251
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Roy KK, Negi N, Subbaiah M, Kumar S, Sharma JB, Singh N. Effectiveness of estrogen in the prevention of intrauterine adhesions after hysteroscopic septal resection: A prospective, randomized study. J Obstet Gynaecol Res 2014; 40:1085-8. [DOI: 10.1111/jog.12297] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/08/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Kallol Kumar Roy
- Department of Obstetrics and Gynecology; All India Institute of Medical Sciences; New Delhi India
| | - Neha Negi
- Department of Obstetrics and Gynecology; All India Institute of Medical Sciences; New Delhi India
| | - Murali Subbaiah
- Department of Obstetrics and Gynecology; All India Institute of Medical Sciences; New Delhi India
| | - Sunesh Kumar
- Department of Obstetrics and Gynecology; All India Institute of Medical Sciences; New Delhi India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynecology; All India Institute of Medical Sciences; New Delhi India
| | - Neeta Singh
- Department of Obstetrics and Gynecology; All India Institute of Medical Sciences; New Delhi India
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252
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Comte F, Philip CA, Berthiller J, Schott AM, Golfier F, Raudrant D. [Hysteroscopic septoplasty: after miscarriages?]. ACTA ACUST UNITED AC 2014; 42:139-43. [PMID: 24559890 DOI: 10.1016/j.gyobfe.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 01/15/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess reproductive outcome of women affected by septate uterus after surgical correction. PATIENTS AND METHODS It is a retrospective study. The setting is a French university hospital. Surgery was performed on 66 patients between 2000 and 2010. Hysteroscopic metroplasty was performed in every group once the diagnosis was made. There were two groups: 35 patients affected by septate uterus had past history of miscarriages, preterm and term deliveries. Thirty-six patients had never been pregnant. RESULTS In the group of 35 patients with a previous obstetric history, the rate of miscarriages was 57.1% before surgery and 10% after surgery. There was a significant gain of live birth ratio of 55% among women being pregnant after surgery compared to women being pregnant before surgery. For patients with no pregnancy before surgery, obstetrical results are the following ones: miscarriages 25.9%, preterm deliveries 11% and term deliveries 59.3%. DISCUSSION AND CONCLUSION Hysteroscopic septoplasty is an easy technique with few complications in our study. Hysteroscopic septoplasty is strongly recommended after recurrent miscarriages or premature deliveries. We use to propose surgery to every patient affected by septate uterus, even if they have never been pregnant.
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Affiliation(s)
- F Comte
- Service de gynécologie obstétrique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - C-A Philip
- Service de gynécologie obstétrique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - J Berthiller
- Pôle information médicale et recherche, site Lacassagne, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - A-M Schott
- Pôle information médicale et recherche, site Lacassagne, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - F Golfier
- Service de gynécologie obstétrique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - D Raudrant
- Service de gynécologie obstétrique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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253
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254
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Bayyarapu VB, Gundabattula SR, Pochiraju M, Kavuri K, Kandi S. Laparoscopy for Rudimentary Horn and Interstitial Pregnancy. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Manjula Pochiraju
- Department of Gynaecology, Fernandez Hospital, Bogulkunta, Hyderabad, Andhra Pradesh, India
| | - Kamala Kavuri
- Department of Fetal Medicine and Ultrasound, Fernandez Hospital, Bogulkunta, Hyderabad, Andhra Pradesh, India
| | - Sujatha Kandi
- Department of Fetal Medicine and Ultrasound, Fernandez Hospital, Bogulkunta, Hyderabad, Andhra Pradesh, India
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255
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Manikandan K, Dasari P, Sagili H. Third-Trimester Uterine Rupture Following Hysteroscopic Septoplasty: The Need for Standardization of Indications. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Manikandan
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Papa Dasari
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Haritha Sagili
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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256
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Gundabattula SR, Joseph E, Marakani LR, Dasari S, Nirmalan PK. Reproductive outcomes after resection of intrauterine septum. J OBSTET GYNAECOL 2014; 34:235-7. [DOI: 10.3109/01443615.2013.836477] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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257
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Coughlan C, Ledger W, Wang Q, Liu F, Demirol A, Gurgan T, Cutting R, Ong K, Sallam H, Li T. Recurrent implantation failure: definition and management. Reprod Biomed Online 2014; 28:14-38. [DOI: 10.1016/j.rbmo.2013.08.011] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 05/05/2013] [Accepted: 08/06/2013] [Indexed: 12/29/2022]
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258
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Tang R, Dang Y, Qin Y, Zou S, Li G, Wang Y, Chen ZJ. WNT9B in 542 Chinese women with Müllerian duct abnormalities: mutation analysis. Reprod Biomed Online 2013; 28:503-7. [PMID: 24581601 DOI: 10.1016/j.rbmo.2013.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 11/10/2013] [Accepted: 11/13/2013] [Indexed: 11/25/2022]
Abstract
The WNT9B gene is a common organizing signal regulating different segments of the mammalian urogenital system and plays a primary role in the development of the female reproductive tract. The aim of the present work was to examine the presence of WNT mutations in a population of women with Müllerian duct abnormalities (MDA) in order to elucidate whether mutations in WNT9B are causative for MDA in Chinese women. Initially, 191 Chinese MDA patients and 192 healthy individuals (controls) were recruited. All coding regions were amplified by PCR and sequenced to search for variants. To verify the initial results, the numbers of patients and ethnic-matched controls were expanded to 542 and 563, respectively. One known single-nucleotide polymorphism and four novel variants were identified in the first stage: two were synonymous; the other two were rare nonsynonymous novel variants (c.566G>A (p.Arg189Gln) and c.773G>A (p.Arg258His)). None of the four novel variants was found in controls. In the second stage, both novel nonsynonymous variants were detected in MDA cases and controls. The results indicate that mutations in the coding sequence of WNT9B are not responsible for MDA in the Chinese population.
