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Kadour Peero E, Badeghiesh A, Baghlaf H, Dahan MH. How do bicornuate uteri alter pregnancy, intra-partum and neonatal risks? A population based study of more than three million deliveries and more than 6000 bicornuate uteri. J Perinat Med 2023; 51:305-310. [PMID: 35946504 DOI: 10.1515/jpm-2022-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore maternal and neonatal outcomes in pregnant women with bicornuate uteri. METHODS Retrospective population-based cohort study utilizing data from the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2010 to 2014. There were 3,846,342 births between 2010 and 2014, included in the study. Six thousand and 195 deliveries were to women with bicornuate uterus. The remaining deliveries without other uterine anomalies were categorized as the reference group (n=3,840,147). RESULTS Pregnant women with bicornuate uterus were older and more likely to be obese (p=0.0001) with previous cesarean deliveries (CD) (31 vs. 17.1%, p=0.0001). After adjustment for confounders, they were more likely to experience pregnancy-induced hypertension (HTN) (aOR 1.21, 95%CI: 1.1-1.3), p=0.0001), preeclampsia (aOR 1.4, 95%CI: 1.2-1.6, p=0.0001) and placenta previa (aOR 1.7, 95%CI: 1.3-2.2, p=0.0001). Moreover, they were more likely to deliver preterm (aOR 2.8, 95%CI: 2.6-3.1, p=0.0001), deliver by CD (aOR 5, 95%CI: 3.1-4.1, p=0.0001), experience preterm pre-labor rupture of membranes (PPROM) (aOR 3.5, 95%CI: 2.6-3.1, p=0.0001), and have a placental abruption (aOR 3.0, 95%CI: 2.5-3.5, p=0.0001). There were increased risks of PPH (aOR 1.4, 95%CI: 1.2-1.6, p=0.0001), wound-complications (aOR 2.0, 95%CI: 1.5-2.7, p=0.0001), hysterectomy (aOR 2.6, 95%CI: 1.6-4.1, p=0.0001), blood-transfusion (aOR 1.7, 95%CI: 1.5-2.1, p=0.0001), and DIC (aOR 1.6, 95%CI: 1.1-2.5), p=0.014) in the group with bicornuate uteri. Also there was higher risk of SGA (aOR 2.9, 95%CI: 2.6-3.2, p=0.0001) and IUFD (aOR 2.5, 95%CI: 1.8-3.3, p=0.0001). CONCLUSIONS Bicornuate uteri can increase risks in pregnancy by many folds. Particularly risks of: premature delivery, CD, PPROM, placental abruption, hysterectomy, SGA and IUFD were increased 250-500%.
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Affiliation(s)
- Einav Kadour Peero
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada.,MUHC Reproductive Center, McGill University, Montreal, QC, Canada
| | - Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada.,MUHC Reproductive Center, McGill University, Montreal, QC, Canada
| | - Haitham Baghlaf
- Maternal-Fetal Medicine Division, Obstetrics & Gynecology Department, University of Tabuk, Tabuk, Saudi Arabia
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, QC, Canada.,MUHC Reproductive Center, McGill University, Montreal, QC, Canada
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2
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Santana González L, Artibani M, Ahmed AA. Studying Müllerian duct anomalies - from cataloguing phenotypes to discovering causation. Dis Model Mech 2021; 14:269240. [PMID: 34160006 PMCID: PMC8246269 DOI: 10.1242/dmm.047977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Müllerian duct anomalies (MDAs) are developmental disorders of the Müllerian duct, the embryonic anlage of most of the female reproductive tract. The prevalence of MDAs is 6.7% in the general female population and 16.7% in women who exhibit recurrent miscarriages. Individuals affected by these anomalies suffer from high rates of infertility, first-trimester pregnancy losses, premature labour, placental retention, foetal growth retardation and foetal malpresentations. The aetiology of MDAs is complex and heterogeneous, displaying a range of clinical pictures that generally lack a direct genotype-phenotype correlation. De novo and familial cases sharing the same genomic lesions have been reported. The familial cases follow an autosomal-dominant inheritance, with reduced penetrance and variable expressivity. Furthermore, few genetic factors and molecular pathways underpinning Müllerian development and dysregulations causing MDAs have been identified. The current knowledge in this field predominantly derives from loss-of-function experiments in mouse and chicken models, as well as from human genetic association studies using traditional approaches, such as microarrays and Sanger sequencing, limiting the discovery of causal factors to few genetic entities from the coding genome. In this Review, we summarise the current state of the field, discuss limitations in the number of studies and patient samples that have stalled progress, and review how the development of new technologies provides a unique opportunity to overcome these limitations. Furthermore, we discuss how these new technologies can improve functional validation of potential causative alterations in MDAs. Summary: Here, we review the current knowledge about Müllerian duct anomalies in the context of new high-throughput technologies and model systems and their implications in the prevention of these disorders.
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Affiliation(s)
- Laura Santana González
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Mara Artibani
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK.,Gene Regulatory Networks in Development and Disease Laboratory, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DS, UK
| | - Ahmed Ashour Ahmed
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford OX3 9DS, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
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3
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Mastrolia SA, Baumfeld Y, Hershkovitz R, Yohay D, Trojano G, Weintraub AY. Independent association between uterine malformations and cervical insufficiency: a retrospective population-based cohort study. Arch Gynecol Obstet 2018; 297:919-926. [PMID: 29392437 DOI: 10.1007/s00404-018-4663-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of our study was to explore maternal and fetal outcomes in the second and third trimester in women with uterine malformations. STUDY DESIGN This was a retrospective population-based cohort study including women with a diagnosis of uterine malformation arised from workup for infertility or recurrent pregnancy loss, was accidental during pregnancy, or was noticed at the time of cesarean delivery. RESULTS A total of 280,721 pregnancies met the inclusion criteria and were divided into two study groups: (1) pregnancies in women with uterine malformations (n = 1099); and (2) controls (n = 279,662). The rate of women presenting uterine malformations was 0.39%. The prevalence of cervical os insufficiency was significantly higher in women with a uterine malformation than in the control group (3.6 vs. 0.4%, p < 0.001). A multivariate analysis, performed to evaluate risk factors for cervical insufficiency in women with uterine malformations. Mullerian anomalies (OR 6.19, 95% CI 4.41-8.70, p < 0.001), maternal age (OR 1.05, 95% CI 1.04-1.06, p < 0.001), recurrent abortions (OR 12.93, 95% CI 11.43-14.62, p < 0.001), and ethnicity (OR 2.86, 95% CI 2.454-3.34, p < 0.001) were found to be independently associated with the development of cervical insufficiency. CONCLUSION Uterine anomalies have a strong association with cervical insufficiency. Women with uterine anomalies have an increased risk to develop pregnancy complications that arise from a loss in cervical function during the midtrimester or early third trimester.
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Affiliation(s)
- Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben Gurion University of the Negev, 151 Rager Boulevard, Beer Sheva, 84101, Israel. .,Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy.
