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Muneeba S, Acharya N, Mohammad S, Reddy LS, Gupta A. Unicornuate Uterus and Rudimentary Horn: An Unusual Cause of Recurrent Fetal Malpresentation Identified During a Scheduled Cesarean Delivery. Cureus 2023; 15:e46277. [PMID: 37908913 PMCID: PMC10615386 DOI: 10.7759/cureus.46277] [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: 08/27/2023] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
This case report presents a unique clinical scenario involving a 32-year-old woman with a unicornuate uterus and a rudimentary horn, leading to recurrent fetal malpresentation. The patient, gravida 3, para 1, presented at 36 weeks of gestational age with contractions and vaginal bleeding. Clinical evaluation revealed a breech presentation and nonreassuring fetal heart tracings. An emergency cesarean section was performed, during which a unicornuate uterus with a rudimentary horn was identified and fused to the main uterine cavity on the left posterior aspect. The rudimentary horn bore a functional left tube and ovary. The surgical procedure was successful, resulting in the delivery of a healthy baby girl. This case underscores the importance of meticulous preoperative assessment, multidisciplinary collaboration, and informed consent in managing complex uterine anomalies to ensure optimal maternal and fetal outcomes.
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Affiliation(s)
- Shaikh Muneeba
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Lucky S Reddy
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya Gupta
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Erdem S, Baglı İ, Ege S, Aydın E, Ozgokce C, Kulahcıoglu MI. Efficacy of hysteroscopic septum resection in infertile women: a single center experience. MINIM INVASIV THER 2023; 32:62-65. [PMID: 36633550 DOI: 10.1080/13645706.2022.2164467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION We aimed to reveal the effectiveness of hysteroscopic septum resection on the reproductive outcomes of infertile patients. MATERIAL AND METHODS We included 46 infertile women who underwent hysteroscopic septum resection of septate uterus (complete: group 1, n = 21; incomplete: group 2, n = 25). Only patients with a septate uterus as the cause of infertility were included in the study. Patients' age, body mass, duration of infertility, type of infertility, duration of surgery, surgical complications, remnant septa, and postoperative reproductive results were recorded. RESULTS Preoperative abortion was found to be nine (42.9%) in group 1 and 15 (60.0%) in group 2. In the postoperative control HSG, remnant septa was found to be significantly higher in group 1 compared to group 2 (three patients or 14.3% and 0%, respectively). Pregnancy was detected in 13 patients (61.9%) in group 1 and 18 patients (72%) in group 2 at the postsurgical follow-up. Abortion occurred for two patients (9.5%) in group 1 and three patients (12%) in group 2. CONCLUSION We obtained positive growth results after hysteroscopic septum resection in both the complete and incomplete cases. However, we found that the duration of surgery was prolonged and the rate of remnant septa increased in cases with a complete septum.
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Affiliation(s)
- Selamı Erdem
- Department of Gynecology and Obstetrics, Sultan Hastanesi, Diyarbakir, Turkey
| | - İhsan Baglı
- Department of Gynecology and Obstetrics, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Serhat Ege
- Department of Gynecology and Obstetrics, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Edıp Aydın
- Department of Gynecology and Obstetrics, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Cagdas Ozgokce
- Department of Gynecology and Obstetrics, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Irfan Kulahcıoglu
- Department of Gynecology and Obstetrics, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
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Al Najar MS, Al Ryalat NT, Sadaqah JS, Husami RY, Alzoubi KH. MRI Evaluation of Mullerian Duct Anomalies: Practical Classification by the New ASRM System. J Multidiscip Healthc 2022; 15:2579-2589. [PMID: 36388626 PMCID: PMC9659481 DOI: 10.2147/jmdh.s386936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Objective To describe variable mullerian duct anomalies using magnetic resonance imaging (MRI) and to classify these anomalies according to the available classification systems, namely the American Fertility Society (AFS) system, the European Society of Human Reproduction and Embryology (ESHRE) system, and the new American Society for Reproductive Medicine (ASRM) system. Design Retrospective chart review. Subjects The pelvic MRI studies and the clinical records of 64 females with mullerian congenital anomalies were retrospectively reviewed between January 2010 and December 2021. The mean age was 22 years (age range 2–63 years). Main Outcome Measures Detailed imaging findings were recorded, and the resulting mullerian anomalies were then classified according to the three classification systems of interest. Results Variable mullerian anomalies were found among patients with multiple frequencies. Mullerian agenesis and hypoplasia were found in 12 patients (19%) and 16 patients (25%), respectively. Uterus didelphys was found in 5 patients (8%). Twelve (19%) patients had septate uterus, while 8 (12.5%) had a bicornuate anomaly. Unicornuate uterus was present in 7 patients (11%). Isolated vaginal anomaly was diagnosed in 4 patients (6%). Renal/urinary tract imaging was available for 27 (42%) patients, and accompanying urinary tract anomalies were noted in 10 of them (37%). Few ovarian and other extra-renal anomalies were observed. Conclusion MRI could efficiently delineate the mullerian anomalies regardless of their complexity. Most of these anomalies were more efficaciously categorized by the ESHRE and the new ASRM systems, compared to the originally widely used AFS system. The new ASRM classification was found to be more practical as it is a modification of the original AFS system, using drawings with clear descriptions instead of symbols. This is particularly helpful in the radiological era, saving time and effort.
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Affiliation(s)
- Mahasen S Al Najar
- Department of Diagnostic Radiology, The University of Jordan Hospital, Amman, Jordan
| | - Nosaiba T Al Ryalat
- Department of Diagnostic Radiology, The University of Jordan Hospital, Amman, Jordan
| | - Jaffer S Sadaqah
- Department of Diagnostic Radiology, The University of Jordan Hospital, Amman, Jordan
| | - Rawand Y Husami
- Department of Diagnostic Radiology, The University of Jordan Hospital, Amman, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Dilbaz B, Mert SA, Diktas EG, Kose C, Ustun YE. The effect of hysteroscopic metroplasty on fertility in T-shaped and Y-shaped dysmorphic uterus. EUR J CONTRACEP REPR 2022; 27:384-389. [PMID: 35727192 DOI: 10.1080/13625187.2022.2085681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE T/Y-shaped dysmorphic uterus is frequently associated with subfertility, abortion, preterm delivery, and recurrent implantation failure. In this study, the impact of hysteroscopic metroplasty for a T/Y-shaped uterus on obstetric outcomes was investigated in patients with infertility and recurrent pregnancy loss (RPL) and compared the uterine anomaly subgroups. METHOD Cases with infertility and/or RPL diagnosed with T/Y-shaped uterus by hysterosalpingography (HSG) and 3D transvaginal ultrasonography (3D TVUSG) with no other male or female pathology have recruited the study. Medical history and the obstetric outcome after two years of follow-up were recorded. RESULTS Out of the 92 cases recruited, T-shaped uteri (Group-1) were observed in 30, while 62 (67.3%) patients had Y-shaped uteri. Pregnancy was achieved in 50 (54.3%) of the cases, 28 (56%) of the pregnancies occurred spontaneously, and in 22 (44%) pregnancy was achieved through assisted reproductive techniques (ART). Term delivery occurred in 29 (76.3%) of the pregnancies while 9 (23.6%) had preterm deliveries and a total of 38 (76%) resulted in a live birth. Out of the 31 patients with previous RPL history, 13 (41.9%) achieved pregnancy and 11 out of 13 (84.6%) had a term pregnancy followed by live birth. CONCLUSION Spontaneous pregnancy, and term pregnancy rates after surgery were found to be promising in these uterine anomalies. The pregnancy outcome of the primary infertile patients was found the same in two groups (50%-46.1%), but the results of the RPL patients were found to be better in the T-shaped group than in the Y-shaped group (70%-28.5%).