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Affiliation(s)
- Rong Tang
- Center for Reproductive Medicine, Provincial Hospital Affiliated with Shandong University, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 250021, China; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, 250021, China; Shandong Provincial Key Laboratory of Reproductive Medicine,324 Jingwu Road, Jinan 250021, China
| | - Yujie Dang
- Center for Reproductive Medicine, Provincial Hospital Affiliated with Shandong University, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 250021, China; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, 250021, China; Shandong Provincial Key Laboratory of Reproductive Medicine,324 Jingwu Road, Jinan 250021, China
| | - Yingying Qin
- Center for Reproductive Medicine, Provincial Hospital Affiliated with Shandong University, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 250021, China; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, 250021, China; Shandong Provincial Key Laboratory of Reproductive Medicine,324 Jingwu Road, Jinan 250021, China
| | - Shuhua Zou
- Qingdao Women and Children Medical Healthcare Center, Qingdao 266000, China
| | - Guangyu Li
- Center for Reproductive Medicine, Provincial Hospital Affiliated with Shandong University, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 250021, China; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, 250021, China; Shandong Provincial Key Laboratory of Reproductive Medicine,324 Jingwu Road, Jinan 250021, China
| | - Yu Wang
- Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Provincial Hospital Affiliated with Shandong University, Jinan 250021, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, 250021, China; The Key Laboratory for Reproductive Endocrinology of Ministry of Education, 250021, China; Shandong Provincial Key Laboratory of Reproductive Medicine,324 Jingwu Road, Jinan 250021, China; Center for Reproductive Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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259
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Fox NS, Roman AS, Stern EM, Gerber RS, Saltzman DH, Rebarber A. Type of congenital uterine anomaly and adverse pregnancy outcomes. J Matern Fetal Neonatal Med 2013; 27:949-53. [DOI: 10.3109/14767058.2013.847082] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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260
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Spontaneous twin pregnancy in uterus bicornis unicollis. Case Rep Obstet Gynecol 2013; 2013:834952. [PMID: 24349808 PMCID: PMC3848245 DOI: 10.1155/2013/834952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/07/2013] [Indexed: 11/17/2022] Open
Abstract
Abnormal fusion of the Müllerian ducts or failure of resorption of the septum causes varying degrees of congenital uterine malformation. They are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Twin gestation in a case of bicornuate uterus is extremely rare. A 37-year-old multiparous woman conceived a twin dichorionic diamniotic pregnancy spontaneously. Three-dimensional ultrasound revealed bicornuate uterus with one embryo in each cavity. Perinatal course was uneventful. At 35 weeks of pregnancy, spontaneous labour started and twin babies were delivered by bilateral low transvers caesarean section. Because of the rare occurrence of twin gestation in bicornuate uterus, there is no uniform guideline to manage these cases appropriately. Delivery by planned caesarean section could avoid the possible obstetric complications by dystocia.
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261
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Isango YI, Mukuku O, Ilunga PM, Kakisingi CN, Nsambi J, Kabamba C, Mutangala G, Mubinda PK, Kimbala J. [Bicervical uterus bicornis permeable: accidental discovery during an emergency caesarean section in a multiparous woman in Lubumbashi]. Pan Afr Med J 2013; 15:75. [PMID: 24198877 PMCID: PMC3810102 DOI: 10.11604/pamj.2013.15.75.2745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/30/2013] [Indexed: 02/05/2023] Open
Abstract
L'utérus bicorne bicervical perméable est une malformation utérine assez rare et son diagnostic est souvent posé fortuitement au cours d'un examen fait pour autre but. Il est asymptomatique et au cours d'une grossesse, cette malformation peut passer inaperçue si aucune surveillance prénatale n'a été faite. Nous rapportons un cas d'utérus bicorne bicervical perméable découvert fortuitement lors d'une césarienne indiquée urgemment pour une dystocie dynamique de type hypercinétique rebelle au traitement chez une multipare âgée de 30 ans. L'intérêt de ce cas est de montrer le pronostic obstétrical chez les femmes fertiles porteuses de cette malformation utérine.
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Affiliation(s)
- Yves Idi Isango
- Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, RD Congo
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262
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Sen KK, Balasubramaniam D, Kanagaraj V. Magnetic resonance imaging in obstructive Müllerian anomalies. J Hum Reprod Sci 2013; 6:162-4. [PMID: 24082660 PMCID: PMC3778608 DOI: 10.4103/0974-1208.117167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/13/2013] [Accepted: 05/02/2013] [Indexed: 11/24/2022] Open
Abstract
Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures. It is characterized by the triad of didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis. Magnetic resonance imaging (MRI) is a sensitive, non-invasive diagnostic modality for demonstrating anatomic variation and associated complications.
