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Kumar N, Tayade S. Successful pregnancy outcome in an untreated case of concomitant transverse complete vaginal septum with unicornuate uterus. J Hum Reprod Sci 2015; 7:276-8. [PMID: 25624665 PMCID: PMC4296403 DOI: 10.4103/0974-1208.147497] [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: 09/19/2014] [Revised: 11/18/2014] [Accepted: 11/18/2014] [Indexed: 11/27/2022] Open
Abstract
Transverse vaginal septum is a result of faulty canalization of embryonic vagina. Septum may be complete but usually has laterally placed tiny hole giving an impression of vaginal vault without cervix. We described a case of untreated transverse vaginal septum with small central aperture diagnosed during labor and unicornuate uterus diagnosed intraoperatively, with successful pregnancy outcome.
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Affiliation(s)
- Naina Kumar
- Department of Obstetrics Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Surekha Tayade
- Department of Obstetrics Gynaecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
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Esmaeilzadeh S, Delavar MA, Andarieh MG. Reproductive outcome following hysteroscopic treatment of uterine septum. Mater Sociomed 2014; 26:366-71. [PMID: 25685079 PMCID: PMC4314157 DOI: 10.5455/msm.2014.26.366-371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/05/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Septate uterus is the most common uterine anomaly and a cause for miscarriage and infertility. Existing data suggested a better reproductive outcome of uterine septum following hysteroscopic septum resection. OBJECTIVE Current study was administered to share our experience in hystroscopic septum resection for reproductive outcome following hysteroscopic treatment of uterine septum and specifically focusing on different treatment protocols after hysteroscopic septum resection. METHODS& MATERIALS This study was a cross-sectional study based on secondary data that was obtained from medical records of infertile women who had undergone transvaginal hysteroscopy and used different treatment protocols after hysteroscopic correction of uterine septum in Infertility and Reproductive Health Research Center between April 2005 and February 2014. RESULTS The total number of infertile women underwent hysteroscopy uterine septoplasty was 106. The hysteroscopy septoplasty resulted in an overall pregnancy rate of 67% and a live birth 57.5%. Pregnancy rate for patients who had not male infertility was 92.1%. The chi-square test did not reveal any statistically significant difference in side affect, pregnancy, live birth, abortion, preterm deliveries, and term deliveries rate between these patients either with consistent hormone therapy plus IUD insertion or with alternate hormone therapy plus IUD after hysteroscopic metroplasty. CONCLUSION The findings of the present study indicated hysteroscopic septum resection to remove a uterine septum in women with infertility is safe and may be an efficacious procedure. Treatment following hysteroscopic septum resection, either the consistent or the alternate protocol is both beneficial to improve pregnancy rate.
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Affiliation(s)
- Seddigheh Esmaeilzadeh
- Fatemezahra Infertility and Reproductive Health Research Center, Department of Obstetrics and Gynecology, Babol University of Medical Sciences, Babol, Iran
| | - Mouloud Agajani Delavar
- Fatemezahra Infertility and Reproductive Health Research Center, Department of Midwifery, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Ghanbari Andarieh
- Fatemezahra infertility and Reproductive Health Research Center, Babol University of Medical Science, Babol, Iran
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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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Sugiura-Ogasawara M, Lin BL, Aoki K, Maruyama T, Nakatsuka M, Ozawa N, Sugi T, Takeshita T, Nishida M. Does surgery improve live birth rates in patients with recurrent miscarriage caused by uterine anomalies? J OBSTET GYNAECOL 2014; 35:155-8. [PMID: 25058627 DOI: 10.3109/01443615.2014.936839] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We found that congenital uterine anomalies have a negative impact on reproductive outcome in recurrent-miscarriage couples, being associated with further miscarriage with a normal embryonic karyotype. There has been no study comparing live birth rates between patients with and without surgery. We conducted a prospective study to prove that surgery for a bicornuate or septate uterus might improve the live birth rate. A total of 170 patients with congenital uterine anomalies suffering two or more miscarriages were examined. The live birth rate after ascertainment of anomalies, cumulative live birth rate and infertility rate, were compared between patients with and without surgery. In patients with a septate uterus, the live birth rate (81.3%) at the first pregnancy after ascertainment of anomalies with surgery tended to be higher than that (61.5%) in those without surgery. The infertility rates were similar in both groups, while the cumulative live birth rate (76.1%) tended to be higher than without surgery (60.0%). Surgery showed no benefit in patients with a bicornuate uterus for having a baby, but tended to decrease the preterm birth rate and the low birth weight. The possibility that surgery has benefits for having a baby in patients with a septate uterus suffering recurrent miscarriage could not be excluded.