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Affiliation(s)
- Berna Dilbaz
- Department of Reproductive Endocrinology and IVF, University of Health Sciences, Etlik Zubeyde Hanim Women's Health, Training and Research Hospital, Ankara, Turkey
| | - Sule Atalay Mert
- Department of Reproductive Endocrinology and IVF, University of Health Sciences, Etlik Zubeyde Hanim Women's Health, Training and Research Hospital, Ankara, Turkey
| | - Elif Gülsah Diktas
- Department of Reproductive Endocrinology and IVF, University of Health Sciences, Etlik Zubeyde Hanim Women's Health, Training and Research Hospital, Ankara, Turkey
| | - Caner Kose
- Department of Reproductive Endocrinology and IVF, University of Health Sciences, Etlik Zubeyde Hanim Women's Health, Training and Research Hospital, Ankara, Turkey
| | - Yaprak Engin Ustun
- Department of Reproductive Endocrinology and IVF, University of Health Sciences, Etlik Zubeyde Hanim Women's Health, Training and Research Hospital, Ankara, Turkey
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Sotiriou S, Satra M, Samara A, Vamvakopoulou D, Simou A, Tzelepis K, Skentou H, Vamvakopoulos N, Garas A. Maternal serum pregnancy-associated plasma protein-A concentration at 11-14 weeks of gestation and preeclampsia risk of women with common congenital anatomic uterine abnormalities. J OBSTET GYNAECOL 2022; 42:1711-1714. [PMID: 35164639 DOI: 10.1080/01443615.2022.2031930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To evaluate maternal serum pregnancy-associated plasma protein-A (PAPP-A) levels at 11-14 weeks of gestation and preeclampsia risk in women with common congenital anatomic uterine abnormalities (AUAs). First trimester screening markers were compared between 12 AUA pregnancies, 60 age matched controls and 12 cases of early preeclampsia. PAPP-A level and birth weight were significantly lower in AUA compared to control and early preeclampsia group (p<.001). Preeclampsia was absent in the AUAs pregnancies group. Birth weight were similar in AUA group when we compared AUA and control group regarding weeks of gestation at delivery and lower but not significantly, when we compared AUA and early preeclampsia group. Our findings suggest that AUA pregnancies are associated with low first trimester maternal serum PAPP-A concentrations not predictive of susceptibility to preeclampsia.Impact statementWhat is already known on this subject? During first trimester screening for preeclampsia based on maternal pregnancy-associated plasma protein A (PAPP-A) levels, various parameters are used, such as the somatometric characteristics of pregnant woman, single or multiple pregnancy, smoking status, family history, diabetes, hypertension and measurement of blood pressure and uterine artery Dopplers.What do the results of this study add? Our pioneer study revealed that there is drastic difference in PAPP-A concentration in women with common anatomic uterine abnormalities (AUAs), in comparison with their age matched control women with normal uterus.What are the implications of these findings for clinical practice and further research? Based on our results, uterine anatomical deviations, is another factor which must be taken in account for preeclampsia risk calculation and further clinical consultation and follow up in those pregnancies. Lower PAPP-A levels in AUA cases is a weak predictor of susceptibility to preeclampsia and could be associated to smaller placental size rather than poor placentation and in future research the calculation of the uterine cavity functional dimension may lead to a more accurate clinical assessment.
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Affiliation(s)
- Sotirios Sotiriou
- Department of Embryology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Satra
- Department of Biology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athina Samara
- Department of Embryology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitra Vamvakopoulou
- Department of Pediatrics and Neonatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Aikaterinh Simou
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Tzelepis
- Department of Urology, Department of Urology, General Hospital of Nicaea-Piraeus, Greece
| | - Hara Skentou
- Department of Embryology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Nikolaos Vamvakopoulos
- Department of Biology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Antonios Garas
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Successful Vaginal Delivery after External Cephalic Version in a Woman with a Large Partial Uterine Septum. Case Rep Obstet Gynecol 2021; 2021:9912271. [PMID: 34104501 PMCID: PMC8159644 DOI: 10.1155/2021/9912271] [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: 03/12/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/03/2022] Open
Abstract
Septate uteri have been associated with adverse pregnancy outcomes including spontaneous abortion, preterm delivery, and malpresentation. It is unclear if uterine septa are associated with infertility. Although some studies have shown improved pregnancy outcomes after septum resection, indications for resection are not well established. We describe a case of a woman with a large partial uterine septum diagnosed during workup for infertility who conceived without septum resection. Both of her subsequent pregnancies were initially breech presentations for which the patient underwent external cephalic version followed by full-term vaginal deliveries. This case adds evidence that an unresected uterine septum should not be considered a contraindication to external cephalic version.
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Jansa V, Laganà AS, Ferrari F, Ghezzi F, Burnik Papler T, Vrtacnik Bokal E, Ban Frangež H. Uterine rupture in pregnancy after hysteroscopic septum resection: a 20-year retrospective analysis. MINIM INVASIV THER 2020; 31:448-455. [PMID: 33331203 DOI: 10.1080/13645706.2020.1837884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In this study, we reviewed the cases of uterine rupture in our setting, identified which of them had previously undergone hysteroscopic septum resection (HSR), and evaluated the main clinical characteristics for each case. MATERIAL AND METHODS We retrospectively analyzed (ClinicalTrial ID: NCT04449640) the delivery outcomes from the National Perinatal Information System of the National Institute of Public Health of the Republic of Slovenia of the last 20 years (1 January 1999 - 31 December 2019) and cross-linked the patients with surgical data from our electronic database. We collected baseline characteristics, surgical details and obstetrical outcomes. We excluded women who had undergone previous myomectomy or cesarean section (CS) and described the clinical course of each case since no statistical analysis was performed. RESULTS We found four patients who had uterine rupture in pregnancy after HSR. Median time to pregnancy was 17 months (range 1-60), all the women underwent CS and fetal-maternal outcomes were acceptable in half of the cases. Symptoms were nonspecific and included pain, fetal distress and vaginal bleeding. CONCLUSION Uterine rupture in pregnancy after a previous HSR is a very rare, but life-threatening event. Prompt diagnosis can ensure successful management and avoid adverse maternal-fetal outcomes.