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Affiliation(s)
- Kamal Kumar Sen
- Department of Radiology & Imaging, P.S.G. Institute of Medical Sciences & Research, Peelamedu, Coimbatore 641004, Tamil Nadu, India
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263
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Stamatopoulos C, Tsimpanakos I, McKenzie-Gray B, Gkioulekas N, Korkontzelos I, Magos A. An unusual case of cervical diverticulum identified by presence of 3 cavities at diagnostic hysteroscopy. J Minim Invasive Gynecol 2013; 20:238-40. [PMID: 23465259 DOI: 10.1016/j.jmig.2012.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/05/2012] [Accepted: 10/18/2012] [Indexed: 11/15/2022]
Abstract
Herein is presented the case report of a patient who had severe dysmenorrhea since menarche, known right unicornuate uterus with a left rudimentary horn, and recurrent hematometra. Previous hysteroscopic drainage of the hematometra temporarily alleviated the symptoms. At subsequent hysteroscopy, 3 cavities were identified, 2 corresponding to the uterine horns and the other to a cervical diverticulum. Hysteroscopic metroplasty with drainage of the rudimentary horn hematometra provided long-term relief of the symptoms. The diagnosis was verified at diagnostic laparoscopy.
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264
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Paradisi R, Barzanti R, Natali F, Guerrini M, Battaglia C, Seracchioli R, Venturoli S. Hysteroscopic metroplasty: reproductive outcome in relation to septum size. Arch Gynecol Obstet 2013; 289:671-6. [DOI: 10.1007/s00404-013-3003-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 08/05/2013] [Indexed: 11/30/2022]
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265
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Abrao MS, Muzii L, Marana R. Anatomical causes of female infertility and their management. Int J Gynaecol Obstet 2013; 123 Suppl 2:S18-24. [PMID: 24119894 DOI: 10.1016/j.ijgo.2013.09.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main female anatomical causes of infertility include post-infectious tubal damage, endometriosis, and congenital/acquired uterine anomalies. Congenital (septate uterus) and acquired (myomas and synechiae) diseases of the uterus may lead to infertility, pregnancy loss, and other obstetric complications. Pelvic inflammatory disease represents the most common cause of tubal damage. Surgery still remains an important option for tubal factor infertility, with results in terms of reproductive outcome that compare favorably with those of in vitro fertilization. Endometriosis is a common gynecologic condition affecting women of reproductive age, which can cause pain and infertility. The cause of infertility associated with endometriosis remains elusive, suggesting a multifactorial mechanism involving immunologic, genetic, and environmental factors. Despite the high prevalence of endometriosis, the exact mechanisms of its pathogenesis are unknown. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. In the majority of cases, surgical treatment of endometriosis has promoted significant increases in fertilization rates. There are obvious associations between endometriosis and the immune system, and future strategies to treat endometriosis might be based on immunologic concepts.
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Affiliation(s)
- Mauricio S Abrao
- Department of Obstetrics and Gynecology, Sao Paulo University, Sao Paulo, Brazil
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266
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Lankford JC, Mancuso P, Appel R. Congenital Reproductive Abnormalities. J Midwifery Womens Health 2013; 58:546-51. [DOI: 10.1111/jmwh.12020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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267
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Azadi A, Ostergard DR, Dassel MW, Yeganeh T, Heyl PS. Pregnancy of 22 Weeks in the Rudimentary Horn of the Uterus. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali Azadi
- Department of Obstetrics and Gynecology and Women's Health, University of Louisville Louisville, KY
| | - Donald R. Ostergard
- Department of Obstetrics and Gynecology and Women's Health, University of Louisville Louisville, KY
| | - Mark W. Dassel
- Department of Obstetrics and Gynecology and Women's Health, University of Louisville Louisville, KY
| | - Taraneh Yeganeh
- Department of Obstetrics and Gynecology and Women's Health, University of Louisville Louisville, KY
| | - Peter S. Heyl
- Department of Obstetrics and Gynecology and Women's Health, University of Louisville Louisville, KY
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268
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Fox NS, Roman AS, Saltzman DH, Klauser CK, Rebarber A. Twin pregnancy in patients with a uterine anomaly. J Matern Fetal Neonatal Med 2013; 27:360-4. [DOI: 10.3109/14767058.2013.819331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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269
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Nayak PK, Mahapatra PC, Mallick J, Swain S, Mitra S, Sahoo J. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients. J Hum Reprod Sci 2013; 6:32-4. [PMID: 23869148 PMCID: PMC3713574 DOI: 10.4103/0974-1208.112378] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 11/04/2012] [Accepted: 02/27/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE: To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres. MATERIALS AND METHODS: This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha) throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included. RESULTS: Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesion (12%) in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups. CONCLUSIONS: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.
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Affiliation(s)
- Prasanta K Nayak
- Department of Obstetrics and Gynaecology, Sriram Chandra Bhanj Medical College, Odisha, India
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270
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Chadha R, Puri M, Saxena R, Agarwala S, Puri A, Choudhury SR. Congenital pouch colon in a girl associated with bilateral atresia of cervix uteri and uterus didelphys. J Indian Assoc Pediatr Surg 2013; 18:81-3. [PMID: 23798813 PMCID: PMC3687153 DOI: 10.4103/0971-9261.109360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This report describes a girl with congenital pouch colon (CPC), uterus didelphys with septate vagina, and a cloacal anomaly. The girl underwent cloacal reconstruction at the age of 15 months. Subsequently, at puberty, the child had primary amenorrhea with severe cyclic abdominal pain due to endometriosis of both the uteruses and adnexal cysts with hematometra and hematosalpinx. Laparotomy with removal of both uteri and the left fallopian tube was performed. Both uteri had atresia of the cervix uteri. This report emphasizes the need for comprehensive evaluation and a long-term management strategy for associated gynecologic anomalies in girls with CPC, especially with regard to patency of the outflow tract.
