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Qi J, Zhou P, Peng H, Deng J, Shao Y, Ye L, Luo S. Clinical and Imaging Characteristics of Herlyn-Werner-Wunderlich Syndrome: a Comprehensive Analysis. Reprod Sci 2024:10.1007/s43032-024-01628-2. [PMID: 38907127 DOI: 10.1007/s43032-024-01628-2] [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: 02/02/2024] [Accepted: 06/16/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE To describe the clinical and imaging characteristics of Herlyn-Werner-Wunderlich syndrome (HWWS). METHODS This study presented an observational case series involving consecutive patients diagnosed with HWWS, whose medical records were retrospectively reviewed. From June 2012 to December 2022, there were a total of 85 patients with HWWS enrolled in our study. We obtained the medical history, including demographic characteristics, clinical presentation, treatment, complications, and radiologic examinations performed. Patients > 18 years of age (n = 58) were recontacted. RESULT In our analysis, 27 patients were categorised as having complete obstruction, and 58 were categorised as having incomplete obstruction. The mean age at the onset of symptoms and diagnosis of complete obstruction was significantly younger than incomplete obstruction (P < 0.05). For complete obstruction, the median time between menarche and the onset of symptoms was 2.1 years, while for incomplete obstruction, it was 5.3 years. There was a significantly lower incidence of intermittent mucopurulent discharge, irregular vaginal haemorrhage, and occasional examination findings of complete obstruction than incomplete obstruction (P < 0.05). Complete obstruction was significantly associated with dysmenorrhea and pelvic endometriosis compared with incomplete obstruction (P < 0.05). CONCLUSIONS There are distinct clinical differences between patients with complete obstruction of the hemivagina and those with incomplete obstruction. HWWS can manifest as various combinations of uterine anomalies, communications anomalies, and renal anomalies. Early recognition and treatment can avoid complications and preserve fertility. KEYSWORDS Herlyn-Werner-Wunderlich syndrome (HWWS); complete obstruction; incomplete obstruction; obstructed hemivagina; congenital malformation.
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Affiliation(s)
- Jiani Qi
- Department of Ultrasonography, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ping Zhou
- Department of Ultrasonography, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hong Peng
- Department of Ultrasonography, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Jin Deng
- Department of Ultrasonography, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yang Shao
- Department of Ultrasonography, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lingjuan Ye
- Department of Ultrasonography, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Shengjuan Luo
- Department of Ultrasonography, The Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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Mert SA, Dilbaz B, Akpinar F, Diktas EG, Kinay T, Ensari T, Tekin OM. Evaluation of the Success of Hysteroscopic Uterine Septum Resection. Gynecol Minim Invasive Ther 2023; 12:230-235. [PMID: 38034112 PMCID: PMC10683958 DOI: 10.4103/gmit.gmit_131_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes. Materials and Methods Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period. Results Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (P < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (P < 0.05). Conclusion Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.
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Affiliation(s)
- Sule Atalay Mert
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Berna Dilbaz
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Funda Akpinar
- Gynecology and Obstetrics Clinic, Ankara Training and Research Hospital, Ankara, Turkey
| | - Elif Gulsah Diktas
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tugba Kinay
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tugba Ensari
- Gynecology and Obstetrics Clinic, Ankara City Hospital, Ankara, Turkey
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Alalfy M, Osman OM, Salama S, Lasheen Y, Soliman M, Fikry M, Ramadan M, Alaa D, Elshemy S, Abdella R. Evaluation of the Cesarean Scar Niche In Women With Secondary Infertility Undergoing ICSI Using 2D Sonohysterography Versus 3D Sonohysterography and Setting a Standard Criteria; Alalfy Simple Rules for Scar Assessment by Ultrasound To Prevent Health Problems for Women. Int J Womens Health 2020; 12:965-974. [PMID: 33177887 PMCID: PMC7650036 DOI: 10.2147/ijwh.s267691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background Many expressions were used to define the defect that is seen by ultrasound after cesarean section (CS) namely scar defect, niche, isthmocele, uterine pouch or diverticula. Objective To compare the accuracy of 2 dimensional sonohysterography (2D SHG) to 3 dimensional sonohysterography (3D SHG) in evaluating cesarean section uterine scar depth (D), base width (BW), width (W) and residual myometrial thickness (RMT) in women with secondary infertility and establishment of a standard criteria; Alalfy simple rules for scar assessment. Patients and Methods This was an observational cross-sectional comparative study that was conducted on women who presented with secondary infertility and were candidates for intracytoplasmic sperm injection (ICSI) and giving a history of a previous cesarean section. Assessment of uterine scar in each woman was performed using 2D transvaginal ultrasound with sonohysterography (SHG) followed by 3D transvaginal with SHG with evaluation of niche depth, width, RMT, niche BW and RMT/depth ratio. The study was conducted at Algezeera hospital, Egypt. Results The present study revealed that 3D ultrasound with SHG is superior in evaluation of the RMT and niche width prior to ICSI providing better characterization of the scar niche. Conclusion Scar niche should be assessed by a combined integrated 2D SHG and 3D SHG scan with the specific geometrical and anatomical considerations, Alalfy simple rules for scar niche assessment that involvemeasurement of niche depth, (Base width) BW, width, RMT and RMT/depth ratio in sagittal plane, RMT in coronal plane / niche width in coronal plane ratio (ratio less than 1 denotes scar weakness with more liability for dehiscence). Trial Registration Clinical Trials.gov Id NCT04076904.