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Affiliation(s)
- Vid Jansa
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Brescia, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Tanja Burnik Papler
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eda Vrtacnik Bokal
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Frishman GN. A septum is not always a septum: diagnosis and management of vaginal longitudinal septums via a video presentation. Fertil Steril 2020; 114:768. [PMID: 32854932 DOI: 10.1016/j.fertnstert.2020.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Gary N Frishman
- Division of Reproductive Endocrinlogy and Infertility, Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Dong W, Xia Y, Ren L, Zhao H, Wang CY, Yao HM, Xiao LD, Nian L, Zhang J, Yang Q, Zhang F, Wen Y, Dong MF, Feng Y. Analysis of postoperative pregnancy outcome in 180 women with congenital uterine malformation. Arch Med Sci 2020; 19:1011-1015. [PMID: 37560726 PMCID: PMC10408007 DOI: 10.5114/aoms.2020.97281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/18/2019] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION This study aims to explore the effects of combination of laparoscopy and hysteroscopy in pregnancy outcome in women diagnosed with congenital uterine malformation (CUM). The observation criteria include pregnancy rate, misdiagnosis rate, rate of spontaneous abortion and preterm birth rate. MATERIAL AND METHODS A total of 180 patients with congenital uterine malformation, who were treated in our hospital from January 2015 to June 2018, were enrolled in the study. Prior to hospitalization, all the patients had neither a history of genital tract surgery nor endocrine abnormalities, chromosomal abnormalities, immune abnormalities or other factors affecting pregnancy. Furthermore, the ovarian functions were normal, and there were no factors leading to infertility in the male partners. The diagnosis was mainly based on medical history, clinical manifestations, gynecological examinations, and ultrasonography including two-dimensional and three-dimensional ultrasonography, as well as hysterosalpingogram (HSG), magnetic resonance imaging (MRI), hysteroscopy, and/or laparoscopy or surgery. Patients were diagnosed and classified according to the Buttram classification. RESULTS Among these 180 patients, 37 patients were diagnosed with complete septate uterus, 96 patients had sub-septate uterus, 25 patients had unicornuate uterus, 11 patients were diagnosed with bicornuate uterus, and 11 patients had didelphic uterus. The total number of preoperative pregnancies was 112, including 106 spontaneous abortions, with an abortion rate of 94.64%, and 86 total postoperative pregnancies, among which spontaneous abortions occurred 11 times, with an abortion rate of 12.79%. The difference was statistically significant (p < 0.05). CONCLUSIONS Uterine malformation surgery can significantly improve the reproductive prognosis in patients with CUM.
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Affiliation(s)
- Wei Dong
- Department of Obstetrics and Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yue Xia
- Department of Gynecology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Li Ren
- Department of Obstetrics and Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Han Zhao
- Department of Obstetrics and Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Chun-Yan Wang
- Department of Gynecology, The Second People’s Hospital of Baoshan City, Baoshan, China
| | - Hui-Mei Yao
- Department of Obstetrics and Gynecology, Cangyuan Wa Autonomous County People’s Hospital, Cangyuan, China
| | | | - Lei Nian
- Department of Obstetrics and Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jie Zhang
- Department of Obstetrics and Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Qin Yang
- Department of Obstetrics and Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Fen Zhang
- Department of Gynecology, Kunming Maternal and Child Health Service Center, Kunming, China
| | - Yan Wen
- DALI University, Dali, China
| | | | - Yun Feng
- Department of Obstetrics and Gynecology, The First People’s Hospital of Yunnan Province, Kunming, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Jang Y, Kim Y. A case report of ectopic pregnancy arising in a unicornuate uterus, accompanied by the undescended tube and ovary with double inferior vena cava. Medicine (Baltimore) 2020; 99:e21105. [PMID: 32664132 PMCID: PMC7360228 DOI: 10.1097/md.0000000000021105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE The incidence of a unicornuate uterus is 0.2% to 0.3% of the whole population. A unicornuate uterus is closely associated with obstetrical complications such as early miscarriages, ectopic pregnancy, and malpresentation. PATIENT CONCERNS A 32-year-old patient developed a rare ectopic pregnancy arising at a distal, fimbriated end of the undescended fallopian tube. DIAGNOSES A transvaginal ultrasound scan revealed hemoperitoneum and no gestational sac in the uterine endometrium. A laparoscopic finding showed that high up in the right abdomen, just below the liver, an ectopic mass could be seen arising at a distal, fimbriated end of the fallopian tube, which was developed adjacent to the undescended right ectopic ovary. INTERVENTIONS After laparoscopic removal of the right salpinx, we removed it with a bag. OUTCOMES One day after the operation, she was discharged without problems. Postoperative hysterosalpingography showed the unicornuate uterus with patent left and some right salpinx. Magnetic resonance imaging revealed a unicornuate uterus, right ovary at the right inferior hepatic area, a bilateral normal kidney, and double inferior vena cava. LESSONS This is the first reported case of its type. It demonstrated that ectopic pregnancy may occur in the upper abdomen, not in the pelvic cavity, in uterine anomaly, and double inferior vena cava; hence, we must thoroughly check the whole abdominal cavity. Additional imaging tests are needed after treatment to see if there are any abnormalities.
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King AL, Pixton S, Lanzarone V. Uterine didelphys with dicavitary twin gestation: A case report. Case Rep Womens Health 2020; 27:e00199. [PMID: 32322536 PMCID: PMC7163069 DOI: 10.1016/j.crwh.2020.e00199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 11/01/2022] Open
Abstract
Uterine didelphys is a rare type of congenital uterine anomaly resulting from incomplete fusion of the paramesonephric ducts during embryogenesis. We report the case of a 27-year-old multiparous woman who presented with ovulation-induced dicavitary dichorionic diamniotic twins in known uterine didelphys. At 29 + 5 weeks of gestation, the patient had preterm prelabour rupture of membranes followed by threatened preterm labour in the right uterus only, which settled with tocolysis. The pregnancy continued for a further 9 days, at which time uterine tightenings returned and the right cervix was fully dilated, resulting in successful vaginal delivery of the first twin, leaving the placenta in situ. The left uterus and cervix remained quiescent for a further 24 h before contractions returned, resulting in emergency caesarean section, with the successful delivery of the second twin. As a rare phenomenon, there is sparse literature on the management of dicavitary twin gestation in uterine didelphys. This case report adds to the evidence for independent functioning of uteri and cervices in cases of uterine didelphys which may enable interval delivery delay in this cohort with known increased risk of preterm birth.