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Affiliation(s)
- Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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271
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Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann H, Gianaroli L, Campo R. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 2013; 28:2032-44. [PMID: 23771171 PMCID: PMC3712660 DOI: 10.1093/humrep/det098] [Citation(s) in RCA: 403] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
STUDY QUESTION What classification system is more suitable for the accurate, clear, simple and related to the clinical management categorization of female genital anomalies? SUMMARY ANSWER The new ESHRE/ESGE classification system of female genital anomalies is presented. WHAT IS KNOWN ALREADY Congenital malformations of the female genital tract are common miscellaneous deviations from normal anatomy with health and reproductive consequences. Until now, three systems have been proposed for their categorization but all of them are associated with serious limitations. STUDY DESIGN, SIZE AND DURATION The European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESGE) have established a common Working Group, under the name CONUTA (CONgenital UTerine Anomalies), with the goal of developing a new updated classification system. A scientific committee (SC) has been appointed to run the project, looking also for consensus within the scientists working in the field. PARTICIPANTS/MATERIALS, SETTING, METHODS The new system is designed and developed based on (i) scientific research through critical review of current proposals and preparation of an initial proposal for discussion between the experts, (ii) consensus measurement among the experts through the use of the DELPHI procedure and (iii) consensus development by the SC, taking into account the results of the DELPHI procedure and the comments of the experts. Almost 90 participants took part in the process of development of the ESHRE/ESGE classification system, contributing with their structured answers and comments. MAIN RESULTS AND THE ROLE OF CHANCE The ESHRE/ESGE classification system is based on anatomy. Anomalies are classified into the following main classes, expressing uterine anatomical deviations deriving from the same embryological origin: U0, normal uterus; U1, dysmorphic uterus; U2, septate uterus; U3, bicorporeal uterus; U4, hemi-uterus; U5, aplastic uterus; U6, for still unclassified cases. Main classes have been divided into sub-classes expressing anatomical varieties with clinical significance. Cervical and vaginal anomalies are classified independently into sub-classes having clinical significance. LIMITATIONS, REASONS FOR CAUTION The ESHRE/ESGE classification of female genital anomalies seems to fulfill the expectations and the needs of the experts in the field, but its clinical value needs to be proved in everyday practice. WIDER IMPLICATIONS OF THE FINDINGS The ESHRE/ESGE classification system of female genital anomalies could be used as a starting point for the development of guidelines for their diagnosis and treatment. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- Grigoris F Grimbizis
- Congenital Uterine Malformations (CONUTA) common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
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272
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Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann H, Gianaroli L, Campo R. The ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies. ACTA ACUST UNITED AC 2013; 10:199-212. [PMID: 23894234 PMCID: PMC3718988 DOI: 10.1007/s10397-013-0800-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/08/2013] [Indexed: 11/12/2022]
Abstract
The new ESHRE/ESGE classification system of female genital anomalies is presented, aiming to provide a more suitable classification system for the accurate, clear, correlated with clinical management and simple categorization of female genital anomalies. Congenital malformations of the female genital tract are common miscellaneous deviations from normal anatomy with health and reproductive consequences. Until now, three systems have been proposed for their categorization, but all of them are associated with serious limitations. The European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESGE) have established a common Working Group, under the name CONUTA (CONgenital UTerine Anomalies), with the goal of developing a new updated classification system. A scientific committee has been appointed to run the project, looking also for consensus within the scientists working in the field. The new system is designed and developed based on: (1) scientific research through critical review of current proposals and preparation of an initial proposal for discussion between the experts, (2) consensus measurement among the experts through the use of the DELPHI procedure and (3) consensus development by the scientific committee, taking into account the results of the DELPHI procedure and the comments of the experts. Almost 90 participants took part in the process of development of the ESHRE/ESGE classification system, contributing with their structured answers and comments. The ESHRE/ESGE classification system is based on anatomy. Anomalies are classified into the following main classes, expressing uterine anatomical deviations deriving from the same embryological origin: U0, normal uterus; U1, dysmorphic uterus; U2, septate uterus; U3, bicorporeal uterus; U4, hemi-uterus; U5, aplastic uterus; U6, for still unclassified cases. Main classes have been divided into sub-classes expressing anatomical varieties with clinical significance. Cervical and vaginal anomalies are classified independently into sub-classes having clinical significance. The ESHRE/ESGE classification of female genital anomalies seems to fulfil the expectations and the needs of the experts in the field, but its clinical value needs to be proved in everyday practice. The ESHRE/ESGE classification system of female genital anomalies could be used as a starting point for the development of guidelines for their diagnosis and treatment.
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Affiliation(s)
- Grigoris F Grimbizis
- Congenital Uterine Anomalies (CONUTA) common ESHRE-ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium ; First Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Tsimiski 51 Street, 54623 Thessaloniki, Greece
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273
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Nathan H, Sornum A. Diagnosis and management of a ruptured rudimentary horn pregnancy in a low-resource setting. BMJ Case Rep 2013; 2013:bcr2013009957. [PMID: 23749832 PMCID: PMC3702986 DOI: 10.1136/bcr-2013-009957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 22-year-old woman presented with amenorrhoea, lower abdominal pain and brown vaginal discharge. She was noted to be in hypovolaemic shock with a distended and peritonitic abdomen. On bimanual examination, the uterus was not palpated, the posterior fornix was full and cervical excitation was present. A clinical diagnosis of a ruptured ectopic pregnancy was made. She was resuscitated and an emergency laparotomy was performed. Intraoperatively, a ruptured rudimentary horn with an ex utero pregnancy was discovered. The right horn and tube were removed, as was the non-viable fetus. There were no postoperative complications and the patient was discharged after 5 days of observation.