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Affiliation(s)
- Mahmoud Alalfy
- Reproductive Health and Family Planning Department, National Research Centre, Dokki, Cairo, Egypt
| | - Omneya M Osman
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Sameh Salama
- Reproductive Health and Family Planning Department, National Research Centre, Dokki, Cairo, Egypt
| | - Yossra Lasheen
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Mahmoud Soliman
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Mohamed Fikry
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Mohamed Ramadan
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Doaaa Alaa
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Shaimaa Elshemy
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
| | - Rana Abdella
- Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, Egypt
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Isikoglu M. Arcuate Uterus: Does It Really Cause Pregnancy Loss? J Obstet Gynaecol India 2016; 66:6-9. [PMID: 26924900 DOI: 10.1007/s13224-016-0847-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/17/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Mete Isikoglu
- GELECEK The Center For Human Reproduction, Antalya, Turkey
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Amin TN, Saridogan E, Jurkovic D. Ultrasound and intrauterine adhesions: a novel structured approach to diagnosis and management. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:131-139. [PMID: 26094824 DOI: 10.1002/uog.14927] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 06/04/2023]
Affiliation(s)
- T N Amin
- Institute for Women's Health, University College London, London, UK
| | - E Saridogan
- Institute for Women's Health, University College London, London, UK
| | - D Jurkovic
- Institute for Women's Health, University College London, London, UK
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Abstract
BACKGROUND The nonobstructive group of anatomic variants involving the reproductive tract includes vaginal agenesis as well as the congenital anomalies of the vagina and uterus, occurring without pain during the pubertal years. OBJECTIVE The objective is to discuss the non-obstructive morphologic variations in anatomy of the uterus and vagina. DESIGN Systematic review using the GRADE system. RESULTS These congenital anomalies are not associated with abnormalities of the external genitalia and therefore may be missed on routine physical examination. When these anomalies do cause symptoms they may be as minor as difficulty with menstrual hygiene or more significant such as primary amenorrhea, dyspareunia, recurrent pregnancy loss, and reproductive complications. CONCLUSIONS Women with non-obstructive reproductive tract anomalies present at various ages due to the asymptomatic nature or late symptom onset of certain conditions. An MRI is the gold standard in evaluation of such conditions to aid in confirming the müllerian variant. Each condition requires careful counseling because obstetric and gynecologic risks and consequences may differ. Treatment is individualized in cases of uterovaginal agenesis with both nonsurgical and surgical options available for neovagina creation. In cases of uterine or vaginal septae, the treatment timing may vary depending on patient history. Finally, in cases of non-obstructive communicating uterine horns, the risk of ectopic pregnancy is high in the remnant horn. Should a pregnancy occur in this small underdeveloped horn, therefore, excision is recommended.