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Affiliation(s)
- Alison Laura King
- Department of Obstetrics and Gynaecology, Nepean Hospital, Penrith, Australia
| | - Sarah Pixton
- Department of Obstetrics and Gynaecology, Nepean Hospital, Penrith, Australia
| | - Valeria Lanzarone
- Department of Obstetrics and Gynaecology, Nepean Hospital, Penrith, Australia
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Replacement Hormone Therapy for Gender Dysphoria and Congenital Sexual Anomalies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1242:121-143. [PMID: 32406031 DOI: 10.1007/978-3-030-38474-6_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
What is it about sexuality that makes it such a burning matter since the dawn of mankind? Much was lost of humankind heritage because of society's attitude toward sex and gender, but we've made progress. Medical knowledge progressed incredibly and so did social and cultural norms. In these days, on most places on the planet, there is acceptance. Still, gender issues take a center stage, often inflaming the social and political milieu everywhere. So how informed and prepared is the medical community to deal with these issues? Aside from medical treatments, gender dysphoric patients need mental health and social support throughout life. Do we have enough guidelines for treatments that have life-long effects? Do we actually know all of those effects? There are many issues to consider, like fertility preservation, puberty suppression with its adverse effects, and not in the least, the effects of the hormonal therapy on the target tissues.
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Neal SA, Morin SJ, Werner MD, Gueye NA, Pirtea P, Scott RT, Goodman LR. Three-dimensional ultrasound diagnosis of T-shaped uterus is associated with adverse pregnancy outcomes after embryo transfer. Reprod Biomed Online 2019; 39:777-783. [DOI: 10.1016/j.rbmo.2019.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022]
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Claude Cyrille NN, Grégory A, Sandrine M, Étienne B, Junie M, Yves Bertrand KO, Jean-Marie K. Septate uterus with cervical duplication and longitudinal vaginal septum: A two case series. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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15
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Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, Spinder T, de Kruif JH, Bloemenkamp KWM, Jansen FW, Veersema S, Mulders AGMGJ, Thurkow AL, Hald K, Mohazzab A, Khalaf Y, Clark TJ, Farrugia M, van Vliet HA, Stephenson MS, van der Veen F, van Wely M, Mol BWJ, Goddijn M. The randomised uterine septum transsection trial (TRUST): design and protocol. BMC WOMENS HEALTH 2018; 18:163. [PMID: 30290803 PMCID: PMC6173848 DOI: 10.1186/s12905-018-0637-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/23/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND A septate uterus is a uterine anomaly that may affect reproductive outcome, and is associated with an increased risk for miscarriage, subfertility and preterm birth. Resection of the septum is subject of debate. There is no convincing evidence concerning its effectiveness and safety. This study aims to assess whether hysteroscopic septum resection improves reproductive outcome in women with a septate uterus. METHODS/DESIGN A multi-centre randomised controlled trial comparing hysteroscopic septum resection and expectant management in women with recurrent miscarriage or subfertility and diagnosed with a septate uterus. The primary outcome is live birth, defined as the birth of a living foetus beyond 24 weeks of gestational age. Secondary outcomes are ongoing pregnancy, clinical pregnancy, miscarriage and complications following hysteroscopic septum resection. The analysis will be performed according to the intention to treat principle. Kaplan-Meier curves will be constructed, estimating the cumulative probability of conception leading to live birth rate over time. Based on retrospective studies, we anticipate an improvement of the live birth rate from 35% without surgery to 70% with surgery. To demonstrate this difference, 68 women need to be randomised. DISCUSSION Hysteroscopic septum resection is worldwide considered as a standard procedure in women with a septate uterus. Solid evidence for this recommendation is lacking and data from randomised trials is urgently needed. TRIAL REGISTRATION Dutch trial registry ( NTR1676 , 18th of February 2009).
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Affiliation(s)
- J F W Rikken
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - C R Kowalik
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - M H Emanuel
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - M Y Bongers
- Maxima Medical Centre, de Run 4600, 5504, DB, Veldhoven, The Netherlands
| | - T Spinder
- Leeuwarden Medical Centre, Henri Dunantweg 2, 8934, AD, Leeuwarden, the Netherlands
| | - J H de Kruif
- Canisius Wilhelmina Hospital, PO Box 9015, 6500, GS, Nijmegen, The Netherlands
| | - K W M Bloemenkamp
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - F W Jansen
- University Medical Centre Leiden, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - S Veersema
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - A G M G J Mulders
- Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - A L Thurkow
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - K Hald
- Oslo University Hospital, P. O. Box 4950, Nydalen, N-0424, Oslo, Norway
| | - A Mohazzab
- Avicenna research institute Teheran, PO Box: 19615-1177, Teheran, Postal code: 1936773493, Iran
| | - Y Khalaf
- Guy's hospital, Great maze pond, London, SE1 9RT, UK
| | - T J Clark
- Birmingham women's hospital, Mindelsohn Way, Birmingham, West Midlands, B15 2TG, UK
| | - M Farrugia
- East Kent Hospitals University, Ethelbert road, Canterbury, Kent, CT1 3NG, UK
| | - H A van Vliet
- Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - M S Stephenson
- University of Illinois Hospital, 1740 W Taylor St, Chicago, IL, 60612, USA
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - M Goddijn
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands.
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Ng'ang'a N, Ratzersdorfer J, Abdelhak Y. Vaginal birth after two previous caesarean deliveries in a patient with uterus didelphys and an interuterine septal defect. BMJ Case Rep 2017; 2017:bcr-2016-219149. [PMID: 28584004 PMCID: PMC5534647 DOI: 10.1136/bcr-2016-219149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 11/04/2022] Open
Abstract
Uterus didelphys is a congenital abnormality characterised by double uteri, double cervices and a double or single vagina that affects 0.3% to 11% of the general female population. A 23-year-old woman, gravida 3 para 3003, with uterus didelphys, acquired an iatrogenic interuterine septal defect during an otherwise routine primary caesarean delivery for fetal malpresentation. The defect was repaired but noted to have dehisced during her second pregnancy. A repeat caesarean section was performed due to fetal malpresentation after an unsuccessful external cephalic version. The dehisced defect was left unrepaired. During her third pregnancy, the placenta implanted in the right uterus, but the fetus migrated to the left uterus at approximately 28 weeks gestation. The umbilical cord traversed the interuterine septal defect. With the fetus in the vertex presentation at term gestation, the patient underwent a vaginal birth after two previous caesarean deliveries without any major perinatal complications.
