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Kraiem S, Zoukar O, Hnayin A, Zouari A, Faleh R, Haddad A. Complete cervical agenesis: successful surgical treatment: one case report. Pan Afr Med J 2020; 36:211. [PMID: 32963677 PMCID: PMC7490135 DOI: 10.11604/pamj.2020.36.211.24408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/11/2022] Open
Abstract
Cervical agenesis is a rare congenital pathology linked to an abnormality in the development of the Mullerian system, the mechanism of this anomaly is unknown. We reported a case of complete cervical agenesis in a 17-year-old girl who underwent a successfully utero-vaginal anastomosis.
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Affiliation(s)
- Soumaya Kraiem
- Department of Gynecology Obstetric, Maternity and Neonatology Center of Monastir, University of Monastir, Monastir, Tunisia
| | - Olfa Zoukar
- Department of Gynecology Obstetric, Maternity and Neonatology Center of Monastir, University of Monastir, Monastir, Tunisia
| | - Asma Hnayin
- Department of Gynecology Obstetric, Maternity and Neonatology Center of Monastir, University of Monastir, Monastir, Tunisia
| | - Ahmed Zouari
- Department of Gynecology Obstetric, Maternity and Neonatology Center of Monastir, University of Monastir, Monastir, Tunisia
| | - Raja Faleh
- Department of Gynecology Obstetric, Maternity and Neonatology Center of Monastir, University of Monastir, Monastir, Tunisia
| | - Anis Haddad
- Department of Gynecology Obstetric, Maternity and Neonatology Center of Monastir, University of Monastir, Monastir, Tunisia
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102
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Detti L, Christiansen ME, Levi D’Ancona R, Gordon JC, Van de Velde N, Peregrin-Alvarez I. Restoration of Uterine Cavity Measurements after Surgical Correction. J Imaging 2020; 6:58. [PMID: 34460651 PMCID: PMC8321055 DOI: 10.3390/jimaging6070058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: We sought to define the uterine and uterine cavity dimensions of subseptate uteri before and after hysteroscopic surgical incision, and compare them to those obtained in normal uteri with 3-D ultrasound. Methods: Two cohorts of consecutive women with normal-appearing uterine cavity and women diagnosed with uterine subseptations, before and after undergoing hysteroscopic incision. 3-D ultrasound was used to measure the uterine cavity width, length, and area on a frozen coronal view of the uterus. Results: A total of 215 women were included: 89 in the normal, and 126 in the subseptate uterus, groups. Uterine length and height were similar in the pre-operative, post-operative subseptate uteri, and in the normal uteri, while the uterine width was significantly greater in the pre-operative (5.1 + 0.8 cm) than post-operative (4.7 + 0.8 cm) and normal uterus (4.6 + 0.7 cm; p < 0.001) groups. The pre-operative uterine cavity length (3.3 + 0.5 cm), width (3.2 + 0.7 cm), and area (4.4 + 1.2 cm2), were significantly greater than the post-operative ones (length 2.9 + 0.4 cm; width 2.6 + 0.6 cm; area 3.7 + 0.8 cm; overall p < 0.001), and became similar to the dimensions of the normal uterus. Of the patients who subsequently conceived, 2.6% miscarried in the corrected subseptation group and 28.8% miscarried in the normal uterus group. Conclusions: We defined the ultrasound dimensions of the uterine cavity in subseptate uteri and their change after surgical correction. Uterine cavity length, width, and area show very little variability in adult normal uteri, while they are increased in uteri with a subseptation greater than 5.9 mm in length, and regain normal measurements after surgical correction.
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Affiliation(s)
- Laura Detti
- Cleveland Clinic, Department of Subspecialty Care for Women’s Health, Ob/Gyn Women’s Health Institute, Cleveland, OH 44195, USA
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Mary Emily Christiansen
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Roberto Levi D’Ancona
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Jennifer C. Gordon
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Nicole Van de Velde
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Irene Peregrin-Alvarez
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
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Parelkar SV, Tiwari P, Sanghvi BV, Gupta RK, Mudkhedkar KP, Mhaskar SS, Shah RS. Posterior Sagittal Approach for Uterovaginal Anastomosis in a Case of Congenital Cervical Atresia with Anorectal Malformation. J Indian Assoc Pediatr Surg 2020; 25:184-186. [PMID: 32581450 PMCID: PMC7302460 DOI: 10.4103/jiaps.jiaps_40_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 12/21/2019] [Accepted: 01/11/2020] [Indexed: 11/20/2022] Open
Abstract
Cervical atresia is a rare association with anorectal malformation (ARM) which can be missed till puberty in the presence of normal vaginal orifice. A 12-year-old girl operated for ARM in neonatal age presented with primary amenorrhea. She had a normal vaginal opening, short perineal body, and prolapsed anteposed anus and was diagnosed with cervical agenesis. As the posterior sagittal approach is standard to place the rectum in correct anatomical position, reconstruction of the anus along with adequate perineal body and uterovaginal anastomosis was performed through this approach. This report highlights the utility and versatility of this approach for the management of such complex cases.
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Affiliation(s)
- Sandesh V Parelkar
- Department of Paediatric Surgery, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Pooja Tiwari
- Department of Paediatric Surgery, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Beejal V Sanghvi
- Department of Paediatric Surgery, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Rahul K Gupta
- Department of Paediatric Surgery, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Kedar P Mudkhedkar
- Department of Paediatric Surgery, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Satej S Mhaskar
- Department of Paediatric Surgery, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Rujuta S Shah
- Department of Paediatric Surgery, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Wu CQ, Childress KJ, Traore EJ, Smith EA. A Review of Mullerian Anomalies and Their Urologic Associations. Urology 2020; 151:98-106. [PMID: 32387292 DOI: 10.1016/j.urology.2020.04.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
Structural anomalies of the female reproductive tract, known as Mullerian anomalies, can occur in isolation or in association with anomalies of other organ systems. Due to shared embryology, the most common association in up to 40% of patients is with renal, ureteral, and bladder anomalies. Affected girls can have a wide range of genitourinary symptoms with urologists playing an integral role in their diagnosis and treatment. To facilitate the recognition and management of these conditions, we provide a review of Mullerian anomalies including the embryology, classifications, syndromes, evaluation, and treatments with attention to their urologic applicability.
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Affiliation(s)
- Charlotte Q Wu
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA.
| | - Krista J Childress
- Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Emory University School of Medicine; Divisions of Pediatric Surgery and Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Elizabeth J Traore
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA
| | - Edwin A Smith
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA
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Wall DJ, Reinhold C, Akin EA, Ascher SM, Brook OR, Dassel M, Henrichsen TL, Learman LA, Maturen KE, Patlas MN, Robbins JB, Sadowski EA, Saphier C, Uyeda JW, Glanc P. ACR Appropriateness Criteria® Female Infertility. J Am Coll Radiol 2020; 17:S113-S124. [PMID: 32370955 DOI: 10.1016/j.jacr.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/12/2022]
Abstract
The most common known causes of female infertility are male factor (26%), ovulatory failure (21%), and tubal damage (14%), while in 28% a couple's infertility remains unexplained. Female-specific causes of infertility include deterioration of oocyte quality with increasing maternal age; ovulatory disorders, most notably polycystic ovarian syndrome; history of salpingitis such as that caused by chlamydia infection; endometriosis; and uterine cavity abnormalities interfering with implantation causing inability to become pregnant or causing recurrent pregnancy loss. These potential causes of female infertility are discussed in this document and the appropriate imaging recommendations for each variant are provided. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | | | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Goyal LD, Dhaliwal B, Singh P, Ganjoo S, Goyal V. Management of Mullerian Development Anomalies: 9 Years' Experience of a Tertiary Care Center. Gynecol Minim Invasive Ther 2020; 9:81-87. [PMID: 32676285 PMCID: PMC7354757 DOI: 10.4103/gmit.gmit_13_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 12/04/2019] [Accepted: 02/19/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives: This study aimed to analyze the clinical and imaging findings as well as the outcomes of patients with Mullerian duct anomalies. Materials and Methods: A retrospective analysis of 41 patients with Mullerian development anomalies treated in a tertiary care center in the past 9 years was done. The presenting symptoms, radiological findings, management, and the outcomes were evaluated. Results: According to the American Fertility Society's classification, 11 patients presented in Class I, 6 in Class II, and 24 in Class III of the classification. It was found that some of the defects such as the unicornuate uterus, a unicornuate uterus with noncommunicating rudimentary horn, and longitudinal vaginal septum were usually asymptomatic whereas disorders such as Mayer-Rokitansky-Küster-Hauser (MRKH), cervicovaginal atresia, and transverse vaginal septum presented with the absence of menarche, cyclical abdominal pain, and abdominal mass, respectively. Defects such as the bicornuate uterus, didelphys uterus, and septate uterus present with poor reproductive performance. Unicornuate uterus with communicating horn presented with rupture of the horn in the antenatal period, which was managed vigorously. Vaginoplasty with a skin graft and amnion graft had excellent results in MRKH syndrome. Patients with cervicovaginal atresia had a poor prognosis and ultimately required a hysterectomy. Hysteroscopic septal resection improved the reproductive performance in the patients with septate uterus. Conclusion: This study concluded that the management of uterine malformations is individualized depending on the symptoms and fertility concerns. Cervicovaginal atresia was associated with restenosis after surgery ultimately required a hysterectomy. MRKH had excellent results with McIndoe vaginoplasty. Optimal and timely management may lead to better outcomes.