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Affiliation(s)
- Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of OBGYN, Baylor College of Medicine, Houston, TX
| | - Debra M Millar
- Department of OBGYN, University of British Columbia, Vancouver, BC
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Abo Dewan KAA, Hefeda MM, ElKholy DGE. Septate or bicornuate uterus: Accuracy of three-dimensional trans-vaginal ultrasonography and pelvic magnetic resonance imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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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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Servaes S, Epelman M. The Current State of Imaging Pediatric Genitourinary Anomalies and Abnormalities. Curr Probl Diagn Radiol 2013; 42:1-12. [DOI: 10.1067/j.cpradiol.2012.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Accuracy of Three-Dimensional Ultrasonography in Differential Diagnosis of Septate and Bicornuate Uterus Compared with Office Hysteroscopy and Pelvic Magnetic Resonance Imaging. J Minim Invasive Gynecol 2012; 19:101-6. [DOI: 10.1016/j.jmig.2011.08.724] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 11/19/2022]
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Management of congenital uterine abnormalities. Reprod Biomed Online 2011; 23:40-52. [DOI: 10.1016/j.rbmo.2011.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 02/07/2011] [Accepted: 02/10/2011] [Indexed: 11/21/2022]
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Jayaprakasan K, Chan YY, Sur S, Deb S, Clewes JS, Raine-Fenning NJ. Prevalence of uterine anomalies and their impact on early pregnancy in women conceiving after assisted reproduction treatment. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:727-732. [PMID: 21337662 DOI: 10.1002/uog.8968] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To estimate the prevalence of congenital uterine anomalies in subfertile women and to evaluate their influence on early pregnancy following assisted reproduction treatment (ART). METHODS We prospectively recruited 1402 subjects undergoing ART over a period of 5 years from 2005 to 2009. Three-dimensional transvaginal sonography was performed in the early follicular phase of the menstrual cycle (days 2-5) and repeated in the late follicular phase (days 10-14) if the shape of the uterine cavity could not be assessed at the first scan. All subjects who conceived following ART were followed up to 12 weeks' gestation. Chi-square test was used to compare the pregnancy rates and miscarriage rates between women shown to have uterine anomalies and those with a normal uterus. RESULTS One thousand three hundred and eighty-five subjects were included for final analysis after excluding 17 subjects in whom a definitive diagnosis could not be made. While 1201 (86.7%) subjects had a normal uterine cavity, uterine anomalies were demonstrated in 184 (13.3%) subjects. Arcuate uteri represented the commonest anomaly (n = 164 (11.8%)) followed by septate (n = 7 (0.5%)), unicornuate (n = 6 (0.4%)), subseptate (n = 5 (0.4%)), bicornuate (n = 1 (0.1%)) and T-shaped uteri (n = 1 (0.1%)). A total of 440 subjects who underwent ART were followed up. The pregnancy rates in women with arcuate uteri (36/66 (54.5%)) and major uterine anomalies (7/10 (70.0%)) were statistically similar (P = 0.09 and P = 0.11, respectively) to that of the matched controls with normal uteri (158/364 (43.4%)). While first-trimester miscarriage rates were similar (P = 0.81) between the control group (20/158 (12.7%)) and women with arcuate uteri (5/36 (13.9%)), women with major uterine anomalies experienced a higher miscarriage rate (3/7 (42.9%); P = 0.05). CONCLUSIONS Women who are referred for ART have a high prevalence of congenital uterine anomalies, the most common anomaly being an arcuate uterus. These anomalies are not associated with a reduction in pregnancy rates following ART. However, while the arcuate uterus was not associated with an increase in first-trimester miscarriage, major uterine anomalies seemed to increase the risk of first-trimester miscarriage.
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Affiliation(s)
- K Jayaprakasan
- Nottingham University Research and Treatment Unit in Reproduction, Division of Human Development, School of Clinical Sciences, University of Nottingham, Nottingham, UK.