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben Gurion University of the Negev, 151 Rager Boulevard, Beer Sheva, 84101, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben Gurion University of the Negev, 151 Rager Boulevard, Beer Sheva, 84101, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben Gurion University of the Negev, 151 Rager Boulevard, Beer Sheva, 84101, Israel
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben Gurion University of the Negev, 151 Rager Boulevard, Beer Sheva, 84101, Israel
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Karami M, Jenabi E. The association between Mullerian anomalies and IUGR: a meta-analysis. J Matern Fetal Neonatal Med 2018; 32:2408-2411. [PMID: 29363367 DOI: 10.1080/14767058.2018.1432588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Published literature regarding the association between Mullerian anomalies and intrauterine growth restriction (IUGR) is controversial. To date, no meta-analysis has been performed for assessing the relationship between the Mullerian anomalies and IUGR. Therefore, the aim of this study was to perform a meta-analysis by combining data from relevant studies to assessing the association of between Mullerian anomalies and IUGR. METHODS A systematic search was conducted in PubMed, Scopus and Web of Science to identify of all studies prior to September 2017. Egger's and Begg's tests were carried out to quantitatively assess publication bias. To estimate the heterogeneity among studies the Q-statistic test and I-squared (I2) test were used. The random-effects model was conducted to obtain pooled odds ratio (OR) as a measure of the association between Mullerian anomalies and IUGR. RESULTS A total of seven studies were included in this meta-analysis with a sample of 605,005 participants. The pooled overall OR was 1.93 (95% CI: 1.52, 2.34). CONCLUSIONS We reported that mullerian anomalies are a risk factor for IUGR. However, further evidence by larger prospective cohort studies is needed to make conclusive evidence regarding the association between mullerian anomalies and IUGR.
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Affiliation(s)
- Manoochehr Karami
- a Social Determinants of Health Research Center , Hamadan University of Medical Sciences , Hamadan , Iran
| | - Ensiyeh Jenabi
- b Pediatric Developmental Disorders Research Center , Hamadan University of Medical Sciences , Hamadan , Iran
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5
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Prior M, Richardson A, Asif S, Polanski L, Parris-Larkin M, Chandler J, Fogg L, Jassal P, Thornton JG, Raine-Fenning NJ. Outcome of assisted reproduction in women with congenital uterine anomalies: a prospective observational study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:110-117. [PMID: 29055072 DOI: 10.1002/uog.18935] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the prevalence of congenital uterine anomalies, including arcuate uterus, and their effect on reproductive outcome in subfertile women undergoing assisted reproduction. METHODS Consecutive women referred for subfertility between May 2009 and November 2015 who underwent assisted reproduction were included in the study. As part of the initial assessment, each woman underwent three-dimensional transvaginal sonography. Uterine morphology was classified using the modified American Fertility Society (AFS) classification of congenital uterine anomalies proposed by Salim et al. If the external contour of the uterus was uniformly convex or had an indentation of < 10 mm, but there was a cavity indentation, it was defined as arcuate or septate. Arcuate uterus was further defined as the presence of a concave fundal indentation with a central point of indentation at an obtuse angle. Subseptate uterus was defined as the presence of a septum, not extending to the cervix, with the central point of the septum at an acute angle; if the septum extended to the internal cervical os, the uterus was defined as septate. Reproductive outcomes, including live birth, clinical pregnancy and preterm birth, were compared between women with a normal uterus and those with a congenital uterine anomaly. Subgroup analysis by type of uterine morphology and logistic regression analysis adjusted for age, body mass index, levels of anti-Müllerian hormone, antral follicle count and number and day of embryo transfer were performed. RESULTS A total of 2375 women were included in the study, of whom 1943 (81.8%) had a normal uterus and 432 (18.2%) had a congenital uterine anomaly. The most common anomalies were arcuate (n = 387 (16.3%)) and subseptate (n = 16 (0.7%)) uterus. The rate of live birth was similar between women with a uterine anomaly and those with a normal uterus (35% vs 37%; P = 0.47). The rates of clinical pregnancy, mode of delivery and sex of the newborn were also similar between the two groups. Preterm birth before 37 weeks' gestation was more common in women with uterine anomalies than in controls (22% vs 14%, respectively; P = 0.03). Subgroup analysis by type of anomaly showed no difference in the incidence of live birth and clinical pregnancy for women with an arcuate uterus, but indicated worse pregnancy outcome in women with other major anomalies (P = 0.042 and 0.048, respectively). CONCLUSIONS Congenital uterine anomalies as a whole, when defined using the modified AFS classification, do not affect clinical pregnancy or live-birth rates in women following assisted reproduction, but do increase the incidence of preterm birth. The presence of uterine abnormalities more severe than arcuate uterus significantly worsens all pregnancy outcomes. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Prior
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
- Department of Child Health, Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - A Richardson
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - S Asif
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - L Polanski
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - M Parris-Larkin
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - J Chandler
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - L Fogg
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - P Jassal
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
| | - J G Thornton
- Department of Child Health, Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - N J Raine-Fenning
- Nurture Fertility, The East Midlands Fertility Centre, Bostock's Lane, Sandiacre, Nottingham, UK
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6
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Khazaei S, Jenabi E, Veisani Y. The association of Mullerian anomalies and placenta abruption: a meta-analysis. J Matern Fetal Neonatal Med 2017; 32:512-516. [DOI: 10.1080/14767058.2017.1379072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Salman Khazaei
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensiyeh Jenabi
- Department of Midwifery, Tuyserkan Branch, Islamic Azad University, Tuyserkan, Iran
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
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7
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The spectrum of imaging appearances of müllerian duct anomalies: focus on MR imaging. Jpn J Radiol 2017; 35:697-706. [DOI: 10.1007/s11604-017-0681-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/30/2017] [Indexed: 11/26/2022]
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8
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Mastrolia SA, Baumfeld Y, Hershkovitz R, Loverro G, Di Naro E, Yohai D, Schwarzman P, Weintraub AY. Bicornuate uterus is an independent risk factor for cervical os insufficiency: A retrospective population based cohort study. J Matern Fetal Neonatal Med 2016; 30:2705-2710. [DOI: 10.1080/14767058.2016.1261396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Giuseppe Loverro
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Edoardo Di Naro
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - David Yohai
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Polina Schwarzman
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Yehuda Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
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McGowan R, Tydeman G, Shapiro D, Craig T, Morrison N, Logan S, Balen AH, Ahmed SF, Deeny M, Tolmie J, Tobias ES. DNA copy number variations are important in the complex genetic architecture of müllerian disorders. Fertil Steril 2015; 103:1021-1030.e1. [DOI: 10.1016/j.fertnstert.2015.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/29/2022]
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10
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Santacana-Laffitte G, Ruiz L, Pedrogo Y, Colon E. Cystic adnexal mass in a 16-year-old female: Ovarian pathology or complication of a Müllerian anomaly? AMERICAN JOURNAL OF CASE REPORTS 2013; 14:153-156. [PMID: 23826455 PMCID: PMC3700479 DOI: 10.12659/ajcr.889050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022]
Abstract
Patient: Female, 16 Final Diagnosis: Pelvic mass Symptoms: None Medication: None Clinical Procedure: CT • MRI Specialty: Diagnostic radiology • pediatrics
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Affiliation(s)
- Guido Santacana-Laffitte
- Department of Diagnostic Radiology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
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11
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Narang HK, Warke HS, Mayadeo NM. Müllerian anomaly with ovary at deep inguinal ring: a rare case finding. J OBSTET GYNAECOL 2013; 33:317-8. [PMID: 23550874 DOI: 10.3109/01443615.2012.754413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- H K Narang
- Department of Obstetrics and Gynecology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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12
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Bocca SM, Abuhamad AZ. Use of 3-dimensional sonography to assess uterine anomalies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1-6. [PMID: 23269704 DOI: 10.7863/jum.2013.32.1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Silvina M Bocca
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 601 Colley Ave, Norfolk, VA 23507, USA.