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Affiliation(s)
- Hannah Nathan
- Department of Obstetrics, Lower Umfolozi District War Memorial Hospital, Empangeni, KZN, South Africa
| | - Alvin Sornum
- Department of Internal Medicine, Ngwelezane Hospital, Empangeni, KZN, South Africa
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274
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Current Concepts and New Trends in the Diagnosis and Management of Recurrent Miscarriage. Obstet Gynecol Surv 2013; 68:445-66. [DOI: 10.1097/ogx.0b013e31828aca19] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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275
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Smit JG, Kasius JC, Eijkemans MJ, Veersema S, Fatemi HM, Santbrink van EJ, Campo R, Broekmans FJ. The international agreement study on the diagnosis of the septate uterus at office hysteroscopy in infertile patients. Fertil Steril 2013; 99:2108-13.e2. [DOI: 10.1016/j.fertnstert.2013.02.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/30/2013] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
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276
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Gouhar GK, Siam S. Uterine septum structure and reproductive performance: Role of 3D TVUS and MRI. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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277
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Park TC, Lee HJ. Pregnancy coexisting with uterus didelphys with a blind hemivagina complicated by pyocolpos due to Pediococcus infection: a case report and review of the published reports. J Obstet Gynaecol Res 2013; 39:1276-9. [PMID: 23718909 DOI: 10.1111/jog.12049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/12/2012] [Indexed: 11/28/2022]
Abstract
A woman in early pregnancy was referred due to severe pelvic pain. Vaginal examination showed a severely protruding left vaginal wall with severe tenderness. A transvaginal ultrasound showed a double uterus and a mixed echogenic mass next to the cervix of the left uterus. After creating an opening in the left vaginal wall and inserting a Foley catheter through the opening into the vaginal wall for drainage with antibiotic therapy, the patient's condition rapidly improved. A culture of the pus drained from the vaginal wall showed Pediococcus species. The patient delivered a healthy infant by cesarean section at term gestation without recurrence of pyocolpos. Ten months after delivery, resection of the vaginal septum was performed and the left cervix was exposed. Ultrasound revealed normal kidneys.
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Affiliation(s)
- Tae Chul Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
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278
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Anatomische Ursachen bei habituellen Aborten. GYNAKOLOGISCHE ENDOKRINOLOGIE 2013. [DOI: 10.1007/s10304-012-0517-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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279
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Narang HK, Warke HS, Mayadeo NM. Müllerian anomaly with ovary at deep inguinal ring: a rare case finding. J OBSTET GYNAECOL 2013; 33:317-8. [PMID: 23550874 DOI: 10.3109/01443615.2012.754413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- H K Narang
- Department of Obstetrics and Gynecology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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280
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Uterine carcinosarcoma in a patient with didelphys uterus. Case Rep Obstet Gynecol 2013; 2013:401962. [PMID: 23533863 PMCID: PMC3606743 DOI: 10.1155/2013/401962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/18/2013] [Indexed: 11/20/2022] Open
Abstract
Background. Didelphys uterus is a noncommon finding in women. Till now, few cases with benign mesenchymal tumors in patients with didelphys uterus are described. We present a case of a patient with carcinosarcoma arising in a didelphys uterus. Case. A 73-year-old patient presented with profuse watery postmenopausal bleeding. On examination under anesthesia, left and right cervixes were identified. Tumor extended from the left cervix into the lower third of the vagina and was adherent to the right vaginal sidewall. There was no evidence of parametrial extension. Tissue was sent for biopsy which revealed high-grade uterine carcinosarcoma. Two uterine fundi and two vaginas in keeping with uterine didelphys were identified on imaging. The patient underwent vaginal excision of the protruding tumor measuring 8 × 6 cm with harmonic scalpel followed by total abdominal hysterectomy and bilateral salpingooophorectomy. Although a number of pelvic and paraaortic lymph nodes were also identified on imaging, she was not planned for lymphadenectomy after MDT (multidisciplinary team) discussion because of her comorbidities. The final histology confirmed the diagnosis. Conclusion. According to our knowledge, this is the second case of carcinosarcoma arising in didelphys uterus in the world literature.
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281
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Jaslow CR, Kutteh WH. Effect of prior birth and miscarriage frequency on the prevalence of acquired and congenital uterine anomalies in women with recurrent miscarriage: a cross-sectional study. Fertil Steril 2013; 99:1916-22.e1. [PMID: 23472945 DOI: 10.1016/j.fertnstert.2013.01.152] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/17/2013] [Accepted: 01/28/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether a prior live birth or an increase in number of miscarriages impacted the prevalence of congenital or acquired uterine anomalies in women with predominantly early recurrent miscarriage (RM). DESIGN Single-center, cross-sectional study. SETTING Patients with RM at a private practice. PATIENT(S) Eight hundred seventy-five women who had two or more consecutive miscarriages. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Frequencies of congenital uterine anomalies (bicornuate, didelphic, septate, t-shaped, and unicornuate uteri) and acquired uterine anomalies (fibroids, polyps, and adhesions). RESULT(S) A uterine anomaly was identified in 169 (19.3%) of the patients. Patients with primary RM were more likely to have congenital anomalies than patients with secondary RM, particularly septa. The occurrence of a prior live birth, however, did not influence the frequency of acquired uterine anomalies, which were detected in equal frequencies in patients with three or more miscarriages when compared with patients with only two miscarriages. CONCLUSION(S) Although RM patients with a prior viable birth are less likely to have a uterine anomaly than those who have never given birth, our results support a recommendation for diagnostic imaging of the uterus after two losses in women with secondary RM as well as for those with primary RM.
