The Value of Three-dimensional Ultrasound Applying in Pre and Postoperative Assessment and Prognosis of Intrauterine Adhesions

1. Study Design This is a prospective, multicenter, large-scale diagnostic testing. We use hysteroscopy finding as standard reference.
2. Study population 600 patients from three tertiary hospitals suspected of having IUA will be prospectively recruited. Thorough assessment including previous reproductive and surgical history as well as menstrual pattern will be performed.
3. Study Procedure 3.1 Diagnosis

IUA will be diagnosed in coronal plane, based on a suggestion reported by a Taiwanese study. The morphological characteristics of the endometrium suggesting IUA include as follow:

• marginal irregularity (in coronal plane)
• defects (interrupted endometrial line)
• obliteration (undetectable endometrium suggesting extensive adhesion)
• fibrosis or calcification (hyperechoic lesion without posterior shadowing, or with posterior shadowing) 3.2 Ultrasound
• Transvaginal Ultrasound will be performed in luteal phase.
• Using E10 Voluson GE with 3D/4D TV probe.
• Scan and rendering will be performed in a standardized technique (omniview mode).
• Several parameters will be measured including endometrial volume, uterine volume, vascularization (VI FI VFI).

3.3 Hysteroscopy

• Hysteroscopic exam will be used as the gold standard for the diagnosis of intrauterine adhesions.
• hysteroscopy will confirm the presence, extent, and morphological characteristics of adhesions and the quality of the endometrium.