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Affiliation(s)
- Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Balpreet Dhaliwal
- Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Paramdeep Singh
- Department of Radiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Sandesh Ganjoo
- Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Vikas Goyal
- Department of Surgery, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
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107
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First Trimester Uterine Rupture: A Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082976. [PMID: 32344763 PMCID: PMC7215710 DOI: 10.3390/ijerph17082976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
The aim is to report a case of spontaneous uterine rupture in the first trimester of pregnancy and to review the literature on the topic. METHODS A literature search was performed using PubMed and Scopus. Relevant English articles were identified without any time or study limitations. The data were aggregated, and a summary statistic was calculated. RESULTS A 35-year-old gravida 5, para 2 was admitted at our department because of fainting and abdominal pain. The woman had a first-trimester twin pregnancy and a history of two previous cesarean sections (CSs). Suspecting a uterine rupture, an emergency laparotomy was performed. The two sacs were completely removed, and the uterine rupture site was closed with a double-layer suture. The patient was discharged from hospital four days later in good condition. On the basis of this experience, a total of 76 case reports were extracted from PubMed and included in the review. Fifty-three patients out of 76 (69.74%) underwent previous surgery on the uterus. Most women (67.92%) had a CS, and in this group a cesarean scar pregnancy (CSP) or a placenta accreta spectrum (PAS) disorder was found to be the etiology in 77.78% of cases. Furthermore, 35.85% of the women had hysterectomy after uterine rupture. Twenty-three patients out of 76 (30.26%) had an unscarred uterus. Of this group, most women presented a uterine anomaly (43.48%). Moreover, 17.39% of these women had a hysterectomy. CONCLUSION According to the literature, the current pandemic use of CS explains most cases of first-trimester uterine rupture.
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108
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Slavchev S, Kostov S, Yordanov A. Pregnancy and Childbirth in Uterus Didelphys: A Report of Three Cases. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E198. [PMID: 32340393 PMCID: PMC7231278 DOI: 10.3390/medicina56040198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
Uterus didelphys is a rare form of congenital anomaly of the Müllerian ducts. The clinical significance of this anomaly of the female reproductive tract is associated with various reproductive issues: increased risk of preterm birth before 37 weeks' gestation, abnormal fetal presentation, delivery by caesarean section, intrauterine fetal growth restriction, low birth weight less than 2500 g, and perinatal mortality. We present three cases of uterus didelphys and full-term pregnancy, which resulted in favorable birth outcomes of live-born, full-term infants. In two of the cases, delivery was performed via Caesarean section: due to lack of labor activity in one of the cases and lack of response to oxytocin stimulation in the second case. The weight of two of the new-born infants was lower than expected for the gestational age.
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Affiliation(s)
- Stanislav Slavchev
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria; (S.S.); (S.K.)
- Medical University–Varna, 9000 Varna, Bulgaria
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, 9000 Varna, Bulgaria; (S.S.); (S.K.)
| | - Angel Yordanov
- Department of Gynecologic Oncology, Medical University Pleven, 5800 Pleven, Bulgaria
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109
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Ege S, Peker N, Bademkıran MH. The prevalence of uterine anomalies in infertile patients with polycystic ovary syndrome: A retrospective study in a tertiary center in Southeastern Turkey. Turk J Obstet Gynecol 2020; 16:224-227. [PMID: 32231852 PMCID: PMC7090257 DOI: 10.4274/tjod.galenos.2019.62589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/12/2019] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate the prevalence of uterine anomalies in infertile patients with polycystic ovary syndrome (PCOS) admitted to our tertiary hospital in Southeastern Turkey. Materials and Methods: The files of 3033 patients with infertility who presented to the infertility polyclinics were retrospectively analyzed, and uterine anomalies were detected in 131 patients. Seven hundred ten of these patients were evaluated as having PCOS, 55 of whom had uterine anomalies. Patients with PCOS were also divided into two subgroups as those with primary and secondary infertility. Results: Of the 3033 patients with infertility who were evaluated, 57 (8%) of 710 infertile patients with PCOS, and 74 (3%) of 2323 non-PCOS patients with infertility had uterine anomalies. A statistically significant difference was found between the two groups (p<0.001), and no significant difference was found between the primary and secondary infertile PCOS subgroups (p=0.3). Septate uteri and arcuate uteri had a high prevalence in the PCOS group, and no t-shaped or hypoplastic uteruses were observed in this group. Conclusion: To or knowledge, this is the first study in our region to examine the relation between PCOS and Müllerian anomalies. We demonstrated uterine anomalies and their prevalence in patients with infertility. A more careful examination is required in order to determine the incidence of uterine anomalies in patients with PCOS.
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Affiliation(s)
- Serhat Ege
- Diyarbakır University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Clinic of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Nurullah Peker
- Dicle University Faculty of Medicine, Department of Obstetrics and Gynecology, Diyarbakır, Turkey
| | - Muhammed Hanifi Bademkıran
- Diyarbakır University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Clinic of Obstetrics and Gynecology, Diyarbakır, Turkey
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Miklavcic J, Laganà AS, Premru Srsen T, Korosec S, Ban Frangež H. Effect of hysteroscopic septum resection on preterm delivery rate in singleton pregnancies. MINIM INVASIV THER 2020; 30:377-383. [PMID: 32196404 DOI: 10.1080/13645706.2020.1743721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Uterine septum is the most common uterine anomaly and is often found during the work-up in primary infertile women. In this study, we aimed to evaluate the potential effect of hysteroscopic septum resection (HSR) on preterm delivery (PTD) in primary infertile women who had singleton pregnancies. MATERIAL AND METHODS We analyzed 420 singleton pregnancies after primary infertility treatment and compared the PTD rates in women who underwent previous HSR (cases) and women who did not undergo previous operative hysteroscopy or cervical dilation (controls), regardless of the modality of conception (spontaneous or by in vitro fertilization). RESULTS We did not find significant differences between cases and controls for the incidence of overall PTD rate (p = .237), PTD before 32 gestational weeks (p = .848), and between 32 and 37 gestational weeks (p = .324), premature rupture of membranes (p = .419), and neonatal birth weight (p = .129). Overall, the risk of spontaneous PTD <37 gestational weeks after HSR was not found to be significantly higher compared to controls (RR 1.29, 0.61-2.73 95% CI; p = .561). CONCLUSION According to our results, previous HSR could be not considered a risk factor for PTD in singleton pregnancies, regardless of the modality of conception (spontaneous or by in vitro fertilization).
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Affiliation(s)
- Jana Miklavcic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Tanja Premru Srsen
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sara Korosec
- Department of Human reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Human reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
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112
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Abuzeid O, LaChance J, Zaghmout O, Corrado J, Hebert J, Ashraf M, Abuzeid MI. The role of diagnostic hysteroscopy in diagnosis of incomplete uterine septum/significant arcuate uterine anomaly in infertile patients in the era of transvaginal 3D ultrasound scan. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2020. [DOI: 10.1186/s43043-019-0009-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To determine the accuracy of measurement of internal indentation length on transvaginal 3D ultrasound scan (TV 3D US) in detecting patients with an incomplete uterine septum (IUS) or a significant arcuate uterine anomaly (AUA) based on the actual length as measured on diagnostic hysteroscopy. We compared the mean internal indentation length on TV 3D US and on diagnostic hysteroscopy in patients with IUS or a significant AUA.
