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Yuan ZL, Ren J, Huang ML, Qi YF, Gao X, Sun YY, He YL, Zhu L, Xue HD. A new magnetic resonance imaging-based PUMCH classification system for congenital cervical malformations: devising a standardised diagnosis pathway. Insights Imaging 2024; 15:177. [PMID: 39020237 PMCID: PMC11255164 DOI: 10.1186/s13244-024-01708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/26/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To develop an innovative magnetic resonance imaging (MRI)-based PUMCH (Peking Union Medical College Hospital) classification system aimed at standardising the diagnosis of congenital cervical malformations (CCMs) by identifying their distinctive MRI features. METHODS Seventy-nine consecutive patients with CCM underwent pre-treatment pelvic MRI; three experienced gynaecological radiologists retrospectively analysed these images. Qualitative assessments included Rock et al's classification; PUMCH classification; haematometra; cervical signal features; ovarian endometriosis; haematosalpinx; and uterine, vaginal, urinary, and musculoskeletal malformations. Quantitative assessments involved the uterine volume, sagittal cervical length, and maximum ovarian cross-sectional area. The surgical treatment types were also recorded. Statistical methods were used to incorporate differences in clinical features and surgical methods into our classification. RESULTS Morphologically, CCMs were categorised into three types: type I (53%) was characterised by the presence of a cervix with visible cervical canals; type II (23%) featured an existing cervix with concealed cervical canals; and type III (24%) indicated cervical aplasia, which involves a blind end in the lower part of the uterine corpus. Haematometra was significantly more prevalent in patients with type I CCM than in those with type II (p < 0.001). There were three cervical signal patterns: no signal (27%), no evident layer differentiation (21%), and multi-layer differentiation with haematocele (52%). Most patients (94%) had complete vaginal atresia. Type I CCM patients had a higher likelihood of regaining normal uterovaginal anatomy compared to types II and III. CONCLUSIONS Our proposed PUMCH classification system has a high potential for enhancing the efficiency of clinical diagnosis among patients with CCM. CRITICAL RELEVANCE STATEMENT The proposed new PUMCH classification promised to elevate the conventional diagnostic trajectory for congenital cervical malformations, offering a valuable framework to refine the selection and planning of surgical interventions, thereby enhancing overall clinical efficacy. KEY POINTS Effective classification of congenital cervical malformations is desirable to optimise the diagnostic process. We presented a PUMCH classification of congenital cervical malformations using pelvic MRI. The new classification significantly aids clinical triage for congenital cervical malformations.
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Affiliation(s)
- Zhi-Lin Yuan
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jing Ren
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Meng-Lin Huang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Ya-Fei Qi
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xin Gao
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yi-Ying Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Yong-Lan He
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China.
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.
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Xu X, Tian Y, Zhou J, Li Z, Meng L, Huang X, Zhang M. A rare case report of Herlyn-Werner-Wunderlich syndrome: Unraveling unusual urinary anomalies and literature review. Heliyon 2024; 10:e33558. [PMID: 39071571 PMCID: PMC11276916 DOI: 10.1016/j.heliyon.2024.e33558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare congenital genitourinary abnormality defined by uterine didelphys, obstructed hemivagina, and ipsilateral urological anomalies. Accurate diagnosis and prompt commencement of therapy can be difficult owing to heterogeneous genitourinary malformation among different patients. This is a case report of a patient with rare HWWS with uterine didelphys, obstructed hemivagina, vagina-ureteral remnant fistula (Gartner's duct cyst), and ipsilateral kidney dysgenesis who complained of intermittent abdominal pain during menstruation. The right ureteral remnant of the patient was distinctive, with three portions. The upper section was connected to the right dysplastic kidney, the lower section formed the fistulous tract with the vagina and bladder, while the middle section communicated with Gartner's Duct Cyst, which merged with the vagina and opened to the posterior cavity of hemivagina. The lower section of the right ureter was excised and ligated during laparoscopic surgery, while the upper section was excised. The patient recovered after surgery. We presented this rare case and conducted a literature review to provide a more comprehensive understanding of HWWS. This could help gynecologists effectively reduce misdiagnosis and missed diagnosis, especially when combined with complicated urinary malformation.