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Combined hysteroscopic findings and 3-dimensional reconstructed coronal view of the uterus to avoid laparoscopic assessment for inpatient hysteroscopic metroplasty: pilot study. J Minim Invasive Gynecol 2011; 18:112-7. [PMID: 21195963 DOI: 10.1016/j.jmig.2010.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 09/10/2010] [Accepted: 09/16/2010] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To assess the use of 3-dimensional (3D) reconstructed coronal view of the uterus and intraoperative hysteroscopic findings to avoid diagnostic laparoscopy during inpatient hysteroscopic metroplasty. DESIGN Pilot study (Canadian Task Force classification II). SETTING University hospital infertility clinic. PATIENTS Fifty-nine patients with recurrent abortion and double uterine cavity with 3D sonographic diagnosis of septate uterus undergoing inpatient hysteroscopic metroplasty. INTERVENTIONS Inpatient hysteroscopic treatment of septate uterus without laparoscopic diagnosis. In addition to sonographic observations, 2 intraoperative hysteroscopic criteria were used to confirm the diagnosis: visualization of muscular fibers and myometrial blood vessels. MEASUREMENTS AND MAIN RESULTS Operative parameters (operative time and fluid absorption), complications (incomplete resection and uterine perforation), requirement for a second intervention, and shape of the uterine cavity at hysteroscopic follow-up. In 56 of 59 patients (94.9%), intervention was performed without complications, and in 3 cases, intervention was suspended because of intraoperative suspicion of bicornate uterus. These 3 patients underwent laparoscopy, which confirmed the diagnosis of septate uterus. In all cases, incision was considered sufficient. Postoperative diagnostic hysteroscopy in all patients showed a normal cavity (fundal notch <1 cm). CONCLUSIONS Combined use of hysteroscopic confirming criteria and 3D sonography seems to be a reliable and simple strategy for characterizing the presence of septate uterus and to perform inpatient metroplasty usually without laparoscopic visualization of the uterine fundus.
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Pundir J, Toukhy TE. Uterine Cavity Assessment Prior to IVF. WOMENS HEALTH 2010; 6:841-7; quiz 847-8. [DOI: 10.2217/whe.10.61] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Approximately 15% of couples are affected with subfertility, of which up to 20% remain unexplained. Uterine cavity abnormalities can be a contributing cause of subfertility and recurrent implantation failure. Uterine cavity assessment has been suggested as a routine investigation in the evaluation of subfertile women. Traditionally, hysterosalpingography has been the most commonly used technique in the evaluation of infertility. Transvaginal ultrasound scan allows visualization of the endometrial lining and cavity, and has been used as a screening test for the assessment of uterine cavity. Abnormal uterine findings on a baseline scan can be further evaluated with saline hysterosonography, which is highly sensitive and specific in identifying intrauterine abnormalities. Hysteroscopy is considered as the definitive diagnostic tool to evaluate any abnormality suspected on hysterosalpingography, transvaginal ultrasound scan or saline hysterosonography during routine investigation of infertile patients. Minimally invasive hysteroscopes have minimized the pain experienced by patients during the procedure and made it feasible to use hysteroscopy as a routine outpatient examination. Following recurrent IVF failure there is some evidence of benefit from hysteroscopy in increasing the chance of pregnancy in the subsequent IVF cycle, both in those with abnormal and normal hysteroscopic findings. Various possible mechanisms have been proposed for this beneficial effect, but more randomized controlled trials are needed before its routine use in the general subfertile population can be recommended.
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Hassan MAM, Lavery SA, Trew GH. Congenital uterine anomalies and their impact on fertility. ACTA ACUST UNITED AC 2010; 6:443-61. [PMID: 20426609 DOI: 10.2217/whe.10.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Congenital uterine anomalies are not uncommon. Many are asymptomatic and have been associated with normal and adverse reproductive outcomes. The interference of these anomalies with a patient's fertility is an interesting but still debatable issue, and the proper management of infertile women with many forms of these anomalies remains controversial. The current literature regarding the frequency and probable causes of infertility among women with congenital uterine anomalies is insufficient to allow any robust conclusions to be drawn. Diagnostic and selection bias, a lack of objective diagnostic criteria for the different anomaly types and heterogeneity of study designs have contributed to the conflicting results from different studies of the prevalence of these anomalies among the infertile and fertile populations. However, emerging evidence from recent literature suggests causal associations between these anomalies (particularly the septate uterus) and infertility, and demonstrates significant improvements in the fecundity of women with septate uteri and otherwise unexplained infertility after hysteroscopic metroplasty. This review provides a critical update of the state of knowledge regarding congenital uterine anomalies, our current understanding of their effect on fertility and discusses how they can be managed from the reproductive perspective.