Results
This is a retrospective study of 546 patients who were found to have IUS (134) or significant AUA (412) on diagnostic hysteroscopy and who had TV 3D US prior to surgery. The mean internal indentation length measured in millimeter on hysteroscopy was significantly higher than the mean internal indentation length measured on TV 3D US in patients with IUS (16.7 + 5.5 vs 5.5 + 4.2; P < 0.001), in patients with significant AUA (12.9 + 2.8 vs 3.9 + 4.6; P < 0.001), and in the overall population (13.8 + 4.0 vs 4.3 + 4.5; P < 0.001). The same findings were obtained when the comparison was limited to patients who had moderate significant internal indentation length (10–14 mm) and those with significant internal indentation length (15–25 mm).
Conclusion
Data in this study suggests that the mean internal indentation length in patients with IUS or AUA can be underestimated on TV 3D US. A diagnostic hysteroscopy is the only gold standard to make the correct diagnosis in these patients.
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Abstract
INTRODUCTION Endometriosis is a common disease in women of reproductive age. In addition to causing pain, it may also reduce fertility. The coexistence of endometriosis and congenital uterine anomalies (CUA) has been frequently reported in the published literature. The present report is a review of existing studies on the subject and our own hitherto unpublished data. EVIDENCE ACQUISITION The electronic search was conducted using the Pubmed database with specific keyword combinations including endometriosis, adenomyosis, infertility, Müllerian malformations/anomalies, and septate uterus. The principal aspects addressed in the present study were: diagnosis, management, and classification of CUA, their impact on fertility and coexistence with endometriosis. EVIDENCE SYNTHESIS Endometriosis and CUA are frequently detected in the exploration of infertility, because both of these are liable to impair fertility. Endometriosis is associated with obstructive anomalies and nonobstructive malformations, especially those concerning the septate uterus. The diagnosis and management of CUA have been discussed for several years. Various classification systems have been proposed. CONCLUSIONS The analysis of the existing literature has revealed the absence of any consensus about the management, diagnosis, and classification of CUA, especially with regard to the septate uterus. We need to find and speak a common language in order to avoid inappropriate or unnecessary surgery and optimize the individual patient's treatment. The combined presence of endometriosis or adenomyosis and CUA is a reason to perform precise diagnostic imaging investigations and early surgery for the purpose of enhancing the chances of pregnancy in infertile patients. Further research is needed on the subject.
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Affiliation(s)
- Damaris Freytag
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Liselotte Mettler
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Nicolai Maass
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Veronika Günther
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Ibrahim Alkatout
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany -
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114
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Davari Tanha F, Dehbashi Z, Amini Harandi M. A Large Cervical Diverticulum Represented as Asherman's Syndrome. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fatemeh Davari Tanha
- Department of Reproductive Endocrinology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Dehbashi
- Department of Obstetrics and Gynecology and Reproductive Endocrinology of Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Amini Harandi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Guo S, Zhang J, Li Y, Ma H, Chen Q, Chen H, Du M. The pubertal development mode of Chinese girls with turner syndrome undergoing hormone replacement therapy. BMC Endocr Disord 2019; 19:72. [PMID: 31296213 PMCID: PMC6625027 DOI: 10.1186/s12902-019-0403-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/25/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Further knowledge about the pubertal development mode of girls with Turner syndrome (TS) who have undergone hormone replacement therapy (HRT) is beneficial to the proposal of an optimal HRT regimen. This study examined the pubertal development mode of girls with TS who underwent HRT and evaluated the characteristics of optimal sex induction therapy in girls with TS. METHOD We conducted a retrospective, longitudinal study over the past two decades at The First Affiliated Hospital, Sun Yat-sen University. PATIENTS Seventy-one patients with TS and two groups of normal Chinese girls. RESULTS The total investigation time was 3.00 (2.00, 4.66) years. The interval of each stage was significantly longer (P < 0.001) in the girls with TS than that in the normal Chinese girls, except for B2-3 (P = 0.011). The uterine volumes of the girls with TS in stages B2 and 3 were greater than those of the control group (P = 0.046), whereas the uterine volume of the control group was inversely greater than that of the TS group among those who reached stages B4 and 5 (P = 0.034). During HRT, the uterine volume grew significantly from all previous stages except for breast stage 5 (B3 vs.2: Z = - 2.031; P = 0.042; B4 vs. 3: Z = - 2.273; P = 0.023; B5 vs. 4: Z = - 1.368; P = 0.171). The paired data of 27 girls with TS showed that the uterine volume (17.93 ± 9.31 ml vs. 13.75 ± 6.67 ml) and width (2.54 ± 0.66 cm vs. 2.22 ± 0.36 cm) increased significantly during artificial cycles compared with before artificial cycles (t = - 2.79 and - 2.51, P = 0.01 and 0.018). CONCLUSION HRT led to normal breast development in girls with TS; half of the girls with TS in our study reached Tanner stage B5, although the uterus ultimately developed suboptimally. The girls' breasts and uteruses grew quickly at the beginning of HRT (stages B2-4). An optimal HRT regimen for girls with TS may specifically focus on Tanner stages B2-4 and artificial cycles.
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Affiliation(s)
- Song Guo
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, The 2nd Zhongshan Road, Number 58, Guangzhou city, Guangdong Province China
| | - Jun Zhang
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, The 2nd Zhongshan Road, Number 58, Guangzhou city, Guangdong Province China
| | - Yanhong Li
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, The 2nd Zhongshan Road, Number 58, Guangzhou city, Guangdong Province China
| | - Huamei Ma
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, The 2nd Zhongshan Road, Number 58, Guangzhou city, Guangdong Province China
| | - Qiuli Chen
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, The 2nd Zhongshan Road, Number 58, Guangzhou city, Guangdong Province China
| | - Hongshan Chen
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, The 2nd Zhongshan Road, Number 58, Guangzhou city, Guangdong Province China
| | - Minlian Du
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, The 2nd Zhongshan Road, Number 58, Guangzhou city, Guangdong Province China
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Wang X, Hou H, Yu Q. Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa: A retrospective cohort study protocol. Medicine (Baltimore) 2019; 98:e16623. [PMID: 31348312 PMCID: PMC6708913 DOI: 10.1097/md.0000000000016623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Different sizes of uterine septum between infertile women and patients with abortions may have a clinical relevance in reproductive performance after surgery. This study aimed to assess if the fecundity of women after surgical correction of the uterine septum is associated with septum size.A retrospective, single-center, cohort study was conducted in Peking Union Medical College Hospital using patients aged between 21 and 37 years. Hysteroscopic metroplasty was performed on 121 patients with a uterine septum. The septum size was assessed by ultrasonography and hysteroscopy. The subjects were divided into 3 groups: Group A consisted of 35 women with complete uterine septum (mean ± standard deviation (SD) age 28.29 ± 3.53; group B consisted of 48 women with uterine septum >2.5 cm (mean ± SD age 28.85 ± 3.63); and group C consisted of 48 women with uterine septum ≤2.5 cm (mean ± SD age 28.79 ± 3.74). Age and body mass index (BMI) were not significantly different among the 3 groups.No serious hysteroscopic complications occurred. However, uterine septa were observed in 4 cases after surgery and 6 cases of intrauterine adhesions were observed after long-term follow-up. The abortion rate decreased, and term delivery rate increased significantly in the 3 groups after hysteroscopic metroplasty. The infertility rate was significantly lower in group C after surgery. However, no significant difference was observed in the infertility rate between groups A and B. The recurrent abortion rate was significantly lower in group A than in groups B and C before surgery. After surgery, the infertility rate was significantly higher in group A than in group B (28.57% and 10.53%, respectively; P = .048). After at least 12-months of follow-up, the pregnancy rate in group A was significantly lower than that in group C (71.43% and 89.47%, respectively; P = .048).Uterine septum resection improves obstetrical outcomes. After surgery, the infertility rate was significantly higher in patients with complete uterine septum than in those with a large partial uterine septum, and the pregnancy rate in patients with complete uterine septum was lower than that in the patients with a small partial uterine septum.
