Three-dimensional ultrasound for diagnosing Robert's uterus: a case series

Robert's uterus (also known as Robert's uterine malformation) is a rare congenital anomaly characterized by a complete, asymmetric muscular septum that divides the uterine cavity into two separate hemi-cavities, one of which is often blind or severely hypoplastic, while the cervix is single and exhibits a normal morphological configuration with a single normal cervix. It is associated with poor reproductive outcomes, including infertility and recurrent pregnancy loss. Accurate diagnosis with conventional two-dimensional (2D) ultrasound is challenging. Three-dimensional (3D) ultrasound enables coronal-plane reconstruction of the uterus, which is crucial for a definitive diagnosis. This study aimed to summarize the 3D ultrasound imaging features of Robert's uterus and evaluate its diagnostic value and impact on reproductive outcomes.

This retrospective case series included 10 patients with Robert's uterus confirmed by hysteroscopy and laparoscopy. All patients underwent preoperative transvaginal 2D and 3D ultrasound. 3D ultrasound clearly demonstrated the characteristic features in all cases: a broad fundus, a complete uterine septum extending to just above the internal cervical os, resulting in two completely separate cavities with visible asymmetry in size and shape, and a single normal cervical canal. The diagnostic accuracy of 3D ultrasound compared with surgical findings was 100%. The main clinical presentations were primary infertility (four cases) and recurrent miscarriage (four cases). All patients underwent hysteroscopic septoplasty under laparoscopic guidance based on 3D ultrasound findings. Postoperative 3D ultrasound at three months showed a largely restored uterine cavity with a residual septum <1 cm in all cases.

3D ultrasound provides a non-invasive, intuitive, and accurate method for diagnosing Robert's uterus by clearly displaying its characteristic anatomy in the coronal plane. It is an ideal tool for preoperative diagnosis, surgical planning, and postoperative assessment. 3D ultrasound should be considered a first-line imaging modality for the evaluation of suspected uterine anomalies, especially in women with unexplained infertility or recurrent pregnancy loss.