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282
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Sakhel K, Benson CB, Platt LD, Goldstein SR, Benacerraf BR. Begin with the basics: role of 3-dimensional sonography as a first-line imaging technique in the cost-effective evaluation of gynecologic pelvic disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:381-388. [PMID: 23443177 DOI: 10.7863/jum.2013.32.3.381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Khaled Sakhel
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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283
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Metroplasty for AFS Class V and VI Septate Uterus in Patients With Infertility or Miscarriage: Reproductive Outcomes Study. J Minim Invasive Gynecol 2013; 20:178-84. [DOI: 10.1016/j.jmig.2012.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/24/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022]
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284
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Gordts S. New developments in reproductive surgery. Best Pract Res Clin Obstet Gynaecol 2013; 27:431-40. [PMID: 23291212 DOI: 10.1016/j.bpobgyn.2012.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/25/2012] [Indexed: 11/25/2022]
Abstract
The introduction of in-vitro fertilisation within reproductive medicine has prompted questions to be asked about the relevance of reproductive surgery. Reproductive surgery is more than a competing discipline; it is complementary to the techniques of in-vitro fertilisation. As a complementary discipline, reproductive surgery covers the field of tubal and ovarian pathology and correction of uterine alterations. In recent decades, more attention has been paid to the importance of the uterus in the process of conception and implantation. The place of reproductive surgery and the existing controversies in the treatment of uterine congenital and acquired pathology, tubal, and ovarian surgery are discussed. Continuous training and accreditation programmes for reproductive technologies and surgery are more important than ever.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium.
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285
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Bilateral ectopic hypoplastic uteri attached to bilateral pelvic sidewalls in a 21-year-old patient with primary amenorrhea: the first published report. Case Rep Obstet Gynecol 2013; 2013:450165. [PMID: 24288635 PMCID: PMC3833282 DOI: 10.1155/2013/450165] [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: 09/11/2013] [Accepted: 09/29/2013] [Indexed: 11/17/2022] Open
Abstract
Müllerian duct anomalies (MDAs) encompass a group of anatomical malformations resulting from defective development, fusion, migration, or resorption of Müllerian (paramesonephric) ducts during embryonic life. Herein, we report the first case of an exceedingly uncommon MDA (bilateral ectopic hypoplastic uteri attached to bilateral pelvic sidewalls) in a 21-year-old woman who was referred to our tertiary care center as a case of primary amenorrhea for workup and further management.
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286
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Abu Rafea BF, Vilos GA, Oraif AM, Power SG, Cains JH, Vilos AG. Fertility and pregnancy outcomes following resectoscopic septum division with and without intrauterine balloon stenting: a randomized pilot study. Ann Saudi Med 2013; 33:34-9. [PMID: 23458938 PMCID: PMC6078579 DOI: 10.5144/0256-4947.2013.34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although uterine stenting is performed routinely following hysteroscopic metroplasty, we were unable to find any evidence documenting its value with regards to septum reformation and/or obstetrical performance. To evaluate the benefits of intrauterine Foley catheter/balloon splinting after resectoscopic septum division on septum reformation, fertility, and pregnancy outcomes. DESIGN AND SETTING Prospective, randomized controlled pilot study (Canadian Task Force Classification I) conducted in university affiliated teaching hospital. PATIENTS AND METHODS Twenty-eight women with infertility and/or adverse pregnancy outcomes diagnosed with intrauterine septum were randomized into having a No. 14 pediatric Foley catheter/balloon for 5 days (n=13) vs. no balloon (n=15) following resectoscopic septum division. None of the patients received preoperative endometrial thinning, antibiotic prophylaxis or adjuvant postoperative hormone therapy. All uterine septa were divided under general anaesthesia using a 26 F (9 mm) resectoscope with a monopolar electrical knife using glycine irrigant solution (1.5%) and 120 watts of power of low voltage (cut) waveform. RESULTS The median age (range) was 29 years (23-38) and 32 years (22-40), respectively (P=.59). The groups were comparable by age, past obstetrical performance and comorbidities including endometriosis stage I-IV in 3 and 4 women, in the catheter/balloon and balloon group, respectively, and one in each group of polycystic ovarian syndrome and Crohn disease and one case of tubal obstruction in the balloon group. There were no intra- or postoperative complications. At 3 months, a hysterosalpingogram was done in 10 (77%) and 13 (87%) women, respectively, the results of which were normal. At 12-18 months, 1 woman in the balloon and 3 in the control group were not trying to conceive and 1 in each group had not conceived. Of the remaining women, 11 (92%) in each group had conceived and pregnancy outcomes included spontaneous abortion 3 (25%) and 4 (33.3%), ectopic pregnancy 0 and 1, second trimester loss 1 (8.3%) and 0 and term pregnancy 8 (66.6%) in both groups. Conception through assisted reproductive technology occurred in 2 and 1 woman, respectively. CONCLUSIONS Following resectoscopic septum division with monopolar knife electrode, splinting the uterine cavity with Foley catheter provided no advantage in septum reformation, clinical pregnancy rate, and pregnancy outcomes.