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13
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El Saman AM, Shahin AY, Nasr A, Tawfik RM, Saadeldeen HS, Othman ER, Habib DM, Abdel-Aleem MA. Hybrid septate uterus, coexistence of bicornuate and septate varieties: a genuine report. J Obstet Gynaecol Res 2012; 38:1308-14. [PMID: 22612567 DOI: 10.1111/j.1447-0756.2012.01866.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To highlight the coexistence of a uterine septum in cases diagnosed as bicornuate uterus on the basis of the external shape of the uterine fundus and to present the outcomes of its hysteroscopic management. METHODS Descriptive clinical report. Cases with two-chambered uterine cavities were recruited with exclusion of cases with pure bicornuate uteri. The differentiation between hybrid and pure septate uterine varieties was based on clinical evaluation, transvaginal ultrasonic evaluation, hysterosalpingography and in addition to bimanual examination under anesthesia. The final diagnosis was confirmed by combined hysteroscopy-laparoscopy examinations. Cases with pure and hybrid septate uteri were managed by hysteroscopic metroplasty and the outcomes were compared. RESULTS Out of 357 cases of double chambered uteri, 18 cases (5%) were found to be a pure bicornuate variety (PBV), 322 (90.2%) cases were found to have pure septate variety (PSV) and 17 cases (4.8%) were found to have hybrid septate variety (HSV). In HSV, there was external fundal depression dividing only the upper part of the corpus giving an imprecise impression of a bicornuate uterus with a laparoscopic view, but there was a long extension of the dividing interface. Nine cases with HSV were associated with a complete utero-cervico-vaginal septum, and five cases had a complete uterine septum. The diagnosis of asymmetric horns, hemi-obstruction or bicervical uterus was made in three cases with HSV. All cases with a septate uterus were offered hysteroscopic metroplasty, and cases with fundal depression were operated under laparoscopic monitoring. In cases with HSV, the procedure was performed safely and successfully in 16/17 cases (94%). One uterine perforation was encountered, giving a six-fold increase in the perforation risk, and passed uneventfully. Successful reproductive outcomes were reported in 178/189 cases (94.1%) with PSV and in 12/15 (80%) with HSV. CONCLUSIONS External fundal depressions of variable depths are associating with a septate uterus, indicating coexistence of the two anomalies. These cases are candidates for hysteroscopic metroplasty under appropriate sonographic and/or laparoscopic monitoring.
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Affiliation(s)
- Ali M El Saman
- Women's Health University Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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14
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Duhan N, Kadian YS, Dahiya K, Yadav K, Rattan KN. Reproductive Issues in Müllerian Anomalies. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2011.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nirmala Duhan
- Department of Obstetrics and Gynecology, Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Yogender Singh Kadian
- Department of Paediatric Surgery, Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Krishna Dahiya
- Department of Obstetrics and Gynecology, Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kiran Yadav
- Department of Obstetrics and Gynecology, Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kamal Nain Rattan
- Department of Paediatric Surgery, Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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15
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Abstract
Uterine didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare congenital anomaly of the Müllerian duct system referred to as Herlyn-Werner-Wunderlich syndrome. Because of its rare occurrence, a high level of suspicion is often required for diagnosis. Clinically, these patients usually present after menarche with pelvic pain, dysmenorrhea, and a palpable pelvic mass. We present a case of a 31-year-old female patient with infertility. Imaging findings were consistent with Herlyn-Werner-Wunderlich syndrome, with a congenital defect in the longitudinal vaginal septum resulting in partial spontaneous decompression of right-sided hematocolpos.
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16
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Bocca SM, Oehninger S, Stadtmauer L, Agard J, Duran EH, Sarhan A, Horton S, Abuhamad AZ. A study of the cost, accuracy, and benefits of 3-dimensional sonography compared with hysterosalpingography in women with uterine abnormalities. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:81-85. [PMID: 22215773 DOI: 10.7863/jum.2012.31.1.81] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES We conducted a prospective blinded study to evaluate the costs, accuracy, risks, and benefits of 3-dimensional (3D) transvaginal sonography compared to hysterosalpingography. METHODS A total of 101 women aged 26 to 44 years with evidence of uterine anomalies were enrolled. All participants had routine hysterosalpingography as part of their infertility evaluation as well as 3D transvaginal sonography as part of the study. Surgical findings were used as the standard for final diagnosis. RESULTS A total of 6 normal uteri and 119 uterine anomalies were classified: 30 congenital uterine anomalies (3 arcuate, 1 unicornuate, 4 bicornuate, 2 didelphys, and 20 septate uteri) and 89 acquired anomalies (38 polyps, 30 fibroids, 17 synechiae, and 4 adenomyosis). Congenital anomalies were correctly identified in 30 of 30 cases by 3D sonography but from 10 to 30 of 30 cases by hysterosalpingography. The detection rates for acquired uterine anomalies were lower for both techniques: 44 to 89 of 89 cases for 3D sonography and 22 to 74 of 89 cases for hysterosalpingography. Only 7 of the 20 septi would have been surgically corrected if patients only had hysterosalpingography. On the contrary, 30 of 30 patients with congenital uterine anomalies, 2 of 4 patients with adenomyosis, and all 6 patients with normal uteri were spared from surgery with diagnoses by 3D sonography. No adverse effects were reported after sonography, and only 6 minor ones were reported after hysterosalpingography. CONCLUSIONS Three-dimensional transvaginal sonography provides visualization and evaluation of the uterine cavity with similar or better accuracy than standard hysterosalpingography in the office setting, with lower cost and morbidity.
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Affiliation(s)
- Silvina M Bocca
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507-1627, USA.
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Marcal L, Nothaft MA, Coelho F, Volpato R, Iyer R. Mullerian duct anomalies: MR imaging. ABDOMINAL IMAGING 2011; 36:756-64. [PMID: 21207225 DOI: 10.1007/s00261-010-9681-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mullerian duct anomalies (MDAs) are rare, affecting approximately 1% of all women and about 3% of women with poor reproductive outcomes. These congenital anomalies usually result from one of the following categories of abnormalities of the mullerian ducts: failure of formation (no development or underdevelopment) or failure of fusion of the mullerian ducts. The American Fertility Society (AFS) classification of uterine anomalies is widely accepted and includes seven distinct categories. MR imaging has consolidated its role as the imaging modality of choice in the evaluation of MDA. MRI is capable of demonstrating the anatomy of the female genital tract remarkably well and is able to provide detailed images of the intra-uterine zonal anatomy, delineate the external fundal contour of the uterus, and comprehensively image the entire female pelvis in multiple imaging planes in a single examination. The purpose of this pictorial essay is to show the value of MRI in the diagnosis of MDA and to review the key imaging features of anomalies of formation and fusion, emphasizing the relevance of accurate diagnosis before therapeutic intervention.