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Affiliation(s)
- Njoki Ng'ang'a
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Jonathan Ratzersdorfer
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
- Maternal Resources, Hackensack, New Jersey, USA
| | - Yaakov Abdelhak
- Department of Obstetrics & Gynecology, Hackensack University Medical Center, Hackensack, New Jersey, USA
- Maternal Resources, Hackensack, New Jersey, USA
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17
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Kumar P, Mohan S, Talwar P, Rai S, Nagaraja N, Sharma P. Diagnostic Office Vaginohysteroscopy in Evaluation of Infertility Prior to IVF: A Retrospective Analysis of 1000 Cases. J Obstet Gynaecol India 2017; 67:275-281. [PMID: 28706367 DOI: 10.1007/s13224-017-0972-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022] Open
Abstract
AIM The aim of this study was to analyze the utility of routine use of diagnostic office vaginohysteroscopy in the evaluation of uterine cavity in infertility patients prior to IVF-ET. MATERIALS AND METHODS We conducted a retrospective analysis of 1000 women who had undergone routine diagnostic office vaginohysteroscopy as an institutional protocol in the evaluation of infertility prior to IVF-ET cycle at a tertiary care hospital. They were divided into two groups: primary infertility (group I) and secondary infertility (group II). The primary outcome was the finding of an abnormal uterine cavity (congenital abnormality vs acquired abnormality). RESULTS One thousand women underwent routine diagnostic office vaginohysteroscopy in the evaluation of infertility prior to IVF-ET. There were no intraoperative or postoperative complications. Vaginohysteroscopy revealed an abnormal uterine cavity in 13.8% (1000 patients) of women. Primary infertility group (I) had 13.19% (811 patients), and secondary infertility group (II) had 16.4% (189 patients) abnormal uterine cavities. CONCLUSION Diagnostic office vaginohysteroscopy has a definite role in the uterine cavity evaluation in infertility patients prior to IVF, but routine use should not be recommended considering the low incidence of abnormal uterine cavity findings. Moreover, the majority of these uterine cavity abnormalities can be detected by less invasive tests such as HSG, TVS, SSG and 3D ultrasound.
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Affiliation(s)
- Praveen Kumar
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Surender Mohan
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Pankaj Talwar
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Seema Rai
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - N Nagaraja
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
| | - Prashant Sharma
- ART Centre, Army Hospital (Research & Referral), Delhi Cantt, India
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18
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Diagnostic imaging and cataloguing of female genital malformations. Insights Imaging 2016; 7:713-26. [PMID: 27507534 PMCID: PMC5028344 DOI: 10.1007/s13244-016-0515-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/13/2016] [Accepted: 07/20/2016] [Indexed: 11/27/2022] Open
Abstract
Abstract To help physicians and radiologists in the diagnosis of female genito-urinary malformations, especially of complex cases, the embryology of the female genital tract, the basis for Müllerian development anomalies, the current classifications for such anomalies and the comparison for inclusion and cataloguing of female genital malformations are briefly reviewed. The use of the embryological system to catalogue female genito-urinary malformations may ultimately be more useful in correlations with clinical presentations and in helping with the appropriate diagnosis and treatment. Diagnostic imaging of the different genito-urinary anomalies are exposed, placing particular emphasis on the anomalies within group II of the embryological and clinical classification (distal mesonephric anomalies), all of them associated with unilateral renal agenesis or dysplasia. Similarly, emphasis is placed on cases of cervico-vaginal agenesis, cavitated noncommunicated uterine horns, and cloacal and urogenital sinus anomalies and malformative combinations, all of them complex malformations. Diagnostic imaging for all these anomalies is essential. The best imaging tools and when to evaluate for other anomalies are also analysed in this review. Teaching points • The appropriate cataloguing of female genital malformations is controversial. • An embryological classification system suggests the best diagnosis and appropriate management. • The anomalies most frequently diagnosed incorrectly are the distal mesonephric anomalies (DMAs). • DMAs are associated with unilateral renal agenesis or renal dysplasia with ectopic ureter. • We analyse other complex malformations. Diagnostic imaging for these anomalies is essential.
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19
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Feteh VF, Dimala CA, Njim T, Fuka B. Post term pregnancy in a non-communicating rudimentary horn of a unicornuate uterus. BMC Res Notes 2016; 9:209. [PMID: 27067669 PMCID: PMC4827177 DOI: 10.1186/s13104-016-2013-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnancy in a rudimentary horn of a unicornuate uterus is rare in obstetrics and when it occurs, it seldom progresses to term as ruptures frequently occur before the third trimester. CASE HISTORY A 29 year old female, presented at 42 weeks 5 days complaining of absent foetal movements, with results of a self-prescribed ultrasound scan showing an "abdominal pregnancy with foetal demise". She was haemodynamically stable and there were no foetal heart tones. At laparotomy, a non-communicating rudimentary horn pregnancy (RHP) was discovered. The right horn and tube were resected, with delivery of a post term female stillbirth. There were no postoperative complications. CONCLUSION Rudimentary horn pregnancies are difficult to diagnose when advanced; especially in low-resource settings with suboptimal antenatal care. Maternal and foetal outcomes in RHPs are usually poor; RHPs should therefore be suspected in pregnancies with atypical ultrasonographic features and more investigations done to confirm the diagnosis in order to reduce the associated morbidity and mortality.
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Affiliation(s)
- Vitalis Fambombi Feteh
- Mboppi Baptist Hospital Douala, P.O Box 15161, Akwa/Douala, Douala, Cameroon. .,Health and Human Development (2HD) Research Group, Douala, Cameroon.
| | - Christian Akem Dimala
- Health and Human Development (2HD) Research Group, Douala, Cameroon.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tsi Njim
- Health and Human Development (2HD) Research Group, Douala, Cameroon.,Regional Hospital Bamenda, North West Region, Bamenda, Cameroon
| | - Bananga Fuka
- Mboppi Baptist Hospital Douala, P.O Box 15161, Akwa/Douala, Douala, Cameroon
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20
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Vale-Fernandes E, Monteiro C, Carvalho L, Serrano P. Congenital genitourinary malformation in a woman with three primary gynaecological tumours: synchronous findings never before described. BMJ Case Rep 2016; 2016:bcr-2015-213840. [PMID: 26929224 DOI: 10.1136/bcr-2015-213840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Carla Monteiro
- Department of Obstetrics and Gynaecology, Hospital de Braga, Braga, Portugal
| | - Luís Carvalho
- Department of Obstetrics and Gynaecology, Hospital de Braga, Braga, Portugal
| | - Paula Serrano
- Department of Obstetrics and Gynaecology, Hospital de Braga, Braga, Portugal
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21
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Nishida M, Otsubo Y, Arai Y, Ichikawa R, Sakanaka M. Difference in reproductive performance between two subtypes of bicornuate uterus. Arch Gynecol Obstet 2016; 293:1335-8. [PMID: 26894306 DOI: 10.1007/s00404-016-4047-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 02/09/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE We compared reproductive outcome in patients with two subtypes of bicornuate uterus who underwent a Strassmann metroplasty procedure. METHODS Eleven patients diagnosed using the R-AFS definition were divided into partial and complete type, then reproductive outcome following a Strassmann metroplasty was evaluated. RESULTS All four patients with the partial type anomaly conceived and achieved a live birth, while none of the seven with the complete type anomaly were able to conceive. CONCLUSION Patients with the partial type of bicornuate uterus showed a favorable prognosis after a Strassmann metroplasty. Conversely, those with the complete type should be treated as uterus didelphis, and not undergo a metroplasty.