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Affiliation(s)
- Xi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
- Department of Obstetrics and Gynecology, Peking University First Hospital
| | - Haiyan Hou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
- Department of Obstetrics and Gynecology, Affiliated Hospital of the Chinese People's Armed Police Force Logistics College, Tianjin, China
| | - Qi Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences
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Obeidat RA, Aleshawi AJ, Tashtush NA, Alsarawi H. Unicornuate uterus with a rudimentary non-communicating cavitary horn in association with VACTERL association: case report. BMC WOMENS HEALTH 2019; 19:71. [PMID: 31146728 PMCID: PMC6543654 DOI: 10.1186/s12905-019-0768-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/14/2019] [Indexed: 12/02/2022]
Abstract
Background The unicornuate uterus is caused by abnormal or failed development of one Müllerian duct. Unicornuate uteri with functioning non-communicating rudimentary horns are susceptible to many gynaecologic and obstetric complications such as hematometra, endometriosis and ectopic pregnancy and thus surgical resection is usually recommended.. Case presentation We report a rare case of a unicornuate right uterus with rudimentary non-communicating (functional) cavitary left horn (class U4a) in a 17-year-old girl who was diagnosed with VACTERL association. She was presented to our centre with 3 years history of secondary sever dysmenorrhea. Pelvic magnetic resonance imaging revealed a normal uterus on the right side, a 7 × 8 cm left endometrioma, a tortuous dilated fluid-filled structure in the left hemipelvis, mostly represented left-sided hematosalpinx, and a well-defined lesion with thick enhancing wall in the left hemipelvis measuring 6.7 × 5.7 × 5.6 cm with a similar enhancement to the uterus in the right. She underwent laparotomy that showed a right unicornuate uterus with a normal cervix and a rudimentary non-communicating distended left horn. In addition, there was a left endometrioma and left hematosalpinx. Resection of the left communicating horn, left salpingectomy and left ovarian cystectomy were performed. The right tube and both ovaries were preserved. At 9-months follow up, the patient had a regular period and the pain subsided completely. Conclusion We report yet the second case of VACTERL association and unicornuate uterus with non-communicating functional rudimentary horn, in hope of expanding the knowledge of a rare occurrence. This case also highlights the importance of considering the diagnosis of Müllerian duct anomalies in patients with a history of other anomalies, and/or history of early-age secondary dysmenorrhea.
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Affiliation(s)
- Rawan A Obeidat
- Department of Obstetrics & Gynecology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan.
| | - Abdelwahab J Aleshawi
- Department of General Surgery, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Nour A Tashtush
- Department Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Haya Alsarawi
- Department of Obstetrics & Gynecology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
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Fox NS, Connolly CT, Hill MB, Klahr RA, Zafman KB, Rebarber A. Pregnancy outcomes in viable pregnancies with a septate uterus compared with viable pregnancies after hysteroscopic uterine septum resection. Am J Obstet Gynecol MFM 2019; 1:136-143. [PMID: 33345819 DOI: 10.1016/j.ajogmf.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Septate uterus is one of the more common Müllerian anomalies and is the anomaly most amenable to surgical correction. It is currently uncertain if hysteroscopic septum resection reduces the incidence of adverse pregnancy outcomes. OBJECTIVE The purpose of this study was to compare pregnancy outcomes in women who had reached at least 20 weeks gestation with those women with a uterine septum and those women who had undergone septum resection before pregnancy. STUDY DESIGN Retrospective cohort study of women with a history of uterine septum who were cared for by a large maternal-fetal medicine practice from 2005-2018. We included women with singleton pregnancies at >20 weeks gestation. Baseline characteristics and pregnancy outcomes were compared between women with a history of a hysteroscopic uterine septum resection and women with an unresected septum. Regression analysis was performed to control for differences in baseline characteristics. The analysis was repeated in nulliparous women only. RESULTS A total of 109 women (163 pregnancies) were included. In the entire population, pregnancy outcomes did not differ between the groups, aside from a higher rate of cesarean delivery in the resected septum group. In the 63 nulliparous women, septum resection was associated with later gestational ages at delivery (39.1 vs 37 weeks; P=.030), decreased preterm birth <37 weeks gestation (4.5% vs 31.6%; adjusted odds ratio, 0.154; 95% confidence interval, 0.027-0.877), and an increased incidence of cesarean delivery in women who attempted vaginal delivery (30.6% vs 0%; P=.012). There was no difference in the rates of small for gestational age, preeclampsia, blood transfusion, retained placenta, or morbidly adherent placenta. CONCLUSION In nulliparous women with viable pregnancies, hysteroscopic resection of a uterine septum is associated with a decreased incidence of preterm birth and an increased incidence of cesarean delivery. These findings need to be confirmed in a well-designed randomized trial before uterine septum resection is recommended routinely.
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Affiliation(s)
- Nathan S Fox
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY.
| | - Courtney T Connolly
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa B Hill
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rebecca A Klahr
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kelly B Zafman
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrei Rebarber
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY
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Son JK, Ali S, Al Khori N, Lee EY. MR Imaging Evaluation of Pediatric Genital Disorders:. Magn Reson Imaging Clin N Am 2019; 27:301-321. [DOI: 10.1016/j.mric.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Obata S, Noguchi T, Chiba S, Miyagi E, Aoki S. Case of decidual discharge from the nonpregnant uterine cavity of the bicorporeal uterus before onset of delivery. J Obstet Gynaecol Res 2019; 45:1410-1413. [PMID: 30977221 DOI: 10.1111/jog.13971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/23/2019] [Indexed: 11/29/2022]
Abstract
A 30-year-old woman with a bicorporeal uterus complained of abdominal pain and vaginal hemorrhage at 28 weeks and 5 days of gestation. There were no signs of placenta previa with echography in the second trimester; however, the echography showed a highly echoic area (91 × 85 mm), indicating placenta previa. Thereafter, abdominal pain and vaginal bleeding increased. Thus, we suspected placental abruption and performed cesarean section. After cesarean section, discharge of placenta-like tissue into the vagina was confirmed and pathological examination of the tissue showed only the decidua. In cases of uterine malformations, in which the uterine cavity is divided into pregnant and nonpregnant sides, the decidua on the nonpregnant side can be discharged before the onset of delivery. In addition, at the time of decidual discharge, echography findings are similar to those of placenta previa and the clinical symptoms are similar to those of placental abruption.
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Affiliation(s)
- Soichiro Obata
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Noguchi
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Sawako Chiba
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
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121
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McGregor J, Thompson G. Role of MRI in uterine didelphys with co-existing endometrial carcinosarcoma. BJR Case Rep 2019; 4:20180010. [PMID: 30931136 PMCID: PMC6438403 DOI: 10.1259/bjrcr.20180010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/02/2022] Open
Abstract
A case report reviewing MRI in a patient diagnosed with carcinosarcoma and uterine didelphys following presentation with post-menopausal bleeding. Staging MRI images demonstrate the anatomical anomaly and pathological features in these co-existing conditions. This report presents an interesting case of carcinosarcoma in a uterine didelphys. This anatomical abnormality is an uncommon finding and is very rarely complicated by carcinosarcoma. There are very few cases reported to date of this unusual condition. Our case is of a 77-year-old female, para 9, who presented with post-menopausal bleeding for 1 month. She followed the pathway for endometrial cancer using Northern Ireland Cancer Network clinical guidelines. This female’s co-existing uterine anomaly and malignant pathology are outlined, staged and beautifully illustrated with dedicated pelvic MRI. The images captured by MRI are used in all aspects of the patients care and treatment planning, and show the benefit of this modality in multidisciplinary meetings guiding gynaecological-oncology surgeons, who must aware of the anatomical variants before embarking on definitive surgery.
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Affiliation(s)
- Jill McGregor
- Emergency Medicine Department, Ulster Hospital Dundonald, Belfast, UK
| | - Gillian Thompson
- Imaging Department, Western Health and Social Care Trust, Londonderry, UK
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Abstract
OBJECTIVE To review the current understanding of the role the uterus plays in recurrent pregnancy loss. FINDINGS Congenital and acquired uterine abnormalities are associated with recurrent pregnancy loss in the first and second trimester. Relevant congenital Mullerian tract anomalies include unicornuate, didelphys, bicornuate and septate uteri. Pregnancy loss has also been associated with acquired uterine abnormalities that distort the uterine cavity such as intrauterine adhesions and submucosal myomas. Initial evaluation of women with recurrent pregnancy loss should include a uterine assessment such as a pelvic ultrasound or sonohysterography. Uterine abnormalities such as uterine septum, intrauterine adhesions and submucosal myomas may be managed surgically with operative hysteroscopy. CONCLUSION Uterine abnormalities, both congenital and acquired, can be responsible for recurrent pregnancy loss.