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Affiliation(s)
- Leonardo Marcal
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:371-382. [PMID: 21830244 DOI: 10.1002/uog.10056] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Congenital uterine anomalies are common but their effect on reproductive outcome is unclear. We conducted a systematic review to evaluate the association between different types of congenital uterine anomaly and various reproductive outcomes. METHODS Searches were performed using MEDLINE, EMBASE, the Cochrane Library and Web of Science. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Uterine defects were grouped into arcuate uteri, canalization defects (septate and subseptate uteri) and unification defects (unicornuate, bicornuate and didelphys uteri). Pooled risk ratios (RR) with 95% confidence intervals (CI) were computed using random effects models. RESULTS We identified nine studies comprising 3805 women. Meta-analysis showed that arcuate uteri were associated with increased rates of second-trimester miscarriage (RR, 2.39; 95% CI, 1.33-4.27, P = 0.003) and fetal malpresentation at delivery (RR, 2.53; 95% CI, 1.54-4.18; P < 0.001). Canalization defects were associated with reduced clinical pregnancy rates (RR, 0.86; 95% CI, 0.77-0.96; P = 0.009) and increased rates of first-trimester miscarriage (RR, 2.89; 95% CI; 2.02-4.14; P < 0.001), preterm birth (RR, 2.14; 95% CI, 1.48-3.11; P < 0.001) and fetal malpresentation (RR, 6.24; 95% CI, 4.05-9.62; P < 0.001). Unification defects were associated with increased rates of preterm birth (RR, 2.97; 95% CI, 2.08-4.23; P < 0.001) and fetal malpresentation (RR, 3.87; 95% CI, 2.42-6.18; P < 0.001). CONCLUSIONS Canalization defects reduce fertility and increase rates of miscarriage and preterm delivery. None of the unification defects reduces fertility but some are associated with miscarriage and preterm delivery. Arcuate uteri are specifically associated with second-trimester miscarriage. All uterine anomalies increase the chance of fetal malpresentation at delivery.
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Affiliation(s)
- Y Y Chan
- Department of Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, UK.
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El Saman AM, Nasr A, Tawfik RM, Saadeldeen HS. Müllerian duct anomalies: successful endoscopic management of a hybrid bicornuate/septate variety. J Pediatr Adolesc Gynecol 2011; 24:e89-92. [PMID: 21514191 DOI: 10.1016/j.jpag.2011.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/16/2011] [Accepted: 02/17/2011] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To highlight the coexistence of uterine septum in cases diagnosed as bicornuate uterus on basis of the external shape of uterine fundus. STUDY DESIGN Case report with description of the technique. SETTING Women's Health Assiut University Hospital. PARTICIPANTS An adolescent female with progressive pains dating since menarche. INTERVENTIONS Hysteroscopic resection under laparoscopic monitoring through an intact hymen. MAIN OUTCOME MEASURE Operative time, complications, postoperative abdominal pain, appearance of the uterine cavity RESULTS A patient with a septate uterus with a fundal depression and hemiuterine obstruction underwent hysteroscopic resection under laparoscopic monitoring. Laparoscopy was beneficial in diagnosis and treatment of associated pathology and monitoring the hysteroscopic procedure. Hysteroscopic metroplasty was performed and resulted in unification of the lower two thirds of the uterus. Dysmenorrhea was dramatically improved after the procedure. Subsequent office hysteroscopy confirmed restoration of a unified lower uterine corpus anatomy mimic to the original bicornuate state. CONCLUSIONS External fundal depression which characterizes bicornuate uterus was associated with a septate uterus with hemi uterine obstruction. This report demonstrates the coexistence of the two anomalies. Endoscopic management of this patient was safe and successful.
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Affiliation(s)
- Ali M El Saman
- Women's Health University Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
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Acién P, Acién MI. The history of female genital tract malformation classifications and proposal of an updated system. Hum Reprod Update 2011; 17:693-705. [PMID: 21727142 DOI: 10.1093/humupd/dmr021] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A correct classification of malformations of the female genital tract is essential to prevent unnecessary and inadequate surgical operations and to compare reproductive results. An ideal classification system should be based on aetiopathogenesis and should suggest the appropriate therapeutic strategy. METHODS We conducted a systematic review of relevant articles found in PubMed, Scopus, Scirus and ISI webknowledge, and analysis of historical collections of 'female genital malformations' and 'classifications'. Of 124 full-text articles assessed for eligibility, 64 were included because they contained original general, partial or modified classifications. RESULTS All the existing classifications were analysed and grouped. The unification of terms and concepts was also analysed. Traditionally, malformations of the female genital tract have been catalogued and classified as Müllerian malformations due to agenesis, lack of fusion, the absence of resorption and lack of posterior development of the Müllerian ducts. The American Fertility Society classification of the late 1980s included seven basic groups of malformations also considering the Müllerian development and the relationship of the malformations to fertility. Other classifications are based on different aspects: functional, defects in vertical fusion, embryological or anatomical (Vagina, Cervix, Uterus, Adnex and Associated Malformation: VCUAM classification). However, an embryological-clinical classification system seems to be the most appropriate. CONCLUSIONS Accepting the need for a new classification system of genitourinary malformations that considers the experience gained from the application of the current classification systems, the aetiopathogenesis and that also suggests the appropriate treatment, we proposed an update of our embryological-clinical classification as a new system with six groups of female genitourinary anomalies.
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Affiliation(s)
- Pedro Acién
- Service of Obstetrics and Gynaecology, Department of Gynaecology, University Hospital of San Juan, Alicante, Spain.
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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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Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update 2011; 17:761-71. [PMID: 21705770 PMCID: PMC3191936 DOI: 10.1093/humupd/dmr028] [Citation(s) in RCA: 366] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The prevalence of congenital uterine anomalies in high-risk women is unclear, as several different diagnostic approaches have been applied to different groups of patients. This review aims to evaluate the prevalence of such anomalies in unselected populations and in women with infertility, including those undergoing IVF treatment, women with a history of miscarriage, women with infertility and recurrent miscarriage combined, and women with a history of preterm delivery. METHODS Searches of MEDLINE, EMBASE, Web of Science and the Cochrane register were performed. Study selection and data extraction were conducted independently by two reviewers. Studies were grouped into those that used ‘optimal’ and ‘suboptimal’ tests for uterine anomalies. Meta-analyses were performed to establish the prevalence of uterine anomalies and their subtypes within the various populations. RESULTS We identified 94 observational studies comprising 89 861 women. The prevalence of uterine anomalies diagnosed by optimal tests was 5.5% [95% confidence interval (CI), 3.5–8.5] in the unselected population, 8.0% (95% CI, 5.3–12) in infertile women, 13.3% (95% CI, 8.9–20.0) in those with a history of miscarriage and 24.5% (95% CI, 18.3–32.8) in those with miscarriage and infertility. Arcuate uterus is most common in the unselected population (3.9%; 95% CI, 2.1–7.1), and its prevalence is not increased in high-risk groups. In contrast, septate uterus is the most common anomaly in high-risk populations. CONCLUSIONS Women with a history of miscarriage or miscarriage and infertility have higher prevalence of congenital uterine anomalies compared with the unselected population.
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Affiliation(s)
- Y Y Chan
- Department of Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK.
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Medeiros LR, Rosa DD, Silva FR, Silva BR, Rosa MI. Laparoscopic approach of a unicornuate uterus with noncommunicating rudimentary horns. ISRN OBSTETRICS AND GYNECOLOGY 2010; 2011:906138. [PMID: 21647229 PMCID: PMC3101792 DOI: 10.5402/2011/906138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 09/21/2010] [Indexed: 11/23/2022]
Abstract
Background. Müllerian duct malformations delineate a miscellaneous group of congenital anomalies that result from arrested development, abnormal formation, or incomplete fusion of the mesonephric ducts.
Case. This paper describes the diagnosis and management of a noncommunicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. Conclusion. This condition was diagnosed by laparoscopy and hysteroscopy examination. Operative videolaparoscopy proved to be a successful approach for the treatment of this congenital Müllerian anomaly.