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Affiliation(s)
- Masato Nishida
- Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, 2-7-14 Shimotakatsu, Tsuchiura, Ibaraki, 300-8585, Japan.
| | - Yasuo Otsubo
- Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, 2-7-14 Shimotakatsu, Tsuchiura, Ibaraki, 300-8585, Japan
| | - Yuko Arai
- Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, 2-7-14 Shimotakatsu, Tsuchiura, Ibaraki, 300-8585, Japan
| | - Ryota Ichikawa
- Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, 2-7-14 Shimotakatsu, Tsuchiura, Ibaraki, 300-8585, Japan
| | - Miyako Sakanaka
- Department of Obstetrics and Gynecology, National Hospital Organization, Kasumigaura Medical Center, 2-7-14 Shimotakatsu, Tsuchiura, Ibaraki, 300-8585, Japan
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22
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Louden ED, Awonuga AO, Gago LA, Singh M. Rare Müllerian Anomaly: Complete Septate Uterus with Simultaneous Longitudinal and Transverse Vaginal Septa. J Pediatr Adolesc Gynecol 2015; 28:e189-91. [PMID: 26376072 DOI: 10.1016/j.jpag.2015.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND We present a patient with primary amenorrhea and a rare combination of anomalies. She was found to have a septate uterus, double cervix, and a longitudinal and a low transverse vaginal septum. CASE An 18-year-old girl with primary amenorrhea presented with severe monthly pelvic pain. Examination and imaging revealed a thin transverse vaginal septum, complete septate uterus, double cervix, and a longitudinal vaginal septum. The transverse and longitudinal vaginal septa were excised and repaired. SUMMARY AND CONCLUSION Although repetitive pregnancy loss and preterm birth are associated with various Müllerian duct anomalies, clinicians should also be suspicious of the presented anomaly in cases of primary amenorrhea and cyclic pelvic pain. To our knowledge, this is the only case of simultaneous septate uterus with longitudinal and transverse vaginal septum and the second case of combined longitudinal and transverse septum, which caused primary amenorrhea. This rare anomaly further supports the bidirectional regression theory of Müllerian development.
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Affiliation(s)
- Erica D Louden
- Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan.
| | - Awoniyi O Awonuga
- Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan
| | | | - Manvinder Singh
- Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan
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23
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Acién P, Acién M. The presentation and management of complex female genital malformations. Hum Reprod Update 2015; 22:48-69. [DOI: 10.1093/humupd/dmv048] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/14/2015] [Indexed: 11/13/2022] Open
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24
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Ludwin A, Ludwin I, Kudla M, Kottner J. Reliability of the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy and American Society for Reproductive Medicine classification systems for congenital uterine anomalies detected using three-dimensional ultrasonography. Fertil Steril 2015; 104:688-97.e8. [DOI: 10.1016/j.fertnstert.2015.06.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 11/27/2022]
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25
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Ludwin A, Ludwin I. Comparison of the ESHRE-ESGE and ASRM classifications of Müllerian duct anomalies in everyday practice. Hum Reprod 2014; 30:569-80. [PMID: 25534461 PMCID: PMC4325671 DOI: 10.1093/humrep/deu344] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY QUESTION Does the European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy (ESHRE–ESGE) classification of female genital tract malformations significantly increase the frequency of septate uterus diagnosis relative to the American Society for Reproductive Medicine (ASRM) classification? SUMMARY ANSWER Use of the ESHRE–ESGE classification, compared with the ASRM classification, significantly increased the frequency of septate uterus recognition. WHAT IS KNOWN ALREADY The ESHRE–ESGE criteria were supposed to eliminate the subjective diagnoses of septate uterus by the ASRM criteria and replace the complementary absolute morphometric criteria. However, the clinical value of the ESHRE–ESGE classification in daily practice is difficult to appreciate. The application of the ESHRE–ESGE criteria has resulted in a significantly increased recognition of residual septum after hysteroscopic metroplasty, with a possible risk of overdiagnosis of septate uterus and problems for its management. STUDY DESIGN, SIZE, AND DURATION A prospective observational study was performed with 261 women consecutively enrolled between June and September 2013. PARTICIPANTS/MATERIALS, SETTING, AND METHODS Non-pregnant women of reproductive age presented for evaluation to a private medical center. A gynecological examination and 3D ultrasonography were performed to assess the anatomy of the uterus, cervix and vagina. Congenital anomalies were diagnosed using the ASRM classification with additional morphometric criteria as well as with the ESHRE–ESGE classification. We compared the frequency and concordance of diagnoses of septate uterus and all congenital malformations of the uterus according to both classifications. The morphological characteristics of septate uterus recognized by both criteria were compared. MAIN RESULTS AND ROLE OF CHANCE Of the 261 patients enrolled in this study, septate uterus was diagnosed in 44 (16.9%) and 16 (6.1%) patients using the ESGE–ESHRE and ASRM criteria, respectively [relative risk (RR)ESHRE–ESGE:ASRM 2.74; 95% confidence interval (CI), 1.6–4.72; P < 0.01]. At least one congenital anomaly were diagnosed in 58 (22.2%) and 43 (16.5%) patients using the ESHRE–ESGE and ASRM classifications (RRESHRE–ESGE:ASRM, 1.35; 95% CI, 0.95–1.92, P = 0.1), respectively. The two criteria had moderate strength of agreement in the diagnosis of septate uterus (κ = 0.45, P < 0.01). There was good agreement in differentiation between anomaly and norm between the two assessment criteria (κ = 0.79, P < 0.01). The percentages of all congenital malformations and results of the differentiation between the anomaly and norm were obtained after excluding the confounding original ESHRE–ESGE criterion of dysmorphic uterus (internal indentation <50% uterine wall thickness). The morphology of septa identified by the ESHRE–ESGE [length of internal fundal indentation (mm): median 10.7; lower–upper quartile, 8.1–20] significantly differed (P < 0.01) from that identified by the ASRM criteria [length of internal fundal indentation (mm): median, 21.1; lower–upper quartile, 18.8–33.1]. Internal fundal indentation in 16 out of 44 (36.4%) cases was <1 cm in the septate uterus by ESHRE–ESGE and met the criteria for normal uterus by ASRM. LIMITATIONS AND REASONS FOR CAUTION The study participants were women who visited a diagnostic and treatment center specialized in uterine congenital malformations for a medical assessment, not from the general public. WIDER IMPLICATIONS OF THE FINDINGS Septate uterus diagnosis by ESHRE–ESGE was quantitatively dominated by morphological states corresponding to arcuate uterus or cases that were not diagnosed as congenital malformations by ASRM. Relative overdiagnosis of septate uterus by ESHRE–ESGE in these cases may lead to unnecessary overtreatment without the expected benefits. The ESHRE–ESGE classification criteria should be redefined due to confusions in the methodology. Until the criteria are revised, septate uterus should not be diagnosed using this classification system and it should not be used as an eligibility criterion for hysteroscopic metroplasty. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Jagiellonian University (grant no. K/ZDS/003821). The authors have no competing interests to declare.