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Affiliation(s)
- M Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences
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Abstract
PURPOSE OF REVIEW To review the prevalence of congenital uterine anomalies and pregnancy outcomes in patients with these anomalies. RECENT FINDINGS Women with a history of recurrent miscarriage have been estimated to have a 3.2-10.4% likelihood of having a major uterine anomaly except arcuate uterus. Hysterosalpingography and/or 2D ultrasound can be used as the initial screening tools. The American Fertility Society classification of Müllerian anomalies is the most commonly utilized standardized classification. However, there is still no international consensus to distinguish between septate and bicornuate uteri. A total of 35.1-65.9% of patients with bicornuate or septate uteri give live births after correctional surgery. In regard to the live birth rate in the absence of surgery, it has been reported that 33.3-59.5% of patients with such anomalies had a successful first pregnancy after the examination, as compared to 71.7% of individuals with normal uteri (P=0.084), with no significant difference in the cumulative live birth rate (78.0 and 85.5%, respectively) between the two groups. SUMMARY Randomized controlled trials comparing the pregnancy outcomes between cases treated and not treated by surgery among patients with a history of recurrent miscarriage are needed because it is not established whether surgery could improve live birth rate.
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Alami R, Hebert J, Ashraf M, Abuzeid M. Successful Management of Infertile Patient with Trans-Fundal Uterine Membrane. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Reda Alami
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI
| | - John Hebert
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Flint Campus, Flint, MI
| | - Mohammad Ashraf
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Flint Campus, Flint, MI
- IVF Michigan, PC, Flint, MI, and Rochester Hills, MI
| | - Mostafa Abuzeid
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI
- Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Flint Campus, Flint, MI
- IVF Michigan, PC, Flint, MI, and Rochester Hills, MI
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Bohlmann MK, von Wolff M, Luedders DW, Beuter-Winkler P, Diedrich K, Hornemann A, Strowitzki T. Hysteroscopic findings in women with two and with more than two first-trimester miscarriages are not significantly different. Reprod Biomed Online 2010; 21:230-6. [DOI: 10.1016/j.rbmo.2010.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Revised: 02/01/2010] [Accepted: 03/15/2010] [Indexed: 10/19/2022]
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The Arcuate Uterine Anomaly: A Critical Appraisal of Its Diagnostic and Clinical Relevance. Obstet Gynecol Surv 2010; 65:449-54. [DOI: 10.1097/ogx.0b013e3181efb0db] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sugiura-Ogasawara M, Ozaki Y, Kitaori T, Kumagai K, Suzuki S. Midline uterine defect size is correlated with miscarriage of euploid embryos in recurrent cases. Fertil Steril 2010; 93:1983-8. [DOI: 10.1016/j.fertnstert.2008.12.097] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 12/18/2008] [Accepted: 12/18/2008] [Indexed: 10/21/2022]
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Colacurci N, De Franciscis P, Mollo A, Litta P, Perino A, Cobellis L, De Placido G. Small-diameter hysteroscopy with Versapoint versus resectoscopy with a unipolar knife for the treatment of septate uterus: A prospective randomized study. J Minim Invasive Gynecol 2007; 14:622-7. [PMID: 17848325 DOI: 10.1016/j.jmig.2007.04.