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Affiliation(s)
- Lidia Rosi Medeiros
- Departament of Gynecologic Surgery, Hospital Mãe de Deus, José de Alencar 1244 apt 1009, Porto Alegre 90880-480, RS, Brazil
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Mane SB, Shastri P, Dhende NP, Obaidah A, Acharya H, Reddy S, Arlikar J, Goel N. Our 10-year experience of variable Müllerian anomalies and its management. Pediatr Surg Int 2010; 26:795-800. [PMID: 20589381 DOI: 10.1007/s00383-010-2640-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Though the Müllerian duct anomalies are rare in incidence, their variable age, and mode of presentation makes their management difficult. METHODS In the last 10 years authors managed 14 patients with different types of Müllerian anomalies. There were eight patients with complete Müllerian agenesis: three of partial Müllerian agenesis, one patient had uterine didelphys with vertical and transverse vaginal septum on left side, one patient had uterine didelphys with cervical agenesis on the right side, one patient had MRKH with anorectal malformation. RESULTS Patients with complete Müllerian agenesis underwent bowel vaginoplasty, and patients with partial Müllerian agenesis with hydrocolpos underwent pull-through vaginoplasty. Patient of uterine didelphys one with septum underwent septum excision and in another with cervical agenesis, cervix opened and drain kept. In MRKH with vestibular fistula, fistulous opening was kept as vaginal opening and rectum brought down as a neoanus. CONCLUSION Müllerian duct anomalies can present in any age group and with variable symptoms. Sigmoid colon vaginoplasty is an excellent procedure for complete or partial Müllerian agenesis. Correct evaluation of these patients and proper management is a challenge.
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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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Taori K, Sharbidre KG, Bopche S, Kulkarni B, Krishnan V, Disawal A. Partial hydatidiform mole in septate uterus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:475-477. [PMID: 19655383 DOI: 10.1002/jcu.20614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Partial mole is a form of gestational trophoblastic disease that may be associated with serious medical complications and occasionally progresses to the second trimester of pregnancy. We present a case report of a partial mole diagnosed at 18 weeks of gestation in a septate uterus with molar placenta in one horn and a dead fetus in the other.
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Affiliation(s)
- Kishor Taori
- Department of Radiodiagnosis, Government Medical College and Hospital, Nagpur, India
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Prentice A, Hipple LJ. Middle trimester missed abortion and uterine anomalies. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619009151166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shirota K, Fukuoka M, Tsujioka H, Inoue Y, Kawarabayashi T. A normal uterus communicating with a double cervix and the vagina: a müllerian anomaly without any present classification. Fertil Steril 2008; 91:935.e1-3. [PMID: 19006794 DOI: 10.1016/j.fertnstert.2008.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 09/06/2008] [Accepted: 09/09/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report a rare uterine anomaly consisting of a normal uterus, a double cervix, and a double vagina. DESIGN Case report. SETTING University hospital. PATIENT(S) A 28-year-old nulligravida patient referred for evaluation of primary infertility and a suspected müllerian anomaly. INTERVENTION(S) Clinical and surgical evaluation of the anomaly. MAIN OUTCOME MEASURE(S) Description and treatment for a rare uterine anomaly and a subsequent literature search. RESULT(S) Successful resection of vaginal septum and subsequent pregnancy. CONCLUSION(S) This extremely rare anomaly is not explained by classic embryologic teachings, and it does not fit into the classification system currently used to describe müllerian anomalies.
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Affiliation(s)
- Kyoko Shirota
- Department of Gynecology and Obstetrics, Faculty of Medicine, Fukuoka University Hospital, Fukuoka, Japan
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Coskun A, Okur N, Ozdemir O, Kiran G, Arýkan DC. Uterus didelphys with an obstructed unilateral vagina by a transverse vaginal septum associated with ipsilateral renal agenesis, duplication of inferior vena cava, high-riding aortic bifurcation, and intestinal malrotation: a case report. Fertil Steril 2008; 90:2006.e9-11. [PMID: 18722606 DOI: 10.1016/j.fertnstert.2008.05.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 04/11/2008] [Accepted: 05/06/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To present a case of müllerian defects associated with other anomalies, including ipsilateral renal agenesia, duplication of inferior vena cava, high-riding aortic bifurcation, and intestinal malrotation. DESIGN Case study. SETTING Academic medical center. PATIENT(S) A 16-year-old woman with müllerian defects associated with vascular and intestinal anomalies. INTERVENTION(S) Excision of vaginal septum. MAIN OUTCOME MEASURE(S) Improvement of symptoms caused by obstructed müllerian defect. RESULT(S) After an incision on the vaginal septum, a large amount of chocolate-colored fluid was drained, and the dimensions of the right uterus were diminished. Then the vaginal septum was excised completely; we saw a second distinct cervical portion. CONCLUSION(S) Uterus didelphys with obstructed hemivagina is almost always associated with renal agenesis ipsilateral to the obstruction. Inferior vena cava duplication associated with müllerian anomalies is an extremely rare condition. In addition, the presented case also had a high-riding aortic bifurcation and intestinal malrotation. To the best of our knowledge, this is the first case to include all of these anomalies.
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Affiliation(s)
- Ayhan Coskun
- Department of Obstetrics and Gynecology, School of Medicine, Sutcu Imam University, Kahramanmaras, Turkey.
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Bocca SM, Oehninger S, Abuhamad AZ. Detection of transient postoperative changes in the endometrial cavity by 3-dimensional ultrasonography after hysteroscopic correction of various uterine anomalies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:461-465. [PMID: 18314524 DOI: 10.7863/jum.2008.27.3.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this series was to prospectively evaluate early postoperative intrauterine changes by 3-dimensional ultrasonography (3DUS) in patients undergoing hysteroscopic correction of various uterine anomalies. METHODS Thirty consecutive patients with a diagnosis of an anomaly of the uterine cavity who underwent hysteroscopic correction were studied. Patients had transvaginal 3DUS to display the midcoronal view of the uterus immediately before and 1 and 2 months after hysteroscopy. The presence of postoperative changes and the pregnancy outcomes (either spontaneous or after assisted reproduction) in the subsequent 6 months after hysteroscopy were recorded. RESULTS Postoperative changes 1 month after hysteroscopy were detected by 3DUS in 20% (6/30) of these patients. The changes detected consisted of intrauterine cystic loculations in 3 patients and endometrial irregularities/possible mucus accumulations in the other 3. These loculations and irregularities were sometimes larger and more complex in nature than the original lesions and always coincided with the resection site. These changes resolved spontaneously after the second postoperative month and did not interfere with embryo implantation or cause pregnancy loss in patients attempting to conceive during the study period. CONCLUSIONS Patients who underwent hysteroscopic correction of various anomalies of the uterine cavity had immediate postoperative findings when imaged by 3DUS that were transient and of no clinical relevance. These transient and self-resolving ultrasonographic changes did not affect the patients' reproductive capacity.
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Affiliation(s)
- Silvina M Bocca
- Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 601 Colley Ave, Norfolk, VA 23507, USA.
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Abstract
Providing its excellent visualization, access to pelvic structures, and less postoperative adhesion, laparoscopy has been an important tool for the treatment of uterovaginal anomalies. We have used it to define the anomaly, monitor endometriosis or a hysteroscopic procedure, replace an absent vagina, and resect abnormal Müllerian structures. This article details the technique and reports the results of the use of operative laparoscopy for the treatment of uterovaginal anomalies in children and adolescents. The author's experience demonstrates some"nonclassical" applications of endosurgery in the management of these anomalies in the pediatric age.
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Affiliation(s)
- Maria Marcela Bailez
- Division of Pediatric Surgery, J P Garrahan Children's Hospital, Buenos Aires, Argentina.
