On MRI pelvis with dedicated sequences, a Mullerian duct anomaly is most accurately classified using which system, and which anomaly is associated with the highest risk of obstetric complications?

• A ESHRE/ESGE classification; arcuate uterus (Class U1b) has highest risk
• B FIGO classification; bicornuate uterus has highest risk
• C American Fertility Society (AFS)/ASRM classification; unicornuate uterus (Class II) has highest obstetric risk ✓
• D WHO classification; septate uterus (Class V) has highest risk

Explanation

The AFS/ASRM classification (Classes I–VII) remains the most widely used clinically. Unicornuate uterus (Class II, with or without rudimentary horn) carries the highest obstetric risk — including the greatest rates of miscarriage, preterm delivery, malpresentation, and ectopic pregnancy in the rudimentary horn. Septate uterus (Class V) has the highest miscarriage rate overall due to implantation on avascular septum. The newer ESHRE/ESGE classification uses the U-C-V system but is not yet universally adopted. MRI with T2-weighted sequences in coronal plane best delineates the uterine contour and cavity simultaneously for accurate classification.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.