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Affiliation(s)
- Jenna M Turocy
- Department of Obstetrics & Gynecology, Columbia University Medical Center, Fertility Center, 5 Columbus Circle, PH, New York, New York, USA.
| | - Beth W Rackow
- Department of Obstetrics & Gynecology, Columbia University Medical Center, Fertility Center, 5 Columbus Circle, PH, New York, New York, USA
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123
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Khalife D, Ghazeeri G, Kutteh W. Review of current guidelines for recurrent pregnancy loss: new strategies for optimal evaluation of women who may be superfertile. Semin Perinatol 2019; 43:105-115. [PMID: 30642578 DOI: 10.1053/j.semperi.2018.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The current evidence-based guidelines for the evaluation of recurrent pregnancy loss recommended by the American Society for Reproductive Medicine and by the European Society of Human Reproduction and Embryology are compared and contrasted in this review. The clinical use of either of these guidelines will result in a probable diagnosis for only half of the affected patients. New strategies for a full evaluation of recurrent pregnancy loss incorporating 24- chromosome microarary on the products of conception offer more explanations for patients and caregivers. This new algorithm should decrease the use of empiric, unproven treatments. Combining the results of genetic testing on the miscarriage tissue with the conventional diagnostic tests has made it possible to explain the etiology of pregnancy loss in more than 90% of the cases. This cost-saving strategy can decrease the emotional distress and frustration for both couples and physicians when it comes to management of recurrent pregnancy loss.
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Affiliation(s)
- Dalia Khalife
- Reproductive Endocrinology and Infertility Division, Department of Obstetrics and Gynecology, American University of Beirut Medical Center P.O. Box: 113-6044. Beirut, Lebanon
| | - Ghina Ghazeeri
- Reproductive Endocrinology and Infertility Division, Department of Obstetrics and Gynecology, American University of Beirut Medical Center P.O. Box: 113-6044. Beirut, Lebanon
| | - William Kutteh
- Clinical Professor of Reproductive Endocrinology Vanderbilt University School of Medicine; Consulting Gynecologist, Department of Surgery Director of Fertility Preservation St. Jude Children's Research Hospital; Managing Partner, Director of Recurrent Pregnancy Loss Center Fertility Associates of Memphis 80 Humphreys Center, Suite 307 Memphis, TN 38120-2363 Phone: 901-747-2229 FAX: 901-747-4446.
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124
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Theodoridis TD, Pappas PD, Grimbizis GF. Surgical management of congenital uterine anomalies (including indications and surgical techniques). Best Pract Res Clin Obstet Gynaecol 2019; 59:66-76. [PMID: 30910446 DOI: 10.1016/j.bpobgyn.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/02/2019] [Accepted: 02/11/2019] [Indexed: 11/17/2022]
Abstract
The prevalence of congenital uterine anomalies (CUA) is reported to be 4.3-6.7% in the general population, 3.4%-8% in the infertile population, and 12.6-18.2% of those with recurrent miscarriages. They are the result of abnormal formation, differentiation, and fusion of the Müllerian or paramesonephric ducts during fetal life. To date, various classification systems have been proposed for the categorization of CUA, but the recently introduced ESHRE/ESGE classification seems to be a new, clear, and systematic categorization, which could be the basis for clinicians to rely on when they refer to CUA and their clinical impact either generally or concerning pregnancy outcomes. CUA are apparently related to an impaired reproductive outcome, while their exact clinical impact as well as the effectiveness of their treatment remain considered controversial. Surgery is indicated in women presenting with symptoms related to specific uterine anomalies, especially in those with fertility problems. In this review, indications, surgical techniques for the repair of CUA according to their classification, and fertility and pregnancy outcomes before and after surgery will be thoroughly reviewed.
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Affiliation(s)
- Theodoros D Theodoridis
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece.
| | - Panagiotis D Pappas
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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Şimşek D, Güven Ç, Şahin Ç, Akdemir A, Ergenoğlu AM, Yeniel AÖ, Şendağ F. Histeroskopik septoplasti sonrası gebelik sonuçları ve farklı cerrahi tekniklerin karşılaştırılması: Retrospektif kohort çalışma. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.416612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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126
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Compromised vitality of spermatozoa after contact with colonic mucosa in mice: implications for fertility in colon vaginoplasty patients. Pediatr Surg Int 2019; 35:71-75. [PMID: 30374634 DOI: 10.1007/s00383-018-4377-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 02/06/2023]
Abstract
AIM OF THE STUDY Colon vaginoplasty (CV) is often performed for cloacal malformation (CM). We used mice to study the vitality of spermatozoa after contact with colonic mucosa as a factor contributing to infertility. METHODS Spermatozoa isolated from the epididymides of C57BL/6J male mice (n = 23) were syringed directly into the vaginas (Vag-group) or colons (Colo-group) of female mice (n = 45). Vitality was determined by assessing motility using computer-assisted sperm analysis, viability by staining with SYBR-14 and propidium iodide, and fertility by in vitro fertilization, prior to deposition, and at 5, 10, 30, and 60 min after deposition. MAIN RESULTS Motility was significantly decreased in Colo only at 10 and 60 min. Viability of Colo spermatozoa was significant at all assessment times, except at 10 min. Normal fertilization was observed with all Vag spermatozoa, but with Colo, there was arrest of embryo development with spermatozoa collected at 5 and 10 min, and no fertilization with spermatozoa collected at 30 and 60 min. CONCLUSIONS The vitality of spermatozoa is compromised by contact with colonic mucosa which could contribute to infertility in CM after CV, because their ovaries and fallopian tubes are considered to be normal.
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Corroenne R, Legendre G, May-Panloup P, El Hachem H, Dreux C, Jeanneteau P, Boucret L, Ferré-L’Hotellier V, Descamps P, Bouet PE. Surgical treatment of septate uterus in cases of primary infertility and before assisted reproductive technologies. J Gynecol Obstet Hum Reprod 2018; 47:413-418. [DOI: 10.1016/j.jogoh.2018.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/16/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022]
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Mohamed MA, AbdelRahman MY. Frequency and types of uterine anomalies during caesarean section. J OBSTET GYNAECOL 2018; 39:147-150. [PMID: 30372654 DOI: 10.1080/01443615.2018.1499712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In this study all women undergoing caesarean section were included regardless of the indication. After the foetus and placenta were delivered, the uterus was examined for the presence or absence of congenital malformation through digital palpation of uterine cavity and direct inspection of the fundus. Of the 653 caesarean sections included, uterine anomalies were diagnosed in 31 women (4.75%). Most of the anomalies were septate and sub-septate uterus (71%) followed by bicornuate uterus (19.4%), while the frequency of unicornuate uterus was 6.4% and uterine didelphys represented only 3.2%. In conclusion, an examination of the uterus internally and externally should be performed as a routine step during caesarean section. Impact statement What is already known on this subject? Most of the data of uterine anomalies has been derived from studies of patients with reproductive problems and not from those with a normal reproductive outcome. What do the results of this study add? Approximately 5% of women were found to have uterine anomalies when examined during caesarean section. If any were detected, we feel that the patient should be informed, as they may affect future reproductive performance and the choice of contraception. What are the implications of these findings for clinical practice and/or further research? An examination of the uterus internally and externally should be considered as a routine step during a caesarean section.