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Zakashansky K, Peiretti M, Mahdavi A, Chun JK, Nezhat F. Combined laparoscopic and radical vaginal treatment of primary vaginal leiomyosarcoma in a patient with unicornuate uterus and pelvic kidney. J Minim Invasive Gynecol 2007; 14:518-20. [PMID: 17630176 DOI: 10.1016/j.jmig.2007.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2006] [Revised: 01/21/2007] [Accepted: 01/28/2007] [Indexed: 11/27/2022]
Abstract
We report a case of primary vaginal leiomyosarcoma occurring in a patient with a unicornuate uterus and pelvic kidney. The patient was treated with radical partial vaginectomy, unilateral groin dissection, total laparoscopic hysterectomy, and left pelvic laparoscopic lymphadenectomy, followed by adjuvant chemotherapy. Twenty-five months after her original procedure, the patient is alive and free of disease. The exact association between müllerian anomalies and primary malignancies of the genitourinary tract is unclear. It is nonetheless important to be aware of the close embryonic association between the genital and urinary tracts when evaluating such patients and choosing the appropriate surgical and therapeutic approach.
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Affiliation(s)
- Konstantin Zakashansky
- Division of Gynecologic Oncology and Minimally Invasive Surgery, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York 10029, USA
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Abstract
If the Müllerian ducts fail to fuse, or, if the wall which is the result of fusion is not adequately resorbed, the result is a spectrum of uterine abnormalities called Müllerian fusion and absorption defects. The impact of these abnormalities on fertility is a subject for debate, but at least a subset seems to have a negative impact on reproductive performance manifesting in recurrent abortion and/or premature labor. Previous surgical interventions required laparotomy, but, with careful application of imaging techniques, a group of patients can be identified with a uterine septum amenable to removal under hysteroscopic direction with little morbidity. Intrauterine adhesions or synechiae are usually secondary to curettage in the context of missed abortion or pregnancy-related hemorrhage. These lesions cover a spectrum that ranges from minor and insignificant to severe cohesive adhesions that affect menstrual function and fertility. Surgical repair of the endometrial cavity affected with such adhesions presents a challenge to the hysteroscopic surgeon. Appropriate management is controversial but may include second loop hysteroscopy and the use of postoperative adjuvants such as systemic estrogens and intrauterine devices or systems designed to impede the development of adhesions.
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Affiliation(s)
- Luigi Fedele
- Clinica Ostetrica e Ginecologica II, Università di Milano, Milano, Italy.
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Abstract
PURPOSE OF REVIEW This review discusses current diagnostic techniques for müllerian anomalies, reproductive outcome data, and management options in reproductive-age women. RECENT FINDINGS Multiple retrospective studies have investigated reproductive outcomes with müllerian anomalies, but few current prospective studies exist. Uterine anomalies are associated with normal and adverse reproductive outcomes such as recurrent pregnancy loss and preterm delivery, but not infertility. Furthermore, unicornuate, didelphic, bicornuate, septate, arcuate, and diethylstilbestrol-exposed uteri have their own reproductive implications and associated abnormalities. Common presentations of müllerian anomalies and current diagnostic techniques are reviewed. Surgical intervention for müllerian anomalies is indicated in women with pelvic pain, endometriosis, obstructive anomalies, recurrent pregnancy loss, and preterm delivery. Although surgery for most uterine anomalies is a major intervention, the uterine septum is preferentially managed with a hysteroscopic procedure. Several recent studies and review articles discuss management of the septate uterus in asymptomatic women, infertile women, and women with a history of poor reproductive outcomes. Current assessment of reproductive outcomes with uterine anomalies and management techniques is warranted. SUMMARY Müllerian anomalies, especially uterine anomalies, are associated with both normal and adverse reproductive outcomes, and management in infertile women remains controversial.
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Affiliation(s)
- Beth W Rackow
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
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Goluda M, St Gabryś M, Ujec M, Jedryka M, Goluda C. Bicornuate rudimentary uterine horns with functioning endometrium and complete cervical-vaginal agenesis coexisting with ovarian endometriosis: a case report. Fertil Steril 2006; 86:462.e9-11. [PMID: 16806208 DOI: 10.1016/j.fertnstert.2005.12.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 12/27/2005] [Accepted: 12/27/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report a patient with bicornuate rudimentary uterine horns with functioning endometrium and complete cervical-vaginal agenesis coexisting with ovarian endometriosis. DESIGN Case report. SETTING University hospital. PATIENT(S) A 37-year-old woman with an extremely rare müllerian anomaly of the uterus and vagina coexisting with ovarian endometriosis. INTERVENTION(S) Resection of the rudimentary uterine horns with bilateral salpingo-oophorectomy. MAIN OUTCOME MEASURE(S) Relief from pelvic pain after the operative procedure. RESULT(S) The definite diagnosis and removal of the müllerian anomaly and endometriosis foci. CONCLUSION(S) Cyclic pelvic pain since the age of 14 was due to cryptomenorrhoea in the presence of the bicornuate rudimentary uterine horns with functioning endometrium and cervical-vaginal agenesis. Ovarian endometriosis developed as a result. In such cases, invasive procedures, such as laparoscopy or laparotomy, should be considered to establish the diagnosis. Removing the functioning rudimentary uterine horns just after menarche should prevent the development of endometriosis and hematometra.
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Affiliation(s)
- Marian Goluda
- 2nd Department of Obstetrics and Gynecology, Wroclaw Medical University, Wroclaw, Poland
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Gholoum S, Puligandla PS, Hui T, Su W, Quiros E, Laberge JM. Management and outcome of patients with combined vaginal septum, bifid uterus, and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome). J Pediatr Surg 2006; 41:987-92. [PMID: 16677898 DOI: 10.1016/j.jpedsurg.2006.01.021] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare müllerian anomaly consisting of uterine didelphy, hemivaginal septum, and ipsilateral renal agenesis. The purpose of this study was to evaluate the natural history and outcome of patients with HWWS. METHODS With ethics review board approval, all patients with uterine/vaginal anomalies were reviewed between 1982 and 2004. Patients with cloacal and/or anorectal anomalies were excluded. Presenting symptoms, preoperative investigations, operative management, and long-term follow-up were assessed. RESULTS Of 80 patients identified with uterine/vaginal anomalies, 12 had HWWS. Median age at presentation was 13 years. Most patients (11/12) in this series presented with either abdominal pain and/or pelvic masses. Two patients had intra-abdominal abscesses. Seven patients were menstruating at presentation with 4 of these patients having dysmenorrhea. Symptom duration ranged from 0.5 to 12 months. Diagnosis was confirmed by ultrasound (n = 11), computed tomographic scan (n = 3), and/or magnetic resonance imaging (n = 2). Operative management included vaginal septectomy and drainage of the hematocolpos/hematometrocolpos. One patient required salpingectomy for pyosalpinx. Follow-up ultrasounds revealed no recurrent collections. Median follow-up was 3 years (2 months to 16 years). Eleven patients were asymptomatic after treatment. One patient complained of irregular menses. CONCLUSION This is one of the largest reviews of HWWS in pediatric patients to date. Good long-term outcome occurs after vaginal septectomy. This diagnosis should be suspected in females with a pelvic mass and ipsilateral renal agenesis.
