Objective To analyze the use of transvaginal three-dimensional ultrasonography in the diagnosis of uterine malformation to provide a scientific basis for the diagnosis of clinical diseases and the evaluation of the types of uterine malformation. Methods A total of 172 patients with suspected uterine malformation admitted to Sanmenxia Central Hospital from October 2020 to June 2022 were selected as the study subjects. They underwent examination by transvaginal two-dimensional ultrasound volumetric imaging and transvaginal three-dimensional ultrasound volumetric imaging. Using the results of hysteroscopy as the gold standard

the diagnostic efficacy

diagnostic predictive value

diagnostic results of different types of uterine malformations

and diagnostic coincidence rate of uterine malformations were compared between transvaginal two-dimensional ultrasound volumetric imaging and transvaginal three-dimensional ultrasound volumetric imaging. Results The agreement between transvaginal three-dimensional ultrasonography and hysteroscopy（Kappa=0.941

P<0.001） was higher than that of transvaginal two-dimensional ultrasonography（Kappa=0.691

P<0.001）. There was no significant difference in the specificity of transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasound volumetric imaging in the diagnosis of uterine malformations（P>0.05）; the sensitivity and accuracy of transvaginal three-dimensional ultrasound volumetric imaging in the diagnosis of uterine malformations were 95.05%（96/101） and 97.09%（167/172）

respectively

which were higher than those of transvaginal two-dimensional ultrasonography [75.25%（76/101）

84.30%（145/172）

respectively]

and the differences were statistically significant（χ~2=15.659

16.676

both P<0.001）. There was no significant difference in the positive predictive value between transvaginal two-dimensional ultrasonography and transvaginal three-dimensional ultrasound volumetric imaging in the diagnosis of uterine malformations（P>0.05）; the negative predictive value of transvaginal three-dimensional ultrasound volumetric imaging in the diagnosis of uterine malformations was 93.42%（71/76）

which was higher than that of transvaginal two-dimensional ultrasonography（73.40%

69/94）

and the difference was statistically significant（χ~2=11.586

P=0.001）. The coincidence rate of transvaginal three-dimensional ultrasound volumetric imaging in the diagnosis of uterine malformation was 95.05%（96/101）

which was higher than that of transvaginal two-dimensional ultrasound imaging（75.25%

76/101）

and the difference was statistically significant（χ~2=15.659

P<0.001）. Conclusion Transvaginal three-dimensional ultrasound volumetric imaging shows higher sensitivity and accuracy in the diagnosis of uterine malformation

and the coincidence rate of diagnosis of uterine malformation is higher than that of transvaginal two-dimensional ultrasonography.