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Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, ul. Kopernika 23, Krakow 31-501, Poland Ludwin & Ludwin Gynecology, Private Medical Center, Krakow 31-511, Poland
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, ul. Kopernika 23, Krakow 31-501, Poland Ludwin & Ludwin Gynecology, Private Medical Center, Krakow 31-511, Poland
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26
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Abstract
Uterine anomalies are one of the most common parental causes of recurrent pregnancy loss, occurring in about 19% of patients. Congenital uterine anomalies are most likely caused by HOX gene mutations, although the mechanism is probably polygenic. There are no known environmental causes other than estrogenic endocrine disruptors such as diethylstilbestrol. Acquired uterine anomalies may result from uterine trauma (adhesions) or benign growths of the myometrium (fibroids) or endometrium (polyps). Although randomized controlled trials are lacking, surgical treatment is recommended for repair of uterine septa, and for removal of severe adhesions and submucosal fibroids, especially if no other causes are identified.
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Affiliation(s)
- Carolyn R Jaslow
- Department of Biology, Rhodes College, 2000 North Parkway, Memphis, TN 38112, USA.
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27
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Takami M, Aoki S, Kurasawa K, Okuda M, Takahashi T, Hirahara F. A classification of congenital uterine anomalies predicting pregnancy outcomes. Acta Obstet Gynecol Scand 2014; 93:691-7. [DOI: 10.1111/aogs.12400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Mio Takami
- Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan
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28
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Ludwin A, Ludwin I, Pityński K, Banas T, Jach R. Role of morphologic characteristics of the uterine septum in the prediction and prevention of abnormal healing outcomes after hysteroscopic metroplasty. Hum Reprod 2014; 29:1420-31. [PMID: 24838703 PMCID: PMC4059338 DOI: 10.1093/humrep/deu110] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
STUDY QUESTION Can morphologic measurements (width, length and surface area) of the uterine septum predict healing-dependent abnormal anatomic results [ARs; residual septum (RS) and intrauterine adhesions in other locations (IUA-OLs)] after complete hysteroscopic metroplasty (HM)? SUMMARY ANSWER Significant predictors of ARs are the septal width and, to a lesser extent, septal surface area. WHAT IS KNOWN ALREADY Anatomic results after hysteroscopic metroplasty have very large variation. A RS >1 cm and IUA-OLs can aggravate reproductive outcomes, resulting in the need for reoperation. New criteria for diagnosing a uterine septum according to the European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE) have been suggested (ESHRE-ESGE criteria). Autocross-linked hyaluronic acid gel (autocross-linked polysaccharide) has an antiadhesive effect. STUDY DESIGN, SIZE, DURATION A prospective, observational cohort study was performed with 96 women consecutively enrolled between 2007 and 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who had uterine septum and previous miscarriage or infertility presented for evaluation at a university hospital, private hospital or private medical center were included. Preoperative septal width, length and surface area were determined with three-dimensional sonohysterography. Women were treated by hysteroscopy in a standardized manner with three- or four-dimensional transrectal ultrasound guidance (complete resection). Patients received either no adhesion barrier (49 patients) or adhesion barrier with autocross-linked polysaccharide (47 patients). Anatomic results were assessed with three-dimensional sonohysterography and second-look hysteroscopy. Healing-dependent ARs were reported using both American Society of Reproductive Medicine (ASRM) criterion of RS length >1 cm (ASRM>1 cm criterion) and ESHRE-ESGE criteria. Univariate and multivariate logistic regression were used to identify predictors of RS, IUA-OLs and ARs. MAIN RESULTS AND ROLE OF CHANCE In patients who had no adhesion barrier, ARs were diagnosed in 11 of 49 patients (23%) using the ASRM > 1 cm criterion and in 20 of 49 patients (41%) using the ESHRE-ESGE criteria for RS [odds ratio (OR)ESHRE-ESGE:ASRM, 2.4, P = 0.05]. In the patients who had autocross-linked polysaccharide, ARsASRM > 1 cm were diagnosed in 2 of 47 patients (4%) and ARsESHRE-ESGE in 4 of 47 patients (9%). RSESHRE-ESGE was diagnosed significantly more often than RSASRM > 1 cm 19 of 96 (20%) versus 5 of 96 (5%) in all patients (ORESHRE-ESGE:ASRM > 1 cm = 4.5, P < 0.01). In patients who had no adhesion barrier, logistic regression with ASRM > 1 cm and ESHRE-ESGE criteria showed that the width and surface area were predictors of ARs. Models adjusted by patient group confirmed the significance of width as a predictor of ARsASRM > 1 cm [OR for width, 3.5 (P < 0.01); OR for group, 0.22 (P < 0.01)], width as a predictor of ARsESHRE-ESGE [OR for width, 2.2 (P < 0.01); OR for group, 0.26 (P < 0.01)] and surface area as a predictor of ARsASRM > 1 cm [OR for surface area, 1.5 (P < 0.01)]; OR for group, 0.32 (P < 0.01). In patients who had autocross-linked polysaccharide, these predictors were not significant. Receiver-operating characteristic curves showed cutoff values for ARsASRM > 1 cm (septal width, 3.42 cm; septal surface area, 4.68cm²) and ARsESHRE-ESGE (septal width, 3.42 cm; septal surface area, 3.51cm²). LIMITATIONS AND REASONS FOR CAUTION Patients were enrolled in the adhesion barrier group in a time-dependent, consecutive and non-randomized manner. WIDER IMPLICATIONS OF THE FINDINGS A wide septum and large surface area may be indications for adhesion barrier. The use of autocross-linked polysaccharide reduces the risk of ARs. The ESHRE-ESGE criteria may cause greater frequency of recognition of RS than the ASRM > 1 cm criterion, which could result in more frequent reoperations with use of the ESHRE-ESGE criteria, possibly without any significant effect on reproductive performance. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Jagiellonian University (grant no. K/ZDS/003821). The authors have no competing interest to declare.