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 04/02/2007] [Accepted: 04/06/2007] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To compare 2 procedures for metroplasty: resectoscopy with monopolar knife versus small-diameter hysteroscopy fitted with a Versapoint device. DESIGN Prospective randomized study (Canadian Task Force classification I). SETTING Endoscopic gynecology units at tertiary care university hospitals. PATIENTS One hundred-sixty patients with septate uterus and a history of recurrent abortion or primary infertility undergoing hysteroscopic metroplasty from 2001 to 2005. INTERVENTIONS Hysteroscopic resection of the uterine septum performed with either a 26F resectoscope with unipolar knife (80 women, group A) or a 5-mm diameter hysteroscope with Versapoint device (80 women, group B). All patients were managed expectantly, with follow-up lasting 1 year. MEASUREMENTS AND MAIN RESULTS Operative parameters (operative time, fluid absorption, complications, need for second intervention) and reproductive outcome parameters (pregnancy, abortion, term and preterm delivery, modality of delivery, cervical cerclage) were measured. Operative time and fluid absorption were significantly greater in group A than in group B (23.4 +/- 5.7 vs 16.9 +/- 4.7 minutes and 486.4 +/- 170.0 vs 222.1 +/- 104.9 mL, respectively). The cumulative complication rate was significantly lower in group B than in group A. No difference in any of the reproductive parameters was observed between the 2 groups: pregnancy and delivery rates were 70% and 81.6% in group A vs 76.9% and 84% in group B. Nine women (18.4%) from group B and 8 women (16%) from group B experienced spontaneous abortions. Most patients (54/82) delivered by cesarean section without differences according to the hysteroscopic technique used for metroplasty (65% in group A vs 67.7% in group B) or to the gestational age (65.1% of term and 68.7% of preterm deliveries). CONCLUSIONS Small-diameter hysteroscopy with bipolar electrode for the incision of uterine septum is as effective as resectoscopy with unipolar electrode regarding reproductive outcome and is associated with shorter operating time and lower complication rate.
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Affiliation(s)
- Nicola Colacurci
- Department of Gynecology, Obstetrics and Reproductive Sciences, Second University of Naples, Naples, Italy
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Lejeune V. Fausses couches spontanées précoces répétées : quelle prise en charge proposer en 2006 ? ACTA ACUST UNITED AC 2006; 34:927-37. [PMID: 16987688 DOI: 10.1016/j.gyobfe.2006.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 08/09/2006] [Indexed: 10/24/2022]
Abstract
More than 1% of the couples whishing children suffer from recurrent miscarriage, but investigations and treatment are not consensual. Most patients have several risk factors, and a minimum investigation of known factors has to be undertaken: karyotyping of the couple, hysteroscopy for searching uterine anatomic anomalies, evaluation for thrombophilias (anticardiolipin antibodies, lupus anticoagulant, protein C activity, Proteine S activity, factor V Leiden and factor II mutations, activated protein C resistance), antinuclear antibodies. Systemic diseases (like lupus) and endocrine abnormalities (like thyroid diseases and diabetes mellitus) have to be detected by clinical examination and questioning. No endocrine investigation is recommended, unless irregular menstruations or sterility. Research in recurrent pregnancy loss are conducted in new associated factors, such as skewed-X-chromosome inactivation, maternal HLA types, modifications in specific immune molecules and cells regulation. Therapeutic proposals are preimplantation genetic diagnosis in case of abnormal karyotiping, hysteroscopic surgery for septate uterus, aspirin plus heparin in antiphospholipid-positive patients, and aspirin plus corticosteroids in systemic lupus. Heparin seems to improve obstetrical prognosis for patients with congenital or acquired thrombophilias, but there are only few studies carried out on the subject. This new therapeutic approach should incite the patients with a negative medical appraisal to be referred to specialized consultations in order to include them in eventual clinical tests. Finally, empathic listening and psychological support are necessary in a pathology with multiple etiological factors.
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Affiliation(s)
- V Lejeune
- Service de gynécologie-obstétrique, centre hospitalier général, allée Marie-Clarac, 32000 Auch, France.