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Affiliation(s)
- Magdy A Mohamed
- a Department of Obstetrics and Gynaecology, Sohag Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Mohamed Y AbdelRahman
- a Department of Obstetrics and Gynaecology, Sohag Faculty of Medicine , Sohag University , Sohag , Egypt
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129
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Two cesarean deliveries after hemi-hysterectomy due to gestational trophoblastic neoplasia. Taiwan J Obstet Gynecol 2018; 57:315-318. [PMID: 29673680 DOI: 10.1016/j.tjog.2018.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Although uterine didelphys per se is not associated with an impaired ability to conceive, the association between uterine anomalies and gestational trophoblastic neoplasia (GTN) remains unclear. The management of chemotherapy-resistant GTN in women with uterine didelphys raises a new issue regarding whether to perform a hemi-hysterectomy. CASE REPORT A 23-year-old, gravida 1, para 0 Japanese woman was referred with a failed intermittent cervical dilatation for hematometra. Four years previously, she developed a GTN Stage III, score 5. As two cycles of chemotherapy with methotrexate (MTX) and one cycle of EMA-CO (etoposide, MTX, actinomycin D, cyclophosphamide and vincristine) did not result in remission, we performed an abdominal hemi-hysterectomy. After a canalization procedure and cervicoplasty were performed, the patient conceived naturally and prematurely delivered by cesarean section twice. CONCLUSION A hemi-hysterectomy should be considered for fertility preservation when GTN develops on either side of a didelphic uterus and adjuvant chemotherapy does not result in remission.
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Gabbai D, Harlev A, Friger M, Steiner N, Sergienko R, Kreinin A, Bashiri A. Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities. J Perinat Med 2018; 46:728-734. [PMID: 28742523 DOI: 10.1515/jpm-2016-0411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/12/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Different etiologies for recurrent pregnancy loss have been identified, among them are: anatomical, endocrine, genetic, chromosomal and thrombophilia pathologies.
Aims:
To assess medical and obstetric characteristics, and pregnancy outcomes, among women with uterine abnormalities and recurrent pregnancy loss (RPL). This study also aims to assess the impact of uterine anatomic surgical correction on pregnancy outcomes.
Methods:
A retrospective case control study of 313 patients with two or more consecutive pregnancy losses followed by a subsequent (index) pregnancy. Anatomic abnormalities were detected in 80 patients. All patients were evaluated and treated in the RPL clinic at Soroka University Medical Center. Out of 80 patients with uterine anatomic abnormalities, 19 underwent surgical correction, 32 did not and 29 had no clear record of surgical intervention, and thus were excluded from this study.
Results:
Women with anatomic abnormalities had a higher rate of previous cesarean section (18.8% vs. 8.6%, P=0.022), tended to have a lower number of previous live births (1.05 vs. 1.37, P=0.07), and a higher rate of preterm delivery (22.9% vs. 10%, P=0.037). Using multivariate logistic regression analysis, anatomic abnormality was identified as an independent risk factor for RPL in patients with previous cesarean section after controlling for place of residence, positive genetic/autoimmune/endocrine workup, and fertility problems (OR 7.22; 95% CI 1.17–44.54, P=0.03). Women suffering from anatomic abnormalities tended to have a higher rate of pregnancy loss compared to those without anatomic abnormalities (40% vs. 30.9%, P=0.2). The difference in pregnancy loss rate among women who underwent surgical correction compared to those who did not was not statistically significant.
Conclusion:
In patients with previous cesarean section, uterine abnormality is an independent risk factor for pregnancy loss. Surgical correction of uterine abnormalities among RPL patients might have the potential to improve live birth rate.
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Affiliation(s)
- Daniel Gabbai
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Harlev
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael Friger
- Faculty of Health Sciences, Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Naama Steiner
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Andrey Kreinin
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asher Bashiri
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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131
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ESHRE-ESGE versus ASRM classification in the diagnosis of septate uterus: a retrospective study. Arch Gynecol Obstet 2018; 298:845-850. [PMID: 30159673 DOI: 10.1007/s00404-018-4878-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy (ESHRE-ESGE) system is designed mainly for clinical orientation; its overdiagnosis of septate uteri was confirmed in a general population in comparison to the American Society of Reproductive Medicine (ASRM) supplemental classification proposed by Ludwin. However, the agreement among septate uterus recognition using the ESHRE-ESGE and the supplemental ASRM classifications and the rate of overdiagnosis of septate uterus by ESHRE-ESGE in infertile women remain unclear. METHODS We conducted a retrospective study of 53,540 infertile patients in our reproductive centre from June 2013 to December 2016, to compare septate uterus recognition using three systems. The data were analysed by the ESHRE-ESGE system, the ASRM by Salim and the ASRM by Ludwin separately. The concordance of diagnoses of septate uteri using these three systems was compared. RESULTS ESHRE-ESGE classification significantly increased the frequency of septate uteri (11.31%, 6056 vs. 7.20%, 3854 vs. 3.80%, 2034). Good agreement was observed between the ESHRE-ESGE and the ASRM by Salim (k = 0.686, p < 0.001) and between the ASRM by Salim and that by Ludwin (k = 0.671, p < 0.001), while moderate agreement was found between the ESHRE-ESGE and ASRM by Ludwin systems (k = 0.444, p < 0.001). These results suggest that Ludwin's criteria are the strictest, while the ESHRE-ESGE system is much more relaxed for septate uterus diagnosis. CONCLUSION A risk of overtreatment may also exist in infertile patients when using the ESHRE-ESGE system. Therefore, the ESHRE-ESGE system should be used with caution when guiding hysteroscopic metroplasty in infertile patients.
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132
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Bicornuate Bicollis Uterus with Obstruction of the Lower Uterine Segment and Cervical Prolapse Complicating Pregnancy. Case Rep Obstet Gynecol 2018; 2018:8910976. [PMID: 30186650 PMCID: PMC6109999 DOI: 10.1155/2018/8910976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/24/2018] [Accepted: 08/01/2018] [Indexed: 11/17/2022] Open
Abstract
Congenital Mullerian duct anomalies are conditions involving the female genital tract. Cases of complex Mullerian duct anomalies with involvement of the renal system are rare. Occasionally, these cases can be associated with obstetrical complications. Cervical prolapse infrequently complicates pregnancy, and an association between uterine malformations and cervical prolapse has not been cited in the literature. We describe the case of a primigravid patient at 38 weeks of gestation noted to have cervical prolapse during evaluation for preeclampsia and labor induction. Obstetrical ultrasound at presentation to the labor and delivery suite revealed a high suspicion for a bicornuate uterus. The patient was delivered by cesarean section due to obstruction of the lower uterine segment of the gravid uterus. Further evaluation post-partum revealed a bicornuate bicolis uterus and renal agenesis. Pregnancies in patients with bicornuate bicollis uterus can be complicated by obstruction of the gravid uterus, resulting in cervical prolapse and necessitating cesarean section.
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133
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Cho JH, Won HJ, Kim MK, Park JH, Hwang JY. New Ambulatory Hysteroscopic Septoplasty using Ballooning in a Woman with Complete Septate Uterus: A Case Report. Dev Reprod 2018; 22:105-109. [PMID: 29707689 PMCID: PMC5915762 DOI: 10.12717/dr.2018.22.1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 03/18/2018] [Accepted: 03/24/2018] [Indexed: 11/17/2022]
Abstract
A 40-year-old G1 P0 L0 A1 woman was referred to our clinic with 6-year history of
infertility. Before visiting the clinic, she had 3 cycles of
In-Vitro Fertilization (IVF) procedures (2 cycles of
Controlled Ovarian Stimulation-IVF and 1 cycle of frozen-thawed Embryo Transfer
(ET)) at other clinic. She had medical history of abortion at early gestation
following FET (frozen-thawed-ET). The patient had complete type of septate
uterus, double cervix and longitudinal vaginal septum. Vaginal septotomy was
done first and 1 month later, hysteroscopic septoplasty was followed using
ballooning filled with dye. After septoplasty, we inserted ballooning and left
for several days to compress septal endometrium on the septectomy area. All
procedures were done in the ambulatory operating room without laparoscopy or
admission. 3 months later, she had in vitro
fertilization-embryo transfer (IVF-ET) and FET procedures in our clinic. She had
successful pregnancy and now is at 22 weeks of gestation. New ambulatory
septoplasty using dye-filled ballooning is easy, safe and minimally invasive
surgery for treatment of complete septate uterus.
