{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T06:06:33Z","timestamp":1789884393935,"version":"4.0.1"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T00:00:00Z","timestamp":1676851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The septate uterus is the most common congenital uterine anomaly, and hysteroscopy is the gold standard for diagnosing it. The goal of this meta-analysis is to perform a pooled analysis of the diagnostic performance of two-dimensional transvaginal ultrasonography, two-dimensional transvaginal sonohysterography, three-dimensional transvaginal ultrasound, and three-dimensional transvaginal sonohysterography for the diagnosis of the septate uterus. Methods: Studies published between 1990 and 2022 were searched in PubMed, Scopus, and Web of Science. From 897 citations, we selected eighteen studies to include in this meta-analysis. Results: The mean prevalence of uterine septum in this meta-analysis was 27.8%. Pooled sensitivity and specificity were 83% and 99% for two-dimensional transvaginal ultrasonography (ten studies), 94% and 100% for two-dimensional transvaginal sonohysterography (eight studies), and 98% and 100% for three-dimensional transvaginal ultrasound (seven articles), respectively. The diagnostic accuracy of three-dimensional transvaginal sonohysterography was only described in two studies, and we did not calculate the pooled sensitivity and specificity for this method. Conclusion: Three-dimensional transvaginal ultrasound has the best performance capacity for the diagnosis of the septate uterus.<\/jats:p>","DOI":"10.3390\/diagnostics13040807","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T02:30:35Z","timestamp":1676946635000},"page":"807","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Diagnostic Performance of Two-Dimensional Ultrasound, Two-Dimensional Sonohysterography and Three-Dimensional Ultrasound in the Diagnosis of Septate Uterus\u2014A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9700-0853","authenticated-orcid":false,"given":"Juan Luis","family":"Alc\u00e1zar","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Carriles","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Bel\u00e9n","family":"Cajas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3676-5991","authenticated-orcid":false,"given":"Susana","family":"Costa","sequence":"additional","affiliation":[{"name":"Department Obstetrics and Gynecology, Centro Hospitalar e Universit\u00e1rio de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Fabra","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario Infanta Sofia, 28702 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Cabrero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5031-8867","authenticated-orcid":false,"given":"Elena","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Tomaizeh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Victoria","family":"Laza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario Materno-Infantil, 06010 Badajoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Monroy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario Materno-Infantil, 06010 Badajoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Isabel","family":"Aguilar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Hernani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital General Universitario de Castell\u00f3n, 12004 Castell\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Castellet","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agustin","family":"Oliva","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario San Carlos, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5095-6981","authenticated-orcid":false,"given":"Mar\u00eda \u00c1ngela","family":"Pascual","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-7155","authenticated-orcid":false,"given":"Stefano","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, 09042 Cagliari, Italy"},{"name":"Dipartimento di Scienze Chirurgiche, University of Cagliari, 09124 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.fertnstert.2010.02.030","article-title":"Congenital Malformations of the Female Genital Tract: The Need for a New Classification System","volume":"94","author":"Grimbizis","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1093\/humupd\/dmn018","article-title":"Prevalence and Diagnosis of Congenital Uterine Anomalies in Women with Reproductive Failure: A Critical Appraisal","volume":"14","author":"Saravelos","year":"2008","journal-title":"Hum. Reprod. Update"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1093\/humupd\/dmr028","article-title":"The Prevalence of Congenital Uterine Anomalies in Unselected and High-Risk Populations: A Systematic Review","volume":"17","author":"Chan","year":"2011","journal-title":"Hum. Reprod. Update"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/humupd\/7.2.161","article-title":"Clinical Implications of Uterine Malformations and Hysteroscopic Treatment Results","volume":"7","author":"Grimbizis","year":"2001","journal-title":"Hum. Reprod. Update"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.ejogrb.2006.12.001","article-title":"Small Uterine Septum Is an Important Risk Variable for Preterm Birth","volume":"135","author":"Verdenik","year":"2007","journal-title":"Eur. J. Obstet Gynecol. Reprod. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1111\/1471-0528.15798","article-title":"The Pathophysiology of the Septate Uterus: A Systematic Review","volume":"126","author":"Rikken","year":"2019","journal-title":"BJOG"},{"key":"ref_7","unstructured":"Practice Committee of the American Society for Reproductive Medicine (2016). Uterine Septum: A Guideline. Fertil. Steril., 106, 530\u2013540."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1093\/humrep\/det098","article-title":"The ESHRE\/ESGE Consensus on the Classification of Female Genital Tract Congenital Anomalies","volume":"28","author":"Grimbizis","year":"2013","journal-title":"Hum. Reprod."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0015-0282(99)00480-X","article-title":"The Septate Uterus: A Review of Management and Reproductive Outcome","volume":"73","author":"Homer","year":"2000","journal-title":"Fertil. Steril."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jmig.2012.09.010","article-title":"Hysteroscopic Metroplasty for the Septate Uterus: Review and Meta-Analysis","volume":"20","author":"Valle","year":"2013","journal-title":"J. Minim Invasive Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1093\/humrep\/deab037","article-title":"Septum Resection versus Expectant Management in Women with a Septate Uterus: An International Multicentre Open-Label Randomized Controlled Trial","volume":"36","author":"Rikken","year":"2021","journal-title":"Hum. Reprod."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.jmig.2021.10.001","article-title":"Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis","volume":"29","author":"Carrera","year":"2022","journal-title":"J. Minim Invasive Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jmig.2012.09.011","article-title":"Two- and Three-Dimensional Ultrasonography and Sonohysterography versus Hysteroscopy with Laparoscopy in the Differential Diagnosis of Septate, Bicornuate, and Arcuate Uteri","volume":"20","author":"Ludwin","year":"2013","journal-title":"J. Minim Invasive Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1002\/uog.14825","article-title":"Accuracy of Three-Dimensional Ultrasound Compared with Magnetic Resonance Imaging in Diagnosis of M\u00fcllerian Duct Anomalies Using ESHRE-ESGE Consensus on the Classification of Congenital Anomalies of the Female Genital Tract","volume":"46","author":"Graupera","year":"2015","journal-title":"Ultrasound Obstet Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1002\/uog.7551","article-title":"Three-Dimensional Ultrasound in the Diagnosis of M\u00fcllerian Duct Anomalies and Concordance with Magnetic Resonance Imaging","volume":"35","author":"Bermejo","year":"2010","journal-title":"Ultrasound Obstet Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jmig.2013.10.014","article-title":"Diagnostic Imaging Modalities for M\u00fcllerian Anomalies: The Case for a New Gold Standard","volume":"21","author":"Berger","year":"2014","journal-title":"J. Minim Invasive Gynecol."},{"key":"ref_17","first-page":"105906","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1002\/uog.15762","article-title":"Synthesizing Evidence from Diagnostic Accuracy TEsts: The SEDATE Guideline","volume":"47","author":"Sotiriadis","year":"2016","journal-title":"Ultrasound Obstet Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring Inconsistency in Meta-Analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.jclinepi.2005.01.016","article-title":"The Performance of Tests of Publication Bias and Other Sample Size Effects in Systematic Reviews of Diagnostic Test Accuracy Was Assessed","volume":"58","author":"Deeks","year":"2005","journal-title":"J. Clin. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1046\/j.1469-0705.1993.03020129.x","article-title":"Transvaginal Sonography of the Uterine Cavity with Hysteroscopic Correlation in the Investigation of Infertility","volume":"3","author":"Narayan","year":"1993","journal-title":"Ultrasound Obstet Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/0020-7292(94)90251-8","article-title":"Sonohysterography versus Hysteroscopy for Diagnosing Endouterine Abnormalities in Fertile Women","volume":"45","author":"Romano","year":"1994","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"631","DOI":"10.7863\/jum.1998.17.10.631","article-title":"Septate Uterus: Detection and Prediction of Obstetrical Complications by Different Forms of Ultrasonography","volume":"17","author":"Kupesic","year":"1998","journal-title":"J. Ultrasound Med."},{"key":"ref_25","first-page":"262","article-title":"Three-Dimensional Ultrasound for Routine Check-Up in In Vitro Fertilization Patients","volume":"41","author":"Radoncic","year":"2000","journal-title":"Croat Med. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0301-2115(01)00434-1","article-title":"Uterine Cavity Assessment in Infertile Women: Comparison of Transvaginal Sonography and Hysteroscopy","volume":"100","author":"Loverro","year":"2001","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0020-7292(02)00417-4","article-title":"Sonohysterosalpingographic Screening for Infertile Patients","volume":"82","author":"Alborzi","year":"2003","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.ejogrb.2005.06.041","article-title":"Transvaginal Sonohysterographic Evaluation of Uterine Malformations","volume":"124","author":"Mistrangelo","year":"2006","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1055\/s-2008-1027728","article-title":"Infertility in Women: Combined Sonohysterography and Hysterosalpingography in the Evaluation of the Uterine Cavity","volume":"30","author":"Porfiri","year":"2009","journal-title":"Ultraschall der Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.fertnstert.2008.05.086","article-title":"Accuracy of Three-Dimensional Ultrasound in Diagnosis and Classification of Congenital Uterine Anomalies","volume":"92","author":"Ghi","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/j.1447-0756.2010.01304.x","article-title":"Diagnostic Accuracy of Sonohysterography, Hysterosalpingography and Diagnostic Hysteroscopy in Diagnosis of Arcuate, Septate and Bicornuate Uterus","volume":"37","author":"Ludwin","year":"2011","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5812\/iranjradiol.8063","article-title":"Diagnostic Accuracy of Transvaginal Sonography in the Detection of Uterine Abnormalities in Infertile Women","volume":"9","author":"Niknejadi","year":"2012","journal-title":"Iran. J. Radiol."},{"key":"ref_33","first-page":"977","article-title":"Uterine Cavity Assessment in Infertile Women: Sensitivity and Specificity of Three-Dimensional Hysterosonography versus Hysteroscopy","volume":"11","author":"Ahmadi","year":"2013","journal-title":"Iran. J. Reprod. Med."},{"key":"ref_34","first-page":"547","article-title":"Comparison of Two Dimensional and Live Three Dimensional Ultrasounds for the Diagnosis of Septated Uterus","volume":"12","author":"Niknejadi","year":"2014","journal-title":"Iran J. Reprod. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.ejrnm.2014.04.001","article-title":"Septate or Bicornuate Uterus: Accuracy of Three-Dimensional Trans-Vaginal Ultrasonography and Pelvic Magnetic Resonance Imaging","volume":"45","author":"Hefeda","year":"2014","journal-title":"Egypt. J. Radiol. Nucl. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"236","DOI":"10.4103\/0974-1208.197661","article-title":"Comparison between Findings of Saline Infusion Sonohysterography and Office Hysteroscopy in Patients with Recurrent Implantation Failure","volume":"9","author":"Reda","year":"2016","journal-title":"J. Hum. Reprod. Sci."},{"key":"ref_37","first-page":"287","article-title":"Accuracy of Two-Dimensional Transvaginal Sonography and Office Hysteroscopy for Detection of Uterine Abnormalities in Patients with Repeated Implantation Failures or Recurrent Pregnancy Loss","volume":"11","author":"Shiva","year":"2018","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s00404-019-05050-x","article-title":"Three-Dimensional Ultrasound in the Diagnosis and the Classification of Congenital Uterine Anomalies Using the ESHRE\/ESGE Classification: A Diagnostic Accuracy Study","volume":"299","author":"Kougioumtsidou","year":"2019","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_39","first-page":"421","article-title":"Diagnostic Accuracy of Sonohysterography and Transvaginal Sonography as Compared with Hysteroscopy and Endometrial Biopsy: A Prospective Study","volume":"63","author":"Blasi","year":"2011","journal-title":"Minerva Ginecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/uog.18923","article-title":"Congenital Uterine Malformation by Experts (CUME): Better Criteria for Distinguishing between Normal\/Arcuate and Septate Uterus?","volume":"51","author":"Ludwin","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1093\/humrep\/dey043","article-title":"ESHRE\/ESGE Female Genital Tract Anomalies Classification System-the Potential Impact of Discarding Arcuate Uterus on Clinical Practice","volume":"33","author":"Knez","year":"2018","journal-title":"Hum. Reprod."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/humrep\/deu344","article-title":"Comparison of the ESHRE-ESGE and ASRM Classifications of M\u00fcllerian Duct Anomalies in Everyday Practice","volume":"30","author":"Ludwin","year":"2015","journal-title":"Hum. Reprod."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1093\/humrep\/dev061","article-title":"The Comprehensiveness of the ESHRE\/ESGE Classification of Female Genital Tract Congenital Anomalies: A Systematic Review of Cases Not Classified by the AFS System","volume":"30","author":"Campo","year":"2015","journal-title":"Hum. Reprod."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/4\/807\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:37:30Z","timestamp":1760121450000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/4\/807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,20]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["diagnostics13040807"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13040807","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,20]]}}}