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12
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Jakiel G, Robak-Cholubek D. Successful outcome of twin gestation after endoscopic metroplasty of complete septate uterus. Gynecol Obstet Invest 2006; 62:17-9. [PMID: 16508322 DOI: 10.1159/000091791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 01/12/2006] [Indexed: 11/19/2022]
Abstract
The successful outcome of twin gestation after the endoscopic metroplasty of uterus septus class Va was described. Authors described and discussed the technical details of diagnosis and treatment of this rare malformation. Five months after treatment the patient spontaneously became pregnant. The pregnancy was determined as dizygotic twins. The cesarean section was performed in the 36th week of gestation because of growth arrest of one fetus and two healthy newborns were delivered.
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Affiliation(s)
- G Jakiel
- Department of Reproduction and Andrology, Medical University of Lublin, Lublin, Poland.
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Sánchez V, Guillén V, Benito V, Torres A, Domingo J, García J. Rotura uterina en gestación a término tras metroplastia histeroscópica. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/s0304-5013(05)72402-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Routine office hysteroscopy in the investigation of infertile couples prior to assisted reproduction. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ics.2004.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Patton PE, Novy MJ, Lee DM, Hickok LR. The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum. Am J Obstet Gynecol 2004; 190:1669-75; discussion 1675-8. [PMID: 15284765 DOI: 10.1016/j.ajog.2004.02.046] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate the diagnostic management and the reproductive outcome after surgical repair of a rare reproductive malformation. STUDY DESIGN Sixteen women with a complete septate uterus, double cervix, and a longitudinal vaginal septum were referred for evaluation. Presenting complaints were chiefly pregnancy loss in parous women (n=9) and dyspareunia in nulligravid women (n=7). The combination of hysterosalpingography, ultrasonography, and/or magnetic resonance imaging was used to correctly identify the anomaly in 15 of the 16 cases. Both hysteroscopic (n=11) and transabdominal (n=5) surgical techniques were used to repair the uterine septum. RESULTS In no case was the correct diagnosis made before referral; the uterus didelphys was the most common misdiagnosis. The preoperative pregnancy loss was 81%. Postoperatively, 12 women conceived for a total of 17 pregnancies; there were 14 term live births or ongoing pregnancies in the third trimester (82%), with a first trimester spontaneous abortion rate of 18%. In 9 women who conceived after hysteroscopic surgery, term live births occurred in 9 of 12 (75%) conceptions. A modified Tompkins metroplasty was performed in 5 women with subsequent term live births or ongoing third trimester pregnancies in 5 of 5 (100%) patients. CONCLUSION The identification of a duplicated cervix and a vaginal septum is consistent with several uterine malformations, which leads to frequent misdiagnosis and errors in management. Significant pregnancy wastage, obstetric complications, and dyspareunia are common, and surgical treatment is therefore advisable. Making the best choice between hysteroscopic or transabdominal metroplasty depends on the anatomic features of the cervix and the uterine cavity, but optimal patient management requires familiarity with both techniques.
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Affiliation(s)
- Phillip E Patton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, USA
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Proctor JA, Haney AF. Recurrent first trimester pregnancy loss is associated with uterine septum but not with bicornuate uterus. Fertil Steril 2003; 80:1212-5. [PMID: 14607577 DOI: 10.1016/s0015-0282(03)01169-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Determine the relative frequency of having a uterine septum or bicornuate uterus in women presenting with first trimester recurrent pregnancy loss and a divided uterine cavity by hysterosalpingography (HSG) or hysteroscopy. DESIGN Retrospective analysis of the frequency of a uterine septum or a bicornuate uterus in all patients undergoing surgery (laparoscopy and hysteroscopy) with the clinical presentation of recurrent pregnancy loss and a divided uterine cavity between January 1995 and October 2002. SETTING An academic medical center. PATIENT(S) Thirty-five consecutive, premenopausal women with a divided uterine cavity on preoperative HSG or hysteroscopy. INTERVENTION(S) Diagnostic laparoscopy and diagnostic hysteroscopy. MAIN OUTCOME MEASURE (S): A fused uterine fundus at laparoscopy indicating a uterine septum. RESULT(S) All 35 patients had a uterine septum. CONCLUSION(S) When presenting with recurrent first trimester pregnancy loss and a divided uterine cavity by HSG or hysteroscopy, virtually all the women have a uterine septum.
