the cavity, separates them.

Describe it in this order

  1. The plane and the approach
  2. Uterus: size, position, outline, myometrium
  3. Endometrium: thickness, echogenicity, outline, cavity contents
  4. Cervix
  5. Right adnexa, then left: ovary seen, any mass described not named
  6. Pouch of Douglas: free fluid
  7. Then, and only then, the impression

Findings

  • Two widely separated uterine bodies, each with its own endometrium

What it means for the patient

Didelphys is complete failure of Müllerian duct fusion: two uteri, two cervices, often a vaginal septum. It is usually found incidentally or in the work-up of pregnancy loss or preterm birth. Three-dimensional ultrasound or MRI distinguishes it from a bicornuate or septate uterus by showing the outer fundal contour. Renal anomalies accompany Müllerian anomalies often enough that the kidneys are always checked.

Framework: Cunningham et al., Williams Obstetrics, 26th edition (maternal physiology, labour mechanics, placental anatomy) (2022).

OBGynSpace Tutor

It coaches the description; it does not read the image for you and will not name the diagnosis before you commit.