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134
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Lv S, Yu J, Xu X. A comparison of effectiveness among frequent treatments of recurrent spontaneous abortion: A Bayesian network meta-analysis. Am J Reprod Immunol 2018; 80:e12856. [PMID: 29709100 DOI: 10.1111/aji.12856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/21/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE A comprehensive network meta-analysis was designed to clarify contradictions and offer valuable clinical guidance in the treatment of recurrent spontaneous abortion (RSA). METHOD The included clinical trials were selected from the relevant medical journal databases and screened. Treatments were ranked by the surface under the cumulative ranking curve. Heat plots were constructed to analyze the inconsistency between direct data and network results, and adjusted funnel plots were constructed to assess publication bias. RESULTS Forty-nine randomized controlled trials involving a total of 8496 RSA patients were selected. With placebo as control, corticosteroid plus low dose aspirin (LDA) plus unfractionated heparin (UFH), granulocyte colony-stimulating factor (G-CSF) alone, and LDA plus low molecular weight heparin (LMWH) all demonstrated effectiveness in increasing successful live birth rates and reducing the incidences of miscarriage. However, no treatment was demonstrably superior to placebo in terms of pregnancy success. For all 3 endpoints (live birth, abortion and success pregnancy), the adjusted funnel plots were symmetric to zero and indicated no publication bias. In terms of live birth and abortion rates, no treatment outperformed placebo in patients with antiphospholipid syndrome. CONCLUSION In consideration of live birth and abortion rates, corticosteroid plus LDA plus UFH appeared to be the optimum treatment strategy; G-CSF was second, followed by LDA with LMWH, LDA plus LMWH plus intravenous immunoglobulin, corticosteroid with LDA and others. Subgroup analysis demonstrated no benefit of antithrombotic therapy in patients with antiphospholipid syndrome.
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Affiliation(s)
- Sha Lv
- Department of Gynaecology and Obstetrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Yu
- Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaoxiao Xu
- Department of Gynaecology and Obstetrics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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135
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Jegannathan D, Indiran V. Magnetic resonance imaging of classified and unclassified Müllerian duct anomalies: Comparison of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology classifications. SA J Radiol 2018; 22:1259. [PMID: 31754489 PMCID: PMC6837830 DOI: 10.4102/sajr.v22i1.1259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
Magnetic resonance imaging (MRI), due to its optimal delineation of anatomy, has become the mainstay in imaging for diagnosing Müllerian duct anomalies (MDA). Pelvic MRI is requested for various conditions such as primary amenorrhoea, infertility or poor obstetric history with regard to MDA, as identifying the exact aetiology for these conditions is vital. Knowledge regarding the classification of MDA is important, as the treatment varies with respect to the different classes. As all the lesions do not fit within the classification of the American Society for Reproductive Medicine, a new anatomy-based classification was established by the European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy, to fulfil the needs of experts. We aim to discuss various classes of classified and unclassified MDA with regard to both the above-mentioned classifications and illustrate some of them using various cases based on pelvic MRI studies.
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Affiliation(s)
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, India
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136
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Ross C, El-Hassan H, Lakasing L. Uterus didelphys: two pregnancies, two term breech caesarean deliveries. BMJ Case Rep 2018; 2018:bcr-2017-221815. [PMID: 29669764 DOI: 10.1136/bcr-2017-221815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a woman with uterus didelphys who spontaneously conceived two singleton pregnancies, one in each uterus, and was delivered in both instances of a healthy breech infant at term by elective caesarean section.
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Affiliation(s)
- Claire Ross
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Hiba El-Hassan
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Lorin Lakasing
- Fetal Medicine Department, Imperial College NHS Trust, London, UK
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137
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Chen X, Liu P, Sheng Y, Li W, Tang R, Ding L, Qin Y, Chen ZJ. The impact of unicornuate uterus on perinatal outcomes after IVF/ICSI cycles: a matched retrospective cohort study. J Matern Fetal Neonatal Med 2018; 32:2469-2474. [PMID: 29649918 DOI: 10.1080/14767058.2018.1438403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the impact of unicornuate uterus on perinatal outcomes after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) cycles. METHODS We performed a retrospective cohort study including 160 women with unicornuate uterus and 1:1 matched controls with normally shaped uterus. They received IVF/ICSI treatment during January 2009 and December 2011. The perinatal outcomes were followed up till December 2014. RESULTS There were no significant differences in pregnancy rate, clinical pregnancy rate or live birth rate (53.6 versus 52.7, 41.4 versus 43.5, 33.8% versus 31.8%) between unicornuate uterus group and controls. Their biochemical pregnancy rate (22.8 versus 17.5%) and miscarriage rate (16.0 versus 18.8%) were similar. No significant differences were identified in preterm birth rate (18.3 versus 11.8%), birthweight (3.24 ± 0.60 versus 3.33 ± 0.54 kg) or birth length (50.47 ± 2.33 versus 50.06 ± 2.40 cm) among the singletons. However, lower gestational age (35.56 ± 2.68 versus 36.71 ± 1.73, p = .019), higher preterm birth rate (55.0 versus 34.4%, p = .038), lower birthweight (2.33 ± 0.58 versus 2.69 ± 0.38 kg, p = .001), lower birth length (45.33 ± 2.46 versus 48.88 ± 2.06 cm, p = .000), as well as higher rate of very low birthweight (13.2% versus 0, p = .007) were found for the twins from unicornuate uterus group. CONCLUSIONS The results indicated unimpaired pregnancy and perinatal outcomes for women with unicornuate uterus conceiving one fetus. However, close attention should be paid to twin pregnancy in unicornuate uterus owing to increased risks of prematurity and low birthweight. Selected single embryo transfer is recommended for women with unicornuate uterus undergoing IVF/ICSI cycles.
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Affiliation(s)
- Xinxia Chen
- a Center for Reproductive Medicine, Shandong University Shandong Provincial Hospital , Jinan , China.,b National Research Center for Assisted Reproductive Technology and Reproductive Genetics , Jinan , China.,c Key Laboratory for Reproductive Endocrinology of Ministry of Education , Jinan , China.,d School of Nursing , Shandong University , Jinan , China
| | - Peihao Liu
- a Center for Reproductive Medicine, Shandong University Shandong Provincial Hospital , Jinan , China.,b National Research Center for Assisted Reproductive Technology and Reproductive Genetics , Jinan , China.,c Key Laboratory for Reproductive Endocrinology of Ministry of Education , Jinan , China
| | - Yan Sheng
- a Center for Reproductive Medicine, Shandong University Shandong Provincial Hospital , Jinan , China.,b National Research Center for Assisted Reproductive Technology and Reproductive Genetics , Jinan , China.,c Key Laboratory for Reproductive Endocrinology of Ministry of Education , Jinan , China
| | - Weiping Li
- e Renji Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Rong Tang
- a Center for Reproductive Medicine, Shandong University Shandong Provincial Hospital , Jinan , China.,b National Research Center for Assisted Reproductive Technology and Reproductive Genetics , Jinan , China.,c Key Laboratory for Reproductive Endocrinology of Ministry of Education , Jinan , China
| | - Lingling Ding
- a Center for Reproductive Medicine, Shandong University Shandong Provincial Hospital , Jinan , China.,b National Research Center for Assisted Reproductive Technology and Reproductive Genetics , Jinan , China.,c Key Laboratory for Reproductive Endocrinology of Ministry of Education , Jinan , China
| | - Yingying Qin
- a Center for Reproductive Medicine, Shandong University Shandong Provincial Hospital , Jinan , China.,b National Research Center for Assisted Reproductive Technology and Reproductive Genetics , Jinan , China.,c Key Laboratory for Reproductive Endocrinology of Ministry of Education , Jinan , China
| | - Zi-Jiang Chen
- a Center for Reproductive Medicine, Shandong University Shandong Provincial Hospital , Jinan , China.,b National Research Center for Assisted Reproductive Technology and Reproductive Genetics , Jinan , China.,c Key Laboratory for Reproductive Endocrinology of Ministry of Education , Jinan , China.,e Renji Hospital , Shanghai Jiao Tong University School of Medicine , Shanghai , China
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139
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Stiles CE, Thuraisingham R, Bockenhauer D, Platts L, Kumar AV, Korbonits M. De novo HNF1 homeobox B mutation as a cause for chronic, treatment-resistant hypomagnesaemia. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM170120. [PMID: 29576871 PMCID: PMC5863246 DOI: 10.1530/edm-17-0120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/27/2018] [Indexed: 12/23/2022] Open
Abstract
29-year-old female presenting with an 8-year history of unexplained hypomagnesaemia, which was severe enough to warrant intermittent inpatient admission for intravenous magnesium. Urinary magnesium was inappropriately normal in the context of hypomagnesaemia indicating magnesium wasting. Ultrasound imaging demonstrated unilateral renal cysts and computed tomography of kidneys, ureters and bladder showed a bicornuate uterus. Referral to genetic services and subsequent testing revealed a de novo HNF1B deletion.
