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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 232-235

Uterine parameters of clinical importance in North Indian females of reproductive age – An ultrasonographic evaluation


1 Assistant Professor, Department of Anatomy, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
2 Associate Professor, Department of Anatomy, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Additional Professor, Department of Anatomy, King George's Medical University, Lucknow, Uttar Pradesh, India
4 Professor, Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
5 Professor and Head, Department of Anatomy, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission07-Jan-2021
Date of Decision27-Sep-2021
Date of Acceptance03-Oct-2021
Date of Web Publication28-Oct-2021

Correspondence Address:
Aruna Arya
Assistant Professor, Department of Anatomy, Muzaffarnagar Medical College, 771 B South Civil Lines, Muzaffarnagar, Uttar Pradesh - 251 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJCA.NJCA_93_20

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  Abstract 


Introduction: The uterine size is important during planning of assisted reproductive techniques and hysterectomy and there is no established normative data from the women of northern India, this study was undertaken with the objective to report the normal length, width and anteroposterior lengths of non-gravid uterus. Methodology: In a prospective observational study, conducted in Department of Anatomy in collaboration with Departments of Radiology, Obstetrics and Gynecology of King George's Medical University, Lucknow, the ultrasonographic measurements of non-gravid uterus were noted. The ultrasonography was performed on females in dorsal decubitus position having full urinary bladder. Uterine position was identified by placing the probe on suprapubic area Length and anteroposterior diameter of uterus were measured by placing the probe in longitudinal direction (sagittal plane). Length was measured from fundus to external os. The anteroposterior diameter is maximum measurement in mid sagittal plane of body of uterus. The transducer was rotated up to 90 degree to measure the transverse diameter. Transverse diameter is the maximum measurement in transverse plane across the fundus. The volume of uterus was calculated. Results: The study included transabdominal ultrasonographic measurements of 100 females of age range 19-49 years (mean age 34.06 ± 0.35 years). Mean length, transverse diameter, anteroposterior diameters and volume noted were 7.71 (±0.47) cm, 4.63 (±0.33) cm, 3.75 (±0.31) cm and 70.54 (± 9.68) cm3. Conclusion: Normative values of uterine length, width and anteroposterior diameters of one-hundred non-pregnant women of northern India reported. Accurate measurement of uterine parameters is useful in timely management of various pathologies associated with abnormal size of uterus, infertility related procedures; such as in-vitro fertilization (IVF), embryo transfer (ET) and intrauterine device insertion.

Keywords: Longitudinal length, transabdominal ultrasonography, uterus


How to cite this article:
Arya A, Tomar S, Diwan RK, Pandey A, Manik P. Uterine parameters of clinical importance in North Indian females of reproductive age – An ultrasonographic evaluation. Natl J Clin Anat 2021;10:232-5

How to cite this URL:
Arya A, Tomar S, Diwan RK, Pandey A, Manik P. Uterine parameters of clinical importance in North Indian females of reproductive age – An ultrasonographic evaluation. Natl J Clin Anat [serial online] 2021 [cited 2021 Dec 8];10:232-5. Available from: http://www.njca.info/text.asp?2021/10/4/232/329504




  Introduction Top


The ideal uterine size (length, width and anteroposterior diameter) and volume assure for highest clinical pregnancy rates.[1] Evaluation of uterine length is important in diagnosis and management of various uterine causes of Infertility.[2] Uterine length measurement assumes importance before an in-vitro fertilization procedure.[1] It was noted that assisted reproductive technique outcomes are better among women with longer longitudinal uterine lengths. Optimal results are observed with uterine lengths of 70 to 79mm.[3],[4]

Volume of uterus helps to determine the appropriate route for hysterectomy (abdominal, vaginal or laparoscopic).[5] Ultrasonography is a very convenient method for morphometric measurement of viscera.[6] Therefore, present study was conducted to measure the various parameters of uterus to provide baseline data.

Uterine cavity size is can also be a measure of fetal umbilical cord length. Usually, the umbilical cord is longer in the babies born to multiparous females in comparison to babies born to primiparous females.[7] Small uterine size signifies anomaly in development or hypoplasia.[8] Disproportionately decrease in size of uterus may be associated with subfertility.[9] There is an increased risk of miscarriage and failed implantation in females with smaller uterine sizes.[10],[11],[12]

As the uterine size is important during planning of assisted reproductive techniques and hysterectomy and there is no established normative data from the women of northern India, this study was undertaken with the objective to report the normal length, width and anteroposterior lengths of non-gravid uterus.


  Materials and Methods Top


This prospective observational study was conducted in the Department of Anatomy in collaboration with the Department of Obstetrics and Gynaecology and Department of Radiodiagnosis, King George's Medical University, UP, Lucknow (September 2016 to June 2017). The Institutional Ethical Committee had approved the study protocol (letter no: 0046/Ethics/R. Cell-16). Study included 100 non pregnant females of reproductive age group.

Inclusion criteria

Nonpregnant females having normal regular menstrual history and without any gynecological problem were included in the study.

