Uterine junctional zone at three-dimensional transvaginal ultrasonography in patients with recurrent miscarriage: a new diagnostic tool?
OBJECTIVE
To evaluate the characteristics of the uterine junctional zone (JZ) by three-dimensional (3D) transvaginal sonography (TVS) in women with recurrent miscarriage (RM) as compared to normal fertile controls.


METHODS
The thickness and the morphology of the JZ were evaluated in 75 women with a history of RM due to different causes and in 20 fertile women without a history of miscarriages or pelvic disease. All patients included in the study were selected among those who attended the outpatient clinic of "Tor Vergata" University. The JZ characteristics were evaluated in the midluteal phase of the cycle on the uterine coronal section obtained by 3D TVS.


RESULTS
Patients with RM showed a JZ maximum thickness significantly increased when compared to that observed in control group (5.8±0.7 vs. 5.0±1.1mm). When grouped according to the different causes of RM, all groups of patients with RM showed an increased JZ thickness when compared to fertile women, with the exception of those with anti-phospholipid antibody syndrome, probably due to the small number of cases with this pathology.


CONCLUSIONS
A thickened JZ could be an independent indicator of the risk of miscarriage and may represent an important contributing factor to some causes of RM. These observations may offer new perspectives for the screening and treatment of patients with RM. Although further studies are needed to ascertain if the reduction of the JZ thickness can determine a better pregnancy outcome, 3D TVS evaluation of the JZ could provide the opportunity to identify women in which appropriate therapeutic protocols can improve the possibility of successful pregnancy.
AFaR (Fatebenefratelli Association for Research), University of Rome "Tor Vergata", Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy. Electronic address: nlazzarin@tiscali.it.
Natalia
N
Lazzarin
Department of Obstetrics and Gynecology, University of Rome "Tor Vergata", Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
Caterina
C
Exacoustos
Department of Obstetrics and Gynecology, University of Rome "Tor Vergata", Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
Elena
E
Vaquero
Department of Obstetrics and Gynecology, University of Siena , Siena, Italy.
Giovanna
G
De Felice
AFaR (Fatebenefratelli Association for Research), University of Rome "Tor Vergata", Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
Dario
D
Manfellotto
Department of Obstetrics and Gynecology, University of Siena , Siena, Italy.
Errico
E
Zupi
D000026:Abortion, Habitual / Q000000981:diagnostic imaging*; D016736:Antiphospholipid Syndrome / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005298:Fertility; D006801:Humans; D021621:Imaging, Three-Dimensional; D011247:Pregnancy; D012307:Risk Factors; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging* / Q000473:pathology
3D transvaginal sonography; Recurrent miscarriage; Uterine junctional zone