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Affiliation(s)
- Suad Gholoum
- Division of Pediatric Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada H3H 1P3
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Weissman A, Eldar I, Malinger G, Sadan O, Glezerman M, Levran D. Successful twin pregnancy in a patient with complete uterine septum corrected during cesarean section. Fertil Steril 2006; 85:494.e11-4. [PMID: 16595235 DOI: 10.1016/j.fertnstert.2005.06.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 06/24/2005] [Accepted: 06/24/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe a successful in vitro fertilization (IVF) twin pregnancy in a patient with complete uterine septum who underwent partial correction during cesarean section. DESIGN Case report. SETTING An IVF unit at a university hospital. PATIENT(S) A 29-year-old female patient with complete uterine septum undergoing IVF-intracytoplasmic sperm injection. INTERVENTION(S) In vitro fertilization-intracytoplasmic sperm injection with single embryo transfer to each uterine cavity. MAIN OUTCOME MEASURE(S) Pregnancy course and outcome. RESULT(S) Both transferred embryos underwent implantation, resulting in twin pregnancy with a single embryo in each hemi-uterus. Cesarean section was performed at 34 weeks' gestation. Two healthy neonates were born. Resection of the uterine septum by electrocauterization was attempted during cesarean section. Diagnostic hysteroscopy performed 6 months later demonstrated the presence of the uterine septum reaching approximately 40% of the cavity. CONCLUSION(S) Whether prophylactic metroplasty should be performed in patients with uterine septae without prior history of miscarriage or pregnancy complications is still under debate. Successful implantation and fetal development might occur without prior metroplasty, as described in our case report. Metroplasty during cesarean section might be only partly successful because part of the septum might be confined in the stretched gravid uterus.
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Affiliation(s)
- Ariel Weissman
- In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, Israel.
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Ramaglia L, Morgese F, Pighetti M, Saviano R. Odontogenic keratocyst and uterus bicornis in nevoid basal cell carcinoma syndrome: case report and literature review. ACTA ACUST UNITED AC 2006; 102:217-9. [PMID: 16876065 DOI: 10.1016/j.tripleo.2005.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Revised: 05/10/2005] [Accepted: 08/12/2005] [Indexed: 11/28/2022]
Abstract
Nevoid basal cell carcinoma syndrome (NBCCS), an autosomal dominant disorder with a high degree of penetrance and variable expressivity, is characterized by basal cell carcinomas, odontogenic keratocysts, palmar and/or plantar pits, and ectopic calcifications of the falx cerebri. More than 100 minor criteria have been described, but 2 major and 1 minor criteria or 1 major and 3 minor criteria are necessary for the diagnosis. In this report we present an 8-year-old girl affected by NBCCS showing a uterus bicornis, a hitherto unreported association. However, further research is needed to confirm the association between NBCCS and mullerian fusion defects and to assess the hypothesis that focuses on chromosome 9 the mutant gene for NBCCS and fusion defects of female genital tract.
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Affiliation(s)
- Luca Ramaglia
- Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, Università di Napoli Federico II, Napoli, Italy.
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Kormányos Z, Molnár BG, Pál A. Removal of a residual portion of a uterine septum in women of advanced reproductive age: obstetric outcome. Hum Reprod 2006; 21:1047-51. [PMID: 16410337 DOI: 10.1093/humrep/dei438] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To learn more about the obstetric outcome after initial septum resection and remnant septum (< or =1 cm) resection. METHODS In 94 patients with septate uteri who underwent uterine septum resection, the reproductive efficiency was analysed in a prospective observational study. The reproductive outcome was analysed after initial resection and (if required) consecutive procedures. RESULTS A total of 94 women were enrolled in the study; all had had two or more miscarriages. The septum was completely removed during the first hysteroscopy in 58 (62%) cases. A residual septum was observed in 36 (38%) patients. Subsequent operative hysteroscopy was performed in the cases (29/36; 80.5%) involving repeated miscarriage and unsuccessful conception. The minimum observation time was 24 months. The difference in delivery rate after the first hysteroscopy between those with a normalized uterine cavity (26/58; 44.8%) and those with remnants (7/36; 19.4%) was statistically significant (P < 0.05). In fact, following the normalization of the uterine cavity, 62.1% (18/29) of the patients delivered, as compared with 19.4% of those (7/36) with a residue and Kaplan-Meyer curves revealed a statistically significant difference (P < 0.05). CONCLUSIONS Women with a remnant uterine septum have an increased chance of successful pregnancy with an improved obstetric outcome after normalization of the uterine cavity.
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Affiliation(s)
- Zsolt Kormányos
- Department of Obstetrics and Gynaecology, Faculty of General Medicine, Albert Szent-Györgyi Medical and Pharmacological Centre, University of Szeged, Szeged, Hungary.
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Monteagudo A, Roman AS. Ultrasound in multiple gestations: twins and other multifetal pregnancies. Clin Perinatol 2005; 32:329-54, vi. [PMID: 15922786 DOI: 10.1016/j.clp.2005.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ultrasound has an important role not only in assessing amnionicity and chorionicity but also in diagnosing abnormalities and providing fetal surveillance throughout the duration of gestation.
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Affiliation(s)
- Ana Monteagudo
- Department of Obstetrics and Gynecology, NYU School of Medicine, 530 First Avenue, NB9N26-B, New York, NY 10016, USA.
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Akar ME, Bayar D, Yildiz S, Ozel M, Yilmaz Z. Reproductive outcome of women with unicornuate uterus. Aust N Z J Obstet Gynaecol 2005; 45:148-50. [PMID: 15760318 DOI: 10.1111/j.1479-828x.2005.00346.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study was undertaken to examine the reproductive impact of unicornuate uterine abnormalities cases in a group of 571 women with a uterine anomaly. Hospital records of 1784 patients who presented to the infertility outpatient clinic with infertility, recurrent pregnancy loss, pain or acute abdomen during the study period between January 1991 and January 2001, were reviewed retrospectively. The reproductive performance of women with unicornuate uterus was poor, with a live birth rate of only 29.2%, prematurity rate of 44%, miscarriage rate of 29%, and an ectopic pregnancy rate of 4%.
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Affiliation(s)
- Munire E Akar
- Zekai Tahir Burak Women's Health Education and Research Hospital, Antalya, Turkey.
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44
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Lee CY, Cheng WC, Hwang JL. Delayed Severe Dysmenorrhea After Tubal Ligation in a Patient With Rudimentary Horn: A Case Report. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Acién P, Acién M, Sánchez-Ferrer M. Complex malformations of the female genital tract. New types and revision of classification. Hum Reprod 2004; 19:2377-84. [PMID: 15333604 DOI: 10.1093/humrep/deh423] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Complex malformations of the female genital tract are often incorrectly identified, treated and reported, probably due to not considering the malformation as a cause of the clinical symptoms and neither the embryological origin of the different elements of the genitourinary tract. METHODS Complex malformations are studied and classified, and new types are presented. The new types of complex malformations presented are: (i) Cases of unilateral vaginal or cervico-vaginal atresia with renal agenesis and uterine duplication, with or without communication between hemiuteri; (ii) the unilateral Rokitansky syndrome; and (iii) the combination in the same patient of unilateral Rokitansky syndrome (Müllerian defect) on one side and blind vagina and ipsilateral renal agenesis syndrome (Wolffian defect) on the other side. RESULTS A revised version of the clinical and embryological classification of genital malformations is presented and an associated diagram points out the origin of these malformations. CONCLUSIONS These genital malformative anomalies reaffirm our hypothesis about the embryology of the human vagina as deriving from the Wolffian ducts and the Müllerian tubercle; and they show that gynecologists should be aware of the related symptoms and the embryology of the female genital tract in order to achieve a better comprehension of the malformations for their right correction or therapeutic approach.
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Affiliation(s)
- Pedro Acién
- Service of Obstetrics and Gynecology, San Juan University Hospital and Department/Division of Gynecology, School of Medicine, Miguel Hernández University, Campus of San Juan, Alicante, Spain.