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Affiliation(s)
- C E Stiles
- Department of EndocrinologyWilliam Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | | | - D Bockenhauer
- UCL centre for Nephrology and Great Ormond Street Hospital NHS TrustLondon, UK
| | - L Platts
- North East Thames Regional Genetics LaboratoryGreat Ormond Street Hospital NHS Trust, London, UK
| | - A V Kumar
- North East Thames Regional Genetics ServiceGreat Ormond Street Hospital NHS Trust, London, UK
| | - M Korbonits
- Department of EndocrinologyWilliam Harvey Research Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
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140
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Şık BA, Özcan A, Kumbasar S, Bozkurt M, Bilecan S. Intrauterine interventions with the aid of ultrasonography. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2018. [DOI: 10.25000/acem.376841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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141
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Abstract
Ultrasonography, especially 3D, is essential in the diagnosis and preoperative evaluation of gynecologic surgeries and is important in surgical planning and counseling of patients. In addition, it is useful during hysteroscopic procedures, particularly difficult Asherman syndrome cases, resection of transverse vaginal septum, and treatment of hematometria. 3D ultrasound is especially helpful for fibroid mapping as the simultaneous visualization of the endometrium and myometrium with the coronal view is possible, it can be done by the gynecologist and at a lower cost than an magnetic resonance imaging. The ability to visualize with ultrasound during surgery may reduce complications and eliminate the use of laparoscopy.
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142
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Ruptured Rudimentary Horn Pregnancy and the Missing Hemoperitoneum: An Unexpected Presentation. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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143
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Carranza F, González-Ravina A, Blasco V, Fernández-Sánchez M. Different Endometrial Receptivity in Each Hemiuterus of a Woman with Uterus Didelphys and Previous Failed Embryo Transfers. J Hum Reprod Sci 2018; 11:297-299. [PMID: 30568362 PMCID: PMC6262671 DOI: 10.4103/jhrs.jhrs_113_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The aim of this report is to describe the clinical case of a 31-year-old patient with uterus didelphys (double uterus) and primary infertility, who had been through several embryo transfers in the context of an in vitro fertilization (IVF) treatment with no success. In the case described, the patient is subjected to a new IVF treatment after an endometrial receptivity array (ERA) test performed in both hemiuteri, to assess endometrial receptivity. As a result, the test showed that the right-sided hemiuterus was receptive in 5 days since the beginning of progesterone administration while the left-sided hemiuterus was not receptive in that day. The IVF treatment is performed with vitrified oocytes and a single embryo in day-3 stage is transferred to the right hemiuterus. We concluded that the ERA analysis is a useful tool for IVF patients with uterus didelphys to choose the most appropriate hemiuterus and day to perform embryo transfer.
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Affiliation(s)
| | | | - Víctor Blasco
- IVI-RMA Sevilla, Avenida República Argentina, Sevilla, ES, Spain
| | - Manuel Fernández-Sánchez
- IVI-RMA Sevilla, Avenida República Argentina, Sevilla, ES, Spain.,Department of Molecular Biology and Biochemical Engineering, University Pablode Olavide, Sevilla, ES, Spain.,Department of Surgery, University of Sevilla, Sevilla, ES, Spain
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144
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Locally advanced squamous cell cervical cancer in a patient with septate uterus. J Contemp Brachytherapy 2017; 9:487-489. [PMID: 29204170 PMCID: PMC5705835 DOI: 10.5114/jcb.2017.70996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/04/2017] [Indexed: 12/25/2022] Open
Abstract
A 33-year-old premenopausal multiparous woman with the history of septate uterus was referred to the hospital with menorrhagia and inter-menstrual bleeding occurring for the last 6 months. Work-up revealed a stage IIB cervical cancer. The patient underwent curative chemo/radiotherapy. The patient’s septate uterus presented several difficulties during application. Brachytherapy was applied using standard computed tomography-compatible tandem and ovoids. The high-risk clinical target volume (HR-CTV), intermediate risk CTV, and organs at risk were contoured according to the Groupe Européen de Curiethérapie – European Society for Radiology and Oncology (GEC-ESTRO) guidelines. Treatment was performed via 3-dimensional high-dose-rate technique with 192Ir, with brachytherapy dose of 28 Gy in 4 fractions/7 Gy each, prescribed to the HR-CTV. Treatment was well tolerated with manageable acute toxicities. To the best of our knowledge, the current case is the second case of septate uterus with locally advanced cervical carcinoma. Due to the lack of guidelines about brachytherapy applications in patients with uterine anomaly and owing to the anatomical anomaly, brachytherapy application is challenging in this patients population.
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145
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Karthik SDS, Kriplani A, Mahey R, Kachhawa G. Successful Reproductive Outcome After Laparoscopic Strassmann's Metroplasty. J Hum Reprod Sci 2017; 10:231-234. [PMID: 29142454 PMCID: PMC5672731 DOI: 10.4103/jhrs.jhrs_11_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mullerian anomalies cause a significant impact on the reproductive outcomes. A bicornuate uterus is a type of lateral fusion defect, which constitutes 26% of all uterine anomalies. Strassmann’s metroplasty is a unification procedure performed to correct the two smaller uterine cavities into a more spacious single cavity. Improved reproductive performance was reported after unification metroplasty. Laparoscopic route can be adopted for this procedure with all the advantages of minimally invasive surgery. Here, we report a success story of a woman who suffered with six miscarriages and secondary infertility who underwent laparoscopic Strassmann’s metroplasty in a tertiary care center and later delivered a baby by caesarean section.
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Affiliation(s)
- S D S Karthik
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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146
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Li X, Ouyang Y, Yi Y, Lin G, Lu G, Gong F. Pregnancy outcomes of women with a congenital unicornuate uterus after IVF–embryo transfer. Reprod Biomed Online 2017; 35:583-591. [DOI: 10.1016/j.rbmo.2017.07.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/30/2017] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
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147
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Cahen-Peretz A, Sheiner E, Friger M, Walfisch A. The association between Müllerian anomalies and perinatal outcome. J Matern Fetal Neonatal Med 2017; 32:51-57. [DOI: 10.1080/14767058.2017.1370703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Adva Cahen-Peretz
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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148
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Vickramarajah S, Stewart V, van Ree K, Hemingway AP, Crofton ME, Bharwani N. Subfertility: What the Radiologist Needs to Know. Radiographics 2017; 37:1587-1602. [DOI: 10.1148/rg.2017170053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Saranya Vickramarajah
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Victoria Stewart
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Katherine van Ree
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Anne P. Hemingway
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Mary E. Crofton
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
| | - Nishat Bharwani
- From the Department of Radiology, St Mary’s Hospital, 3rd Floor QEQM Building, London W2 1NY, England; Imperial College Healthcare NHS Trust, London, England (N.B.); and Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England (N.B.)
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149
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Khander A, Stern E, Gerber RS, Fox NS. The association between obstetrical history and preterm birth in women with uterine anomalies. J Matern Fetal Neonatal Med 2017. [DOI: 10.1080/14767058.2017.1347625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amrin Khander
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erica Stern
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel S. Gerber
- Department of Obstetrics and Gynecology, New York Presbyterian – Weill Cornell Medical College, New York, NY, USA
| | - Nathan S. Fox
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Maternal Fetal Medicine Associates, PLLC, New York, NY, USA
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150
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Liu J, Wu Y, Xu S, Su D, Han Y, Wu X. Retrospective evaluation of pregnancy outcomes and clinical implications of 34 Han Chinese women with unicornuate uterus who received IVF-ET or ICSI-ET treatment. J OBSTET GYNAECOL 2017; 37:1020-1024. [PMID: 28657383 DOI: 10.1080/01443615.2017.1318266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Junfen Liu
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Yuanxia Wu
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Suming Xu
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Dan Su
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Yingli Han
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
| | - Xueqing Wu
- Center for Reproductive Medicine, Shanxi Women and Children Hospital, Taiyuan, Shanxi, P. R. China
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