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287
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Connell M, Owen C, Segars J. Genetic Syndromes and Genes Involved in the Development of the Female Reproductive Tract: A Possible Role for Gene Therapy. ACTA ACUST UNITED AC 2013; 4. [PMID: 25506511 PMCID: PMC4264624 DOI: 10.4172/2157-7412.1000127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Müllerian and vaginal anomalies are congenital malformations of the female reproductive tract resulting from alterations in the normal developmental pathway of the uterus, cervix, fallopian tubes, and vagina. The most common of the Müllerian anomalies affect the uterus and may adversely impact reproductive outcomes highlighting the importance of gaining understanding of the genetic mechanisms that govern normal and abnormal development of the female reproductive tract. Modern molecular genetics with study of knock out animal models as well as several genetic syndromes featuring abnormalities of the female reproductive tract have identified candidate genes significant to this developmental pathway. Further emphasizing the importance of understanding female reproductive tract development, recent evidence has demonstrated expression of embryologically significant genes in the endometrium of adult mice and humans. This recent work suggests that these genes not only play a role in the proper structural development of the female reproductive tract but also may persist in adults to regulate proper function of the endometrium of the uterus. As endometrial function is critical for successful implantation and pregnancy maintenance, these recent data suggest a target for gene therapy. Future research will be needed to determine if gene therapy may improve reproductive outcomes for patients with demonstrated deficient endometrial expression related to abnormal gene expression.
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Affiliation(s)
- Mt Connell
- Department of Obstetrics and Gynecology, Truman Medical Center, Kansas City, Missouri
| | - Cm Owen
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Jh Segars
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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288
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Heinonen PK. Pregnancies in women with uterine malformation, treated obstruction of hemivagina and ipsilateral renal agenesis. Arch Gynecol Obstet 2012; 287:975-8. [DOI: 10.1007/s00404-012-2680-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 12/06/2012] [Indexed: 01/01/2023]
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289
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Hall JG. Uterine structural anomalies and arthrogryposis-death of an urban legend. Am J Med Genet A 2012; 161A:82-8. [DOI: 10.1002/ajmg.a.35683] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/23/2012] [Indexed: 11/11/2022]
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290
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Triplets with Two IUFD with IUGR of Live Fetus with DIC in a Patient with BOH and Septate Uterus. J Obstet Gynaecol India 2012; 62:19-20. [DOI: 10.1007/s13224-013-0360-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 06/11/2012] [Indexed: 10/27/2022] Open
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291
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Chen SQ, Deng N, Jiang HY, Li JB, Lu S, Yao SZ. Management and reproductive outcome of complete septate uterus with duplicated cervix and vaginal septum: review of 21 cases. Arch Gynecol Obstet 2012; 287:709-14. [DOI: 10.1007/s00404-012-2622-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022]
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292
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Iwase A, Goto M, Manabe S, Kobayashi H, Kondo M, Kikkawa F. Successful surgical management of a septate uterus constricted with leiomyomas: hysteroscopic metroplasty using a Foley catheter. Arch Gynecol Obstet 2012; 287:835-6. [PMID: 23053312 DOI: 10.1007/s00404-012-2578-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
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293
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294
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Pai HD, Kundnani MT, Palshetkar NP, Pai RD, Saxena N. Reproductive performance after hysteroscopic metroplasty in women with primary infertility and septate uterus. JOURNAL OF GYNECOLOGICAL ENDOSCOPY AND SURGERY 2012; 1:17-20. [PMID: 22442505 PMCID: PMC3304264 DOI: 10.4103/0974-1216.51904] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is enough evidence in the literature to support that removal of septum improves pregnancy rates in women with bad obstetric history. However, its role in patients with otherwise unexplained infertility is still not clear due to paucity of enough evidence. OBJECTIVE To assess reproductive performance in women with septate uterus and otherwise unexplained infertility after hysteroscopic metroplasty. MATERIALS AND METHODS 72 women with septate uterus and otherwise unexplained primary infertility were included in the study. All these women underwent hysteroscopic septal resection. Reproductive performance of these women within one year of surgery was studied and analysed. RESULT 33 women (45.83%) conceived within one year of surgery. Only 4 women (12%) had spontaneous abortions and only 5 (15%) had preterm delivery. CONCLUSION Hysteroscopic metroplasty in women with septate uterus significantly improves the reproductive performance.
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Affiliation(s)
- Hrishikesh D Pai
- Consultant Infertility Specialist, Lilavati Hospital and MRC, Mumbai, India
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295
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Ghafarnejad M, Adabi K, Moosavi SA. Uteroneovaginal cannulation using Pezzer catheter in patients with vaginal agenesis and functional uterus. J Obstet Gynaecol Res 2012; 39:210-6. [PMID: 22888767 DOI: 10.1111/j.1447-0756.2012.01975.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to introduce a method for uterus preservation in patients with vaginal agenesia and functional uterus. MATERIAL AND METHODS Six patients with vaginal agenesia and one patient with cervicovaginal agenesis with functional uterus were enrolled in the study. Laparoscopy, vaginal reconstruction, laparatomy, hematocolpos evacuation and cannulation were carried out between atretic cervix and neovagina using a Pezzer catheter. No sutures or grafts were used. Patients were trained to use a vaginal mold regularly. Pezzer catheter remained in place for 6 months to maintain menstrual drainage and avoid orifice obstruction. RESULTS The surgical procedure was successful in all cases. Menses returned and abdominal pain was relieved in all patients. Three patients faced stenosis and two cases suffered from infection. One patient became pregnant and delivered at term. Self-image and quality of life were improved in all cases. CONCLUSIONS Uteroneovaginal cannulation using a Pezzer catheter relieves pain, restores regular menses and fertility and reduces symptoms related to retrograde menstruation in patients with vaginal agenesis and functional uterus.