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Affiliation(s)
- Xiaotong Xu
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China
| | - Yanpeng Tian
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China
| | - Jingwen Zhou
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China
- Department of Gynecology, Loujiang New City Hospital of Taicang, Suzhou, Jiangsu, 215334, PR China
| | - Zhongkang Li
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China
| | - Li Meng
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China
| | - Xianghua Huang
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China
| | - Mingle Zhang
- Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, PR China
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Suker A, Li Y, Robson D, Marren A. Australasian Recurrent Pregnancy Loss Clinical Management Guideline 2024 Part I. Aust N Z J Obstet Gynaecol 2024. [PMID: 38934264 DOI: 10.1111/ajo.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/03/2024] [Indexed: 06/28/2024]
Abstract
Guidelines for the investigation and management of recurrent pregnancy loss (RPL) have been developed in Europe, USA and UK, but there is currently no Australasian guideline. The Australasian Certificate of Reproductive Endocrinology and Infertility Consensus Expert Panel on Trial Evidence group has prepared a two-part guideline to provide guidance on the management of RPL. In Part I chromosomal, anatomical, and endocrine factors are outlined along with relevant recommendations for clinical management, levels of evidence and grades of consensus. In Part II thrombophilia, autoimmune factors, infective, inflammatory, and endometrial causes, environmental and lifestyle factors, male factor and unexplained causes will be outlined.
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Affiliation(s)
- Adriana Suker
- Department of Obstetrics & Gynaecology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ying Li
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
| | - Danielle Robson
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
| | - Anthony Marren
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
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Aslan B, Şükür YE, Özmen B, Sönmezer M, Berker B, Aytaç R, Atabekoğlu CS. Proposal for Diagnostic Criteria of Y-Shaped Dysmorphic Uterus Based on 3-Dimensional Transvaginal Ultrasound Measurements. J Minim Invasive Gynecol 2024; 31:504-510. [PMID: 38553000 DOI: 10.1016/j.jmig.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
STUDY OBJECTIVE To define objective and readily applied diagnostic criteria for Y-shaped uteri using 3-dimensional transvaginal ultrasound (3D-TVUS) volume recordings. DESIGN A retrospective case-control diagnostic measurements study. SETTING A tertiary university hospital's reproductive health and research center. PATIENTS Two hundred thirteen patients who presented with infertility between January 2020 and December 2022. INTERVENTIONS Two blinded physicians re-evaluated the 3D-TVUS images of all patients for the presence of a uterine abnormality. The images of patients with a Y-shaped uterus were re-evaluated, and descriptive measurements were done. MEASUREMENTS AND MAIN RESULTS The most common uterine abnormality in this cohort was the Y-shaped uterus with a prevalence of 12.2%, followed by the arcuate, T-shaped, and septate uteri, respectively. Reviewers identified 26 and 28 Y-shaped uteri, respectively, and came to a consensus on 25 images. Diagnostic criteria for the Y-shaped uterus based on 3D-TVUS findings have been specified as: lateral indentation depths between 4 and 7 mm, fundal indentation depth between 5 and 9 mm, lateral indentation angles between 121° and 149°, fundal indentation angle between 121° and 145°, and Y-angles 25° to 46°. CONCLUSION Some subtypes of dysmorphic uteri, such as the Y-shaped uterus, whose clinical significance is unknown and may be variants of the normal, may actually be more common than thought. Determining objective diagnostic criteria with 3D-TVUS will allow standard research on these anomalies and their clinical significance.