Exclusion criteria

  1. Pregnant females
  2. Females on oral contraceptive pills
  3. Females on oral or injectable ovulation induction drugs
  4. Females on hormonal replacement therapy
  5. Females with IUCD
  6. Females with carcinoma of ovary or uterus or any pelvic mass
  7. Females who underwent any gynecological/obstetrical surgery were excluded from the study.


Procedure

In the Obstetrics and Gynaecology Department, the USG was done on the GE Logiq 200 PRO Series ultrasound system with 3.5 MHz frequency probe.

In the Radiodiagnosis Department, USG was done on Philips Affiniti 70 ultrasound and color Doppler system with 1–5 MHz frequency C5-1 probe.

The USG was performed on females in dorsal decubitus position having full urinary bladder. Uterine position was identified by placing the probe on suprapubic area.

Length and anteroposterior diameter of the uterus were measured by placing the probe in longitudinal direction (sagittal plane) [Figure 1]a. Length was measured from fundus to external os.

The anteroposterior diameter is the maximum measurement in the midsagittal plane of the body of the uterus. The transducer was rotated up to 90° to measure the transverse diameter. Transverse diameter is the maximum measurement in transverse plane across the fundus [Figure 1]a and [Figure 1]b.[13]
Figure 1: Direction of ultrasound probe: (a) Longitudinal direction while measuring the length and anteroposterior diameter of the uterus, (b) Transverse direction while measuring the transverse diameter of the uterus

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After measuring longitudinal length, transverse diameter, and anteroposterior, the volume of the uterus was calculated using the following formula:

Uterine volume = 0.523 × longitudinal length (LL) × transverse diameter (TD) × anteroposterior diameter (APD).

The statistical analysis was done using the SPSS (Statistical Package for Social Sciences) version 15.0 (IBM, Chicago, Illinois ( IL), USA). All the data were tabulated and mean and standard deviation were calculated.


  Results Top


The study included transabdominal ultrasonographic measurements of 100 females of age range 19-49 years (mean age 34.06 ± 0.35 years). [Figure 2] and [Figure 3] shows the measurements taken during the study.
Figure 2: Ultrasound images showing the morphometric parameters of the uterus: (a) Maximum length, (b) Minimum length, (c) Maximum anteroposterior diameter, (d) Minimum anteroposterior diameter

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Figure 3: Ultrasound images showing the morphometric parameters of the uterus: (a) Maximum transverse diameter, (b) Minimum transverse diameter

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The lowest value of all three measured parameters viz. longitudinal length, transverse diameter and antero-posterior diameter were observed in females of 19 years of age. Maximum length and transverse diameter of the uterus were observed in the females of 38 years of age. Maximum anteroposterior diameter was observed in females of 30 years of age.


  Discussion Top


Knowledge of normal dimension of uterus is important for evaluating reproductive health status of women,[3] as the enlargement of uterus is associated with development of various uterine diseases such as uterine fibroid and adenomyosis. Normative curves for uterine dimensions throughout life are important to establish normality and to detect abnormal uterine morphology and size. There is incresaed risk of miscariage and failed implantation in females with small uterine size. Hence determination of uterine size is an important aspect of the evaluation of uterus in case of infertility.[2]

Das set al., in their study on 98 cases, concluded that vaginal hysterectomy could be done without any difficulty in the females having uterine volume up to 200 cm3. However, uterus with the volume 300- 400 cm3, debulking or morcellation may be required.[14] Uterine weight also plays an important role in deciding whether patient requires morcellation or not while performing total laparoscopic hysterectomy. Females with uterine weight of 350 g or more required morcellation during total laparoscopic hysterectomy.[5]

In a study on Irani population, Esmaelzadeh et al., observed the longitudinal length of uterus in nulliparous females was 7.28 ± 0.13 cm.[15] Sirisena et al., found mean longitudinal length of uterus 7.50 cm in females of reproductive age.[16] Mean uterine length (7.71 cm) in the present study is similar to than the findings of Sirisena et al [Table 1]. Saharkhiz N et al., in their comparative study done between conventional blind embryo transfer and embryo transfer based on previously measured uterine length indicated that embryo transfer based on previously measured uterine length method results in significantly higher clinical pregnancy and implantation rates as compared with blind method, and it signifies that length of uterus is a factor affecting the outcome of ART.[17] It was reported in one of the studies done in United States that lower birth rate was experienced in females with uterine length of more than 90mm, and highest rate of live birth was observed in the females having uterine length approximately 80mm.[2]
Table 1: Tabulation of uterine parameters noted (n = 100)

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Egbase et al. concluded in their sonographic study on 807 infertile females that highest implantation and pregnancy rate was seen in the females with uterine length 7-9 cm compared with other groups (<7cm or >9cm).[18] In our study, mean uterine length of females of reproductive age is 7.71 ± 0.47 cm indicating optimum length of uterus for implantation [Table 1].