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Affiliation(s)
- A. Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow31-501, Poland
- Centermed – Private Hospital and Clinic, Krakow31-530, Poland
- Ludwin & Ludwin Gynecology – Private Medical Centre, Krakow31-511, Poland
- Correspondence address. Tel: +48 12 424 8560; Fax: +48 12 424 8584; E-mail:
| | - I. Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow31-501, Poland
- Centermed – Private Hospital and Clinic, Krakow31-530, Poland
- Ludwin & Ludwin Gynecology – Private Medical Centre, Krakow31-511, Poland
| | - K. Pityński
- Department of Gynecology and Oncology, Jagiellonian University, Krakow31-501, Poland
| | - T. Banas
- Department of Gynecology and Oncology, Jagiellonian University, Krakow31-501, Poland
| | - R. Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow31-501, Poland
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Caserta D, Mallozzi M, Meldolesi C, Bianchi P, Moscarini M. Pregnancy in a unicornuate uterus: a case report. J Med Case Rep 2014; 8:130. [PMID: 24779751 PMCID: PMC4031931 DOI: 10.1186/1752-1947-8-130] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 02/18/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction A unicornuate uterus accounts for 2.4 to 13% of all Müllerian anomalies. A unicornuate uterus with a non-communicating rudimentary horn may be associated with gynecological and obstetric complications such as infertility, endometriosis, hematometra, urinary tract anomalies, abortions, and preterm deliveries. It has a poor reproductive outcome and pregnancy management is still unclear. Case presentation We report a case of a 26-year-old Caucasian woman presenting with a unicornuate uterus with a non-communicating rudimentary horn. The diagnosis of the anomaly was based on two-dimensional and three-dimensional sonography. The excision of her symptomatic rudimentary horn and her ipsilateral fallopian tube was performed laparoscopically. The growth of the fetus was normal. At 20 weeks’ pregnancy, her cervix started shortening and a tocolytic therapy was started. A cesarean delivery was successfully performed at 39 weeks and 4 days’ gestation. Conclusions Although the reproductive outcome of women with unicornuate uterus is poor, a successful pregnancy is possible. Routine excision of the rudimentary horn should be undertaken during non-pregnant state laparoscopically, and it would be necessary to screen such pregnancies for the development of intrauterine growth retardation with serial ultrasound assessments of the estimated fetal weight and the cervix length.
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Affiliation(s)
- Donatella Caserta
- Department of Gynecological-Obstetric and Urological Sciences, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-1039, Rome 00189, Italy.
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Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker SY, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann HH, Gianaroli L, Campo R. Reply: are the ESHRE/ESGE criteria of female genital anomalies for diagnosis of septate uterus appropriate? Hum Reprod 2014; 29:868-9. [PMID: 24480715 DOI: 10.1093/humrep/deu002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G F Grimbizis
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsgvest 43/0001, 3000 Leuven, Belgium
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Martínez-Escoriza JC, Palacios-Marqués A, Oliva-García AB, Ballester-Galiana H. Uterine duplicity without communication between both hemiuteri and cervicovaginal atresia: importance of a thorough diagnosis before treatment. BMJ Case Rep 2013; 2013:bcr-2013-200923. [PMID: 24081597 DOI: 10.1136/bcr-2013-200923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The study described diagnostic and therapeutic processes for an exceptional congenital female genital anomaly involving a 15-year-old girl with progressive dysmenorrhoea and intense abdominal pain, and analyses pathogenesis of embryological anomalies associated with uterine duplicity (UD). Diagnostic methodology is analysed; treatment is described; and recommendations are provided. For the study of anomalies such as UD, we recommend the use of an ultrasound, vaginoscopy, MRI and laparoscopy imaging. Keeping in mind that hemihysterectomy should only be performed in cases with endometriosis or other unusual circumstances, surgical treatment should be avoided. A complete study based on gynaecological examination and ultrasound should be performed in adolescents with severe and progressive dysmenorrhoea. Based on the findings, imaging tests such as MRI and, if necessary, laparoscopy coinciding with menstruation, should be conducted before opting for surgical treatment.
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Al-Safi ZA, Russ PD, Post MD, Polotsky AJ. Adenomyosis within a uterine septum in a patient with secondary infertility. Gynecol Endocrinol 2013; 29:804-6. [PMID: 23741967 DOI: 10.3109/09513590.2013.801445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adenomyosis is a benign infiltration of endometrial stroma and glands into the myometrium. Until the advent and advancement of imaging techniques such as transvaginal ultrasound scan (TVUS) and magnetic resonance imaging (MRI), the diagnosis of adenomyosis could only be made with confidence using histology following hysterectomy. CASE The patient is a 37-year-old woman, with a long history of secondary infertility. A hysterosalpingogram (HSG) and a pelvic MRI showed two separate uterine cavities. The patient underwent laparoscopy and hysteroscopy revealing a bicornuate appearance of the uterus and a uterine septum. Resection of the septum showed adenomyosis on histologic examination. COMMENT Adenomyosis of uterine septum should be considered if MRI shows features of adenomyosis elsewhere in the uterus with thickened junctional zone. Further research is needed to investigate this association with the pathogenesis of adenomyosis.
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Affiliation(s)
- Zain A Al-Safi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Colorado Denver, Aurora, CO 80045, USA.
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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: 385] [Impact Index Per Article: 35.0] [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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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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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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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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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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Campo R, Van Belle Y, Grimbizis G. We may not have it all together, but together we have it all. The importance of intra- and interdisciplinary collaboration. Facts Views Vis Obgyn 2013; 5:33-43. [PMID: 24753950 PMCID: PMC3987375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The tremendous development of knowledge, the accumulation of clinical experience, and the enriching of everyday practice with the results of basic and clinical research created the need for splitting medicine in specialities and sub-specialities. Although this evolution is inevitable in order to meet the complex needs and demands of patients, we have to be aware of the risk of neglecting the holistic approach of a person in distress. Indeed, the organ-focused and pathology-centred approach of a patient may not exempt us of the rudiments of care such as the notion that a human being is more than the sum of its parts. This involves the absolute obligation for intra and inter-disciplinary cooperation. Recently, the European leading societies in Gynaecology, the European Board Obstetricians and Gynaecologists (EBCOG), the European Society of Human reproduction and Embryology (ESHRE), the European Society for Gynaecological Endoscopy (ESGE) and the European Academy for Gynaecological Surgery (+he Academy), have established some common impressive initiatives to improve women's health care. As a result of an intensive research programme coordinated by +he Academy with a multidisciplinary team of gynaecologists and surgeons a unique structured training and certification programme in endoscopic surgery is established. This project is a fine example making the dream of multidisciplinary approach reality and achieving some most impressive results. It is without any doubt a major step forwards in the improvement of the quality -assurance in endoscopic surgery in benefit of the patients care and has been accepted by our leading European and national societies. Recently, ESGE and ESHRE developed a new classification on female genital anomalies. An evidence-based -updated new classification published in the official journal of both societies was the ended result. THIS CREATIVE, SUCCESSFUL AND UNEVENTFUL COLLABORATION UNDERLINES THE NEED FOR RESPECTING SOME CRUCIAL POINTS: to clearly outline the topic of common action, to find the working platform, to define the method and to respect -independence of each society by clarifying the borders and the responsibilities. Keeping the window of the collaboration open is crucial for keeping the window to medicine of the future unlocked.
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Affiliation(s)
- R. Campo
- European Academy for Gynecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium.
| | - Y. Van Belle
- European Academy for Gynecological Surgery, Diestsevest 43/0001, 3000 Leuven, Belgium.
| | - G. Grimbizis
- 21st Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” General Hospital, Ring Road, N.Efkarpia, 54603, Thessaloniki, Greece.
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