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Affiliation(s)
- Marzieh Ghafarnejad
- Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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296
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Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril 2012; 98:1103-11. [PMID: 22835448 DOI: 10.1016/j.fertnstert.2012.06.048] [Citation(s) in RCA: 677] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 06/25/2012] [Indexed: 11/16/2022]
Abstract
The majority of miscarriages are sporadic and most result from genetic causes that are greatly influenced by maternal age. Recurrent pregnancy loss (RPL) is defined by two or more failed clinical pregnancies, and up to 50% of cases of RPL will not have a clearly defined etiology.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama, USA
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297
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Extrinsic factors influencing fetal deformations and intrauterine growth restriction. J Pregnancy 2012; 2012:750485. [PMID: 22888434 PMCID: PMC3409542 DOI: 10.1155/2012/750485] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 06/04/2012] [Accepted: 06/04/2012] [Indexed: 12/16/2022] Open
Abstract
The causes of intrauterine growth restriction (IUGR) are multifactorial with both intrinsic and extrinsic influences. While many studies focus on the intrinsic pathological causes, the possible long-term consequences resulting from extrinsic intrauterine physiological constraints merit additional consideration and further investigation. Infants with IUGR can exhibit early symmetric or late asymmetric growth abnormality patterns depending on the fetal stage of development, of which the latter is most common occurring in 70–80% of growth-restricted infants. Deformation is the consequence of extrinsic biomechanical factors interfering with normal growth, functioning, or positioning of the fetus in utero, typically arising during late gestation. Biomechanical forces play a critical role in the normal morphogenesis of most tissues. The magnitude and direction of force impact the form of the developing fetus, with a specific tissue response depending on its pliability and stage of development. Major uterine constraining factors include primigravida, small maternal size, uterine malformation, uterine fibromata, early pelvic engagement of the fetal head, aberrant fetal position, oligohydramnios, and multifetal gestation. Corrective mechanical forces similar to those that gave rise to the deformation to reshape the deformed structures are often used and should take advantage of the rapid postnatal growth to correct form.
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298
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Singh N, Singh U, Verma ML. Ruptured bicornuate uterus mimicking ectopic pregnancy: A case report. J Obstet Gynaecol Res 2012; 39:364-6. [PMID: 22691311 DOI: 10.1111/j.1447-0756.2012.01914.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ruptured uterus presenting in first trimester of pregnancy is extremely uncommon and should raise the suspicion of uterine malformations. We report a case of a 24-year-old primigravida with 10 weeks of gestation presenting with acute abdomen and hemoperitoneum. Laparotomy revealed bicornuate uterus with ruptured rudimentary horn. The incidence, diagnosis and management of such cases is discussed.
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Affiliation(s)
- Nisha Singh
- Department of Obstetrics and Gynecology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
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Santos XM, Krishnamurthy R, Bercaw-Pratt JL, Dietrich JE. The utility of ultrasound and magnetic resonance imaging versus surgery for the characterization of müllerian anomalies in the pediatric and adolescent population. J Pediatr Adolesc Gynecol 2012; 25:181-4. [PMID: 22357190 DOI: 10.1016/j.jpag.2011.12.069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To evaluate the utility of transabdominal ultrasound and magnetic resonance imaging in the evaluation of American Society for Reproductive Medicine (†)(ASRM)-classified müllerian anomalies compared to surgical findings in the pediatric and adolescent population. DESIGN Retrospective chart review. SETTING Tertiary academic center. PARTICIPANTS Thirty-eight patients with müllerian anomalies seen in our pediatric and adolescent gynecology clinic were identified both on the basis of ICD-9 codes and having magnetic resonance imaging at Texas Children's Hospital between 2004 and 2009. INTERVENTIONS None. MAIN OUTCOMES MEASURE Correlation among transabdominal ultrasound and magnetic resonance imaging findings with surgical findings. RESULTS Mean age was 12.2 (± 4.1) years. Twenty-eight patients underwent magnetic resonance imaging and required surgical intervention, and 88.5% demonstrated correlative consistency with surgical findings. Twenty-two patients underwent ultrasound, magnetic resonance imaging, and surgery, which revealed consistency among ultrasound and surgical findings (59.1%) and consistency among magnetic resonance imaging and surgical findings (90.9%). In ASRM diagnoses evaluated by magnetic resonance imaging, surgical findings correlated in 92% (Pearson 0.89). Overall, 55.2% of patients had a renal malformation. CONCLUSIONS Magnetic resonance imaging is the gold standard imaging modality for müllerian anomalies and is an effective technique for noninvasive evaluation and accurate classification of the type of anomaly in the pediatric and adolescent population. Magnetic resonance imaging should be considered as an adjunct to transabdominal ultrasound to evaluate müllerian anomalies.
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Affiliation(s)
- X M Santos
- Section of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
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Brännström M, Diaz-Garcia C, Hanafy A, Olausson M, Tzakis A. Uterus transplantation: animal research and human possibilities. Fertil Steril 2012; 97:1269-76. [PMID: 22542990 DOI: 10.1016/j.fertnstert.2012.04.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
Uterus transplantation research has been conducted toward its introduction in the human as a treatment of absolute uterine-factor infertility, which is considered to be the last frontier to conquer for infertility research. In this review we describe the patient populations that may benefit from uterus transplantation. The animal research on uterus transplantation conducted during the past two decades is summarized, and we describe our views regarding a future research-based human attempt.
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Affiliation(s)
- Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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