Limitations

In our study we observed variable uterine parameters, that may be due to variation in the parity which we couldn't assess in our study. Along with the parity there may be other factors including the presence of small leiomyomata, adenomyosis, which can lead to change in mean uterine volume. Also, we have not selected the same day of menstrual cycle to scan the uterus in all females, therefore uterine volume varied.


  Conclusion Top


Our study will supplement the normative data on uterine parameters covering a wide age range in North India. The nomogram of uterine parameters provided by our study will be immensely useful for gynecologists and infertility specialists. The difference in the uterine parameters observed in our study from those reported from other countries may be due to parity of females; phases of menstrual cycle; and racial, dietary, hereditary, and environmental factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gao H, Liu D, Li Y, Tang J, Hu S, Wu X, et al. Uterine size and volume are associated with a higher clinical pregnancy rate in patients undergoing assisted reproduction technology. Medicine (Baltimore). 2019;98:e14366.   Back to cited text no. 1
    
2.
Hawkins LK, Correia KF, Srouji SS, Hornstein MD, Missmer SA. Uterine length and fertility outcomes: A cohort study in the IVF population. Hum Reprod. 2013;28:3000-6.   Back to cited text no. 2
    
3.
Parmar AM, Agarwal DP, Hathila N, Singel TC. Sonographic Measurements of Uterus And its Correlation with Different Parameters In Parous And Nulliparous Women. Int J Med Sci Education [Internet]. 2016;3:306-10. Available from: https://home.ijmse.com/index.php/ijmse/article/view/148. [Last accessed on 21 Oct 2021].  Back to cited text no. 3
    
4.
Verguts J, Ameye L, Bourne T, Timmerman D. Normative data for uterine size according to age and gravidity and possible role of the classical golden ratio. Ultrasound in Obstetrics & Gynecology. 2013;42:713-7.   Back to cited text no. 4
    
5.
Dubuisson J, Veit-Rubin N. Uterine volume and vaginal hysterectomy: Interest and limits of uterine morcellation. Gynecol Obstet Fertil. 2016;44:175-80.   Back to cited text no. 5
    
6.
Callen PW. Ultrasonography in Obstetrics and Gynecology E-Book. Elsevier Health Sciences; 2011. p. 3334.   Back to cited text no. 6
    
7.
Olaya-C M, Bernal JE. Clinical associations to abnormal umbilical cord length in Latin American newborns. Journal of Neonatal-Perinatal Medicine. 2015;8:251-6.   Back to cited text no. 7
    
8.
Troiano RN. Magnetic Resonance Imaging of Mullerian Duct Anomalies of the Uterus. Topics in Magnetic Resonance Imaging. 2003;14:269-79.   Back to cited text no. 8
    
9.
Philipp E, Dutt T. Hypoplastic uterus. Journal of Obstetrics and Gynaecology. 1985;5:265.   Back to cited text no. 9
    
10.
McDonnell CM, Coleman L, Zacharin MR. A 3-year prospective study to assess uterine growth in girls with Turner's syndrome by pelvic ultrasound. Clin Endocrinol (Oxf). 2003;58:446-50.   Back to cited text no. 10
    
11.
Khastgir G, Abdalla H, Thomas A, Korea L, Latarche L, Studd J. Oocyte donation in Turner's syndrome: an analysis of the factors affecting the outcome. Hum Reprod. 1997;12:279-85.   Back to cited text no. 11
    
12.
Overton CE, Davis CJ, West C, Davies MC, Conway GS. High risk pregnancies in hypopituitary women. Hum Reprod. 2002;17:1464-7.   Back to cited text no. 12
    
13.
Timor-Tritsch IE, Monteagudo A. Scanning techniques in obstetrics and gynecology. Clin Obstet Gynecol. 1996;39:167-74.   Back to cited text no. 13
    
14.
Das S, Sheth S. Uterine volume: an aid to determine the route and technique of hysterectomy. J Obstet Gynaecol India. 2004;54:68-72.   Back to cited text no. 14
    
15.
Esmaelzadeh S, Rezaei N, HajiAhmadi M. Normal uterine size in women of reproductive age in northern Islamic Republic of Iran. East Mediterr Health J. 2004 May;10(3):437–41.   Back to cited text no. 15
    
16.
Sirisena UAI, Jwanbot DI, Pam SD, Goshit SJ, Samson RI. Normal Uterine Size in women of reproductive age in Jo, Nigeria: An ultrasonographic investigation. J Health Med Nursing 2015;19:71-6.   Back to cited text no. 16
    
17.
Saharkhiz N, Nikbakht R, Salehpour S. Comparison between conventional blind embryo transfer and embryo transfer based on previously measured uterine length. Int J Fertil Steril 2014; 8:249-54.   Back to cited text no. 17
    
18.
Egbase PE, Al-Sharhan M, Grudzinskas JG. Influence of position and length of uterus on implantation and clinical pregnancy rates in IVF and embryo transfer treatment cycles. Human Reproduction. 2000;15:1943-6.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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