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Caliskan E, Ozkan S, Cakiroglu Y, Sarisoy HT, Corakci A, Ozeren S. Diagnostic accuracy of real-time 3D sonography in the diagnosis of congenital Mullerian anomalies in high-risk patients with respect to the phase of the menstrual cycle. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:123-127. [PMID: 20091695 DOI: 10.1002/jcu.20662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To compare the diagnostic accuracy of 2-dimensional sonography (2DUS) and real-time 3-dimensional sonography (3DUS) in the diagnosis of congenital mullerian defects (CMD) with respect to the phase of the menstrual endometrium. METHOD The accuracy of sonography was examined on 108 women by 2 gynecologists during the 1st 5 days after cessation of menstrual flow and then re-examined at the cycle days 20-24. Entrance criteria for the patients enrolled in the study were as follows: women who were referred to our center with a suspected Mullerian anomaly at hysterosalpingography, and women who were suspected to have a uterine anomaly at our hospital during infertility, dysmenorrhea, and recurrent abortion workup. First, 1 of the gynecologists performed the 2DUS, and afterwards the 2nd gynecologist performed the real-time 3DUS. Results from both examiners were compared and correlated with the definitive diagnosis obtained by MRI, laparoscopy, or hysteroscopy. The sensitivity and specificity values of 2DUS and real-time 3DUS for the diagnosis of CMD were calculated at follicular and luteal phases. RESULT Among the 108 cases suspected to have CMD, the sensitivity and specificity values of real-time 3DUS were significantly higher in the follicular sensitivity, 94.7%, specificity, 75.0%, and luteal phases (sensitivity, 100%, specificity, 93.7%) when compared with 2DUS values (sensitivity of 30.2% and specificity of 78.1% in the follicular phase and sensitivity of 42.1% and specificity of 81.2% in the luteal phase). CONCLUSION Real-time 3DUS is an accurate method that can be used for the diagnosis of congenital mullerian defects.
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Affiliation(s)
- Eray Caliskan
- Department of Obstetrics and Gynecology, Kocaeli University School of Medicine, Umuttepe Kampusu, 41000, Uctepeler, Kocaeli, Turkey
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Saravelos SH, Cocksedge KA, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update 2008; 14:415-29. [PMID: 18539641 DOI: 10.1093/humupd/dmn018] [Citation(s) in RCA: 303] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence of congenital uterine anomalies in women with reproductive failure remains unclear, largely due to methodological bias. The aim of this review is to assess the diagnostic accuracy of different methodologies and estimate the prevalence of congenital uterine anomalies in women with infertility and recurrent miscarriage (RM). METHODS Studies from 1950 to 2007 were identified through a MEDLINE search; all relevant references were further reviewed. RESULTS The most accurate diagnostic procedures are combined hysteroscopy and laparoscopy, sonohysterography (SHG) and possibly three-dimensional ultrasound (3D US). Two-dimensional ultrasound (2D US) and hysterosalpingography (HSG) are less accurate and are thus inadequate for diagnostic purposes. Preliminary studies (n = 24) suggest magnetic resonance imaging (MRI) is a relatively sensitive tool. A critical analysis of studies suggests that the prevalence of congenital uterine anomalies is approximately 6.7% [95% confidence interval (CI), 6.0-7.4] in the general population, approximately 7.3% (95% CI, 6.7-7.9) in the infertile population and approximately 16.7% (95% CI, 14.8-18.6) in the RM population. The arcuate uterus is the commonest anomaly in the general and RM population. In contrast, the septate uterus is the commonest anomaly in the infertile population, suggesting a possible association. CONCLUSIONS Women with RM have a high prevalence of congenital uterine anomalies and should be thoroughly investigated. HSG and/or 2D US can be used as an initial screening tool. Combined hysteroscopy and laparoscopy, SHG and 3D US can be used for a definitive diagnosis. The accuracy and practicality of MRI remains unclear.
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Affiliation(s)
- Sotirios H Saravelos
- Reproductive Medicine and Surgery Unit, University of Sheffield, Sheffield Teaching Hospitals, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK.