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Affiliation(s)
- Jon A Proctor
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Marten K, Vosshenrich R, Funke M, Obenauer S, Baum F, Grabbe E. MRI in the evaluation of müllerian duct anomalies. Clin Imaging 2003; 27:346-50. [PMID: 12932688 DOI: 10.1016/s0899-7071(02)00587-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Müllerian duct anomalies (MDAs) result from nondevelopment or nonfusion of the müllerian ducts and occur in 1-5% of women. Accurate diagnosis of the various subtypes is of great importance as MDAs are frequently associated with a broad variety of clinical symptoms. Recently, evidence arose that MRI might play a major role in diagnosis of MDAs. We present four cases of diverse subtypes of MDAs and the corresponding MRI findings. MATERIALS AND METHODS Patients (n = 4) with clinical suspicion of MDAs were examined with MRI. Coronal and transaxial T1- and T2-weighted images were acquired. Diagnosis was made and patients were grouped according to the American Fertility Society's classification. Patients underwent laparoscopy or laparotomy in order to confirm the diagnosis. RESULTS MRI revealed MDAs in all patients. In detail, one patient was diagnosed with hypoplastic uterus, one with unicornuate uterus with a noncommunicating rudimentary horn, one with bicornuate uterus bicollis with a double vagina and one with septate uterus. MRI diagnosis was correct in all cases, as confirmed by subsequent surgical intervention. CONCLUSION MRI is a valuable tool in diagnosis of MDA subtypes. Its use will help to spare patients mutilating surgery and to prevent pregnancy-associated complications.
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Affiliation(s)
- K Marten
- Department of Radiology, Georg August University, Robert-Koch-Str. 40, D-37075 Goettingen, Germany
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Colacurci N, De Franciscis P, Fornaro F, Fortunato N, Perino A. The significance of hysteroscopic treatment of congenital uterine malformations. Reprod Biomed Online 2003; 4 Suppl 3:52-4. [PMID: 12470566 DOI: 10.1016/s1472-6483(12)60117-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hysteroscopic surgery replaced abdominal metroplasty and is today the treatment of choice for congenital uterine malformations. This is not just because of its reproductive results, which are comparable to those achieved with the abdominal approach, but mainly because of several post-operative benefits (reduced morbidity, convalescence and costs, and no scar tissue on the abdominal and uterine walls), improved reproductive performance (no reduction in uterine volume, shorter interval to conception after operation) and the mode of delivery (avoiding Caesarean section). Decisions on when and how to treat uterine septa, in relation to the type of malformation, are discussed. In particular, indications for treatment have been broadened to include not only the septate uterus associated with adverse reproductive outcome, but also patients before any potential obstetric accidents, especially in those with declining fecundity (>35 years), with reproductive problems (unexplained infertility) and before assisted reproductive techniques, as well as in women with no actual desire of pregnancy. Two types of hysteroscopic treatment are available: resectoscopic and office hysteroscopic surgery. The indications for resectoscopic surgery are broad-based septa and complete septa with single or double cervix. The resectoscope allows an excellent continuous flow system, providing continuous washing of the uterine cavity and a clear view, removing bubbles and debris during the procedure. However, an exact measurement of fluid balance must be performed to avoid excessive fluid intravasation. Laparoscopic or sonographic monitoring is mandatory. Treatment of limited-based small septa whose apex is easily visible can be achieved with an outpatient approach using office mini-hysteroscopic surgery and the vaginoscopic technique. The intra-operative check of the fundus is performed by ultrasonography. No preparation of the endometrium is required, except for large, broad-based septa, and hormonal therapy and intrauterine devices are not utilized post-operatively. The post-operative follow-up consists of a hysteroscopic check performed 1-3 months after surgery.