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Affiliation(s)
- Batuhan Aslan
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
| | - Batuhan Özmen
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Sönmezer
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Bülent Berker
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Ruşen Aytaç
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Cem Somer Atabekoğlu
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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Navarro V, Acién M, Acién P. Applicability and Suitability of the Embryological-Clinical Classification of Female Genital Malformations: A Systematic Review. J Clin Med 2024; 13:2988. [PMID: 38792529 PMCID: PMC11121905 DOI: 10.3390/jcm13102988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Complex urogenital malformations are clinically highly relevant; thus, they must be appropriately diagnosed and classified before initiating treatment. Background/Objectives: This study aimed to evaluate the applicability and suitability of the embryological-clinical classification of female genital malformations. Methods: A systematic review of cases of genital malformations reported in the literature from 2000 to 2020 was conducted. Case reports and series with the following combinations: "female genital tract" AND (malformation OR anomaly OR müllerian anomaly OR uterine anomaly OR cervical anomaly OR vaginal anomaly OR cloacal anomaly OR urogenital sinus); and "female genital tract" AND (renal agenesis OR ectopic ureter) were searched. A total of 3124 articles were identified, of which 824 cases of genital malformation were extracted. The characteristics of each malformation were included in a database for further analyses. Results: Using the embryological-clinical classification, 89.9% of the published cases and 86.5% of the 52 cases defined as unclassifiable by their authors have been classified in this review. In 73 cases (72.2%), the classification of the malformation using the AFS system was incomplete because although the type of uterine anomaly of the AFS classification matched that of the embryological-clinical classification, characteristics of the urinary system or the vagina were overlooked when using the AFS system. Following a dispersion matrix, we have been able to show that the embryological-clinical classification system is able to classify and subclassify the genitourinary malformations more accurately. Conclusions: The applicability of the embryological-clinical classification has been confirmed after classifying most of the cases of genital malformation previously published. This system also provides a more complete and accurate classification than other classifying systems exclusively based on Müllerian duct development or uterovaginal parameters, demonstrating its suitability.
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Affiliation(s)
- Victoria Navarro
- Obstetrics and Gynecology Service, Elda University Hospital, 03600 Elda, Alicante, Spain;
- Reproductive Biopathologies Mixed Research Unit FISABIO-UA-UMH, 03550 San Juan, Alicante, Spain
| | - Maribel Acién
- Reproductive Biopathologies Mixed Research Unit FISABIO-UA-UMH, 03550 San Juan, Alicante, Spain
- Obstetrics and Gynecology Service, San Juan University Hospital, 03550 San Juan, Alicante, Spain
- Division of Gynecology, Miguel Hernández University, Campus of San Juan, 03550 San Juan, Alicante, Spain;
- Grant Next Generation EU-EGA Institute for Women’s Health, University College London, London WC1E 6DE, UK
| | - Pedro Acién
- Division of Gynecology, Miguel Hernández University, Campus of San Juan, 03550 San Juan, Alicante, Spain;
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Kerimkulova MK, Oliveira Souza Lima SR, Elamin AE, Hamid YH, Faran N, Khan I. Multidisciplinary Management of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome in an Adolescent With Complex Congenital Anomalies: A Case Report. Cureus 2024; 16:e56961. [PMID: 38665700 PMCID: PMC11044895 DOI: 10.7759/cureus.56961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome presents with complex diagnostic and therapeutic challenges and is characterized by uterine didelphys, obstructed hemivagina, and ipsilateral renal anomaly. A 14-year-old female with a history of anorectal malformation and urogenital sinus anomaly presented with menstrual blood in her urine, abdominal pain, and distension. Investigations revealed a bicornuate uterus, vesicovaginal fistula, and right ovarian cyst, leading to the diagnosis of OHVIRA syndrome. A multidisciplinary approach resulted in salpingo-oophorectomy and subtotal hysterectomy. This case highlights the diagnostic challenges and emphasizes the role of advanced imaging and a multidisciplinary team in managing such complex conditions. It stresses the importance of patient-centered surgical planning tailored to the individual's anatomy and reproductive goals. Early recognition and a tailored, multidisciplinary approach are crucial in managing OHVIRA syndrome and improving outcomes for patients with rare congenital anomalies.
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Affiliation(s)
| | | | | | - Yusra H Hamid
- Community Medicine, University of Khartoum, Faculty of Medicine, Khartoum, SDN
| | - Nuzhat Faran
- Internal Medicine, Fatima Memorial Hospital, Lahore, PAK
| | - Ismail Khan
- Internal Medicine, Nishtar Medical University, Multan, PAK
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Kiblboeck S, Oppelt P, Oppelt P, Stein R, Ommer S, Pavlik R, Rall K, Kongrtay K, Wagner H, Hermann P, Trautner PS. Can Classifications Adequately Represent Genital Malformations?: EVA Study ( E SHRE/ESGE | V CUAM | A