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Deutch TD, Abuhamad AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of müllerian duct anomalies: a review of the literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:413-423. [PMID: 18314520 DOI: 10.7863/jum.2008.27.3.413] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this article is to review the published literature and determine the roles that magnetic resonance imaging (MRI) and endovaginal 3-dimensional ultrasonography (3DUS) play in the diagnosis of müllerian duct anomalies (MDAs). METHODS A PubMed search was performed to identify all of the articles pertaining to the use of MRI or 3DUS for the evaluation or diagnosis of MDAs. Clinical studies, review articles, case reports, and descriptive studies were reviewed. RESULTS Magnetic resonance imaging and 3DUS are highly sensitive and specific in identifying women with MDAs. Magnetic resonance imaging is 100% to 28.6% sensitive and 100% to 66% specific in correctly categorizing MDAs. Three-dimensional ultrasonography is 100% to 98% sensitive and 100% specific in correctly categorizing MDAs. CONCLUSIONS In experienced hands, both MRI and 3DUS are adequate modalities for identifying women with MDAs. There is a lack of studies comparing MRI with 3DUS for the diagnosis and categorization of MDAs. However, it seems likely that 3DUS is more sensitive and specific than MRI in categorizing specific types of MDAs. The high sensitivity and specificity of 3DUS make it an ideal tool for identifying women with MDAs that are amenable to hysteroscopic resection. Therefore, we believe that as practitioners become more experienced, 3DUS will emerge as the reference standard for the diagnosis of MDAs.
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Affiliation(s)
- Todd D Deutch
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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Leone FPG, Ferrazzi E. 3 simple diagnostic criteria (color of the cut tissue, vascularization, and sensitive innervation). J Minim Invasive Gynecol 2008; 15:123-5; author reply 125-6. [PMID: 18262162 DOI: 10.1016/j.jmig.2007.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 10/30/2007] [Indexed: 11/20/2022]
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A prospective evaluation of uterine abnormalities by saline infusion sonohysterography in 1,009 women with infertility or abnormal uterine bleeding. Fertil Steril 2006; 86:1731-5. [DOI: 10.1016/j.fertnstert.2006.05.044] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 05/12/2006] [Accepted: 05/12/2006] [Indexed: 11/15/2022]
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Valenzano MM, Mistrangelo E, Lijoi D, Fortunato T, Lantieri PB, Risso D, Costantini S, Ragni N. Transvaginal sonohysterographic evaluation of uterine malformations. Eur J Obstet Gynecol Reprod Biol 2006; 124:246-9. [PMID: 16129545 DOI: 10.1016/j.ejogrb.2005.06.041] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 12/23/2004] [Accepted: 06/14/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the diagnostic value and the usefulness of sonohysterography (SHG) in the detection of uterine anomalies, compared with other diagnostic methods. STUDY DESIGN From January 2002 to December 2003, we collected 54 patients with a history of primary or secondary infertility or repeated spontaneous abortion and with a clinically or sonographically suspected abnormal uterus. All patients had previously undergone hysterosalpingography (ISG). All patients were examined by standard transvaginal ultrasound. Sonohysterography was then carried out by the intrauterine injection of an isotonic saline solution. Suspected uterine anomalies were also confirmed by hysteroscopy (HS) and/or laparoscopy. RESULTS Sonohysterography was able to detect all the anomalies. The sensitivity and specificity of sonohysterography were the same as for hysteroscopy. However, there was no significant difference between the diagnostic capabilities of the methods analyzed. CONCLUSIONS Transvaginal sonohysterography with saline solution is a low-cost, easy, and helpful examination method for uterine malformations. We propose that sonohysterography should be performed for the primary investigation of infertility and repeated miscarriages.
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Affiliation(s)
- Mario Menada Valenzano
- Department of Obstetrics and Gynecology, Genova University, Largo Rosanna Benzi 10, 16132 Genova, Italy
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Amso NN, Griffiths A. The role and applications of ultrasound in ambulatory gynaecology. Best Pract Res Clin Obstet Gynaecol 2005; 19:693-711. [PMID: 16257581 DOI: 10.1016/j.bpobgyn.2005.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ultrasound has changed gynaecological practice and continues to do so. One of the earliest applications of abdominal scanning in gynaecology was for monitoring follicular development during fertility treatment with clomiphene citrate or gonadotrophins in the 1960s and 1970s. Subsequently, it was natural that with the introduction of in vitro fertilization, abdominal and transvaginal ultrasound played a key role in the development of oocyte retrieval techniques. These were truly the first interventional ultrasound-guided ambulatory procedures in gynaecology. In this chapter, the reader will be introduced to the roles that the various ultrasound modalities play in our current daily practice, and how they have changed the management of numerous gynaecological conditions in both diagnostic and therapeutic contexts. We will also outline the recent developments and the 'hot' research topics in this field.
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Affiliation(s)
- Nazar N Amso
- Department of Obstetrics & Gynaecology, Wales College of Medicine, Cardiff University, University Hospital of Wales, Heath Park, UK.
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