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Abstract
While estimates of the frequency of müllerian duct anomalies vary widely owing to different patient populations, nonstandardized classification systems, and differences in diagnostic data acquisition, these anomalies are clinically important, particularly in women who present with infertility. An understanding of the differences between these uterovaginal anomalies, as outlined in the most widely accepted classification system-that published by the American Fertility Society (AFS) in 1988-is imperative given the respective clinical manifestations, different treatment regimens, and prognosis for fetal salvage. Although the AFS classification system serves as a framework for description of anomalies, communication among physicians, and comparison of therapeutic modalities, there often is confusion about appropriate reporting of certain anomalies, particularly those with features of more than one class. Many of the anomalies are initially diagnosed at hysterosalpingography and ultrasonography; however, further imaging is often required for definitive diagnosis and elaboration of secondary findings. At this time, magnetic resonance imaging is the study of choice because of its high accuracy and detailed elaboration of uterovaginal anatomy. Laparoscopy and hysteroscopy are reserved for women in whom interventional therapy is likely to be undertaken.
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Affiliation(s)
- Robert N Troiano
- Department of Radiology, Weill Medical College of Cornell University, 1300 York Ave, New York, NY 10021, USA.
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Monteagudo A, Strok I, Greenidge S, Timor-Tritsch IE. Quadruplet pregnancy: two sets of twins, each occupying a horn of a septate (complete) uterus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1107-1113. [PMID: 15284471 DOI: 10.7863/jum.2004.23.8.1107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Ana Monteagudo
- Department of Obstetrics and Gynecology, New York University School of Medicine, 550 First Ave, New York, NY 10016, USA.
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Abstract
Congenital uterine anomalies (mullerian duct anomalies) comprise a spectrum of developmental malformations associated with varying degrees of adverse reproductive outcomes. Although traditionally diagnosed by hysterosalpingography or ultrasound, further elaboration of the findings frequently was performed with laparoscopy/laparotomy and hysteroscopy. The need for diagnostic surgical intervention has largely been eclipsed with the advent of magnetic resonance imaging, which has become the imaging modality of choice for characterization of congenital mullerian anomalies.
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Affiliation(s)
- Robert N Troiano
- Department of Radiology, Cornell University of Weill Medical College, New York, New York 10021, USA
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Joki-Erkkilä MM, Heinonen PK. Presenting and long-term clinical implications and fecundity in females with obstructing vaginal malformations. J Pediatr Adolesc Gynecol 2003; 16:307-12. [PMID: 14597020 DOI: 10.1016/s1083-3188(03)00157-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate presenting and long-term clinical consequences in females with obstructing vaginal anomalies. DESIGN A retrospective study. SETTING A university hospital in southern Finland. PARTICIPANTS Twenty-six females with obstructing vaginal malformations. The conditions were classified into transverse vaginal obstruction (transverse septum or imperforate hymen) and longitudinal vaginal obstruction (longitudinal vaginal septum). INTERVENTIOS: 13 out of 16 women with transverse vaginal obstruction underwent incision of the imperforate hymen and three underwent excision of a complete transverse vaginal septum. Ten patients with obstructing hemivagina had incision of the longitudinal vaginal septum. MAIN OUTCOME MEASURES Presenting symptoms and delay in diagnosis, outcome of primary surgical treatment, possible late complaints associated with obstruction, fecundity, perinatal outcome, and presence of other anomalies were studied. The mean followup period in the transverse and longitudinal obstruction group respectively was 13 years (range 1-29) and 16 years (range 1-44). RESULTS Transverse vaginal obstructions were diagnosed within less than a month from the primary symptoms, while the diagnosis of longitudinal obstruction was delayed for an average of 27 months. Two out of three females with transverse vaginal septum underwent re-operation for vaginal constriction and three out of 10 with longitudinal vaginal septum had re-excision of the septum. All females with longitudinal obstruction had uterine and renal malformations as opposed to those with transverse vaginal obstruction. In the transverse vaginal obstruction group, two out of the six females who had their renal status assessed had double ureters. Dysfunctional uterine bleeding (19% in the transverse and 40% in the longitudinal obstruction group), dyspareunia (30% and 0%) and dysmenorrhea (19% and 20%) were the most common complaints during the followup. No endometriosis was found in the group that underwent a subsequent laparotomy or laparoscopy (18/26). Female infertility was not found in those 14 females who were attempting to conceive. Twenty-five (89%) out of 28 pregnancies ended in delivery, the live birth rate being 82% in the longitudinal and 94% in the transverse obstruction group. CONCLUSION Accurate diagnosis together with adequate treatment may reduce the need for re-operations in cases with obstructing vaginal malformations. No specific gynecologic long-term clinical symptoms were identified in obstructing vaginal anomalies.
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Affiliation(s)
- Minna M Joki-Erkkilä
- Department of Obstetrics and Gynecology, Tampere University Hospital, and Medical School, University of Tampere, Tampere, Finland.
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Warne SA, Wilcox DT, Creighton S, Ransley PG. Long-Term Gynecological Outcome of Patients with Persistent Cloaca. J Urol 2003; 170:1493-6. [PMID: 14501643 DOI: 10.1097/01.ju.0000086702.87930.c2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Persistent cloaca is a complex malformation that remains a difficult reconstructive challenge, and data on long-term outcome are scarce. Gynecological abnormalities are common with cloaca but may remain asymptomatic until puberty or adult life. We evaluate long-term gynecological sequelae in these patients with persistent cloaca. MATERIALS AND METHODS The records and radiographs of postpubertal patients (mean age 16.8 years, range 10 to 32) treated for cloacal malformation at 1 institution from 1970 to 2001 were retrospectively reviewed. Outcome data at puberty were available in 41 patients. Of the patients 24 are currently older than 16 years and outcome data for sexual activity were available in 21 with 3 lost to followup. RESULTS All 41 patients were evaluated at puberty, and 28 (68%) had uterine function, 13 (32%) were menstruating normally and 15 (36%) presented with hematometra/hematocolpos. All 15 girls with an obstructed uterus required surgery, which included hysterectomy in 2, partial hysterectomy with vaginoplasty in 3 and vaginoplasty in 9. There was 1 complex case of fistula. Etiology of the obstructed uterus was vaginal stenosis after reconstruction in 3 cases, stenosis of persistent urogenital sinus (no previous reconstruction) in 11 and cervical stenosis in 1. Ten patients experienced primary amenorrhoea, which was confirmed in 8 (20%) while 2 (5%) continue to be followed for possible cryptic obstruction. In 10 girls the diagnosis of absent/vestigial uterus was made at early laparotomy but this was erroneous in 6 in whom uterine function developed at puberty. Of the 21 older girls (age at review 17 to 32 years, mean 24) 12 are or have been sexually active and 6 have been examined by a gynecologist and have an adequate vagina but are not sexually active. To date 4 patients have required revision vaginal surgery in adulthood to facilitate intercourse (re-do vaginoplasty in 3, introitoplasty in 1). One woman has postponed vaginal reconstructive procedures and 2 others are currently being followed. There have been no pregnancies in this series to date. CONCLUSIONS Patients born with persistent cloaca have a high incidence of gynecological problems at the onset of menses and in early adult life. Therefore, it is necessary to reassess these girls at early puberty by ultrasound/magnetic resonance imaging and vaginoscopy. Additional surgery may then be necessary to create a vagina for menstruation and sexual intercourse.
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Affiliation(s)
- S A Warne
- Department of Pediatric Urology, Great Ormond Street Children's Hospital/Insitute of Child Health, Guy's Hospital, London, United Kingdom.
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