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Affiliation(s)
- Nicola Colacurci
- Institute of Gynaecology and Obstetrics, School of Medicine, Second University of Naples, Naples, Italy.
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García-Enguídanos A, Calle ME, Valero J, Luna S, Domínguez-Rojas V. Risk factors in miscarriage: a review. Eur J Obstet Gynecol Reprod Biol 2002; 102:111-9. [PMID: 11950476 DOI: 10.1016/s0301-2115(01)00613-3] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Miscarriage is one of the most frequent problems in human pregnancy. The most widely accepted definition is that proposed by the World Health Organization (WHO) in 1977. The incidence among clinical pregnancies is about 12-15% but including early pregnancy losses it is 17-22%. The only two etiologic factors recognized by all authors are uterine malformations and parental balanced chromosomal rearrangements. There have been many other suggested risk factors. In this revision we discuss these.
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Zabak K, Bénifla JL, Uzan S. [Septate uterus and reproduction disorders: current results of hysteroscopic septoplasty]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2001; 29:829-40. [PMID: 11770278 DOI: 10.1016/s1297-9589(01)00228-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Uterus septus is the most frequent congenital uterine anomalies caused by insufficient resorption of the müllerian ducts. Retrospective statistical analysis shows that the uterine septa have the worst reproductive outcome with a high incidence of early abortions. It is well recognized that it increased the incidence of recurrent (> or = 3) miscarriages (79% among 1,601 pregnancies), reproductive failure and obstetric complications. A septate uterus does not seem to be an infertility factor. On the other hand, the incidence of unexplained infertility was significantly higher (40%) in the patients with secondary infertility; thus, a contribution from the uterine septum in delayed conception of these patients cannot be excluded. Hysteroscopic surgery has replaced conventional abdominal route. Hysteroscopic metroplasty improves obstetrical prognosis in women with septate uterus, and it's advantages are easiness, low morbidity rate, without the hysterotomy's consequences like adnexial adhesions. Metroplasty is indicated in women with a history of miscarriages (2 or more), which decreased to 15%, in patients with an unexplained infertility, and in women in whom assisted reproductive treatment is being contemplated. Combined with laparoscopy, the hysteroscopic metroplasty is the gold standard for assessing uterine septa, especially in these infertile women. Laparoscopy also is required to complete the diagnostic work up of infertility, and provides an opportunity to treat any coexisting pelvic pathology.
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Affiliation(s)
- K Zabak
- Service de gynécologie obstétrique, Hôpital Rothschild, 33, bd de Picpus, 75571 Paris, France.
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Kupesic S. Clinical implications of sonographic detection of uterine anomalies for reproductive outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:387-400. [PMID: 11779002 DOI: 10.1046/j.0960-7692.2001.00539.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The purpose of this review article was to analyze the literature on the prevalence, diagnosis and treatment of the congenital uterine anomalies and to discuss current dilemmas on their influence on reproductive outcome. Congenital uterine anomalies are commonly associated with repeated pregnancy failure, in particular an increased risk of first- and second-trimester miscarriages and preterm delivery. Recent reports on two-dimensional and three-dimensional transvaginal ultrasound and saline contrast sonohysterography appear promising for diagnosis and classification of congenital uterine anomalies. The ability to visualize both the uterine cavity and the fundal uterine contour on a three-dimensional scan facilitates the diagnosis of uterine anomalies and enables differentiation between septate and bicornuate uteri. Color Doppler ultrasound allows visualization of intraseptal vascularity and may help in distinguishing the avascular from the vascular septum. Less connective tissue in the septum may result in poor decidualization and placentation, while an increased amount of muscle tissue in the septum can cause miscarriage by the production of local uncoordinated myometrial contractility. Hysteroscopic septum excision is an effective procedure which improves live-birth rates. Because of its simplicity, minimal invasiveness, low morbidity and low cost, a more liberal approach to the treatment of uterine anomalies is being advocated.
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Affiliation(s)
- S Kupesic
- Department of Obstetrics and Gynecology, Medical School University of Zagreb, Sveti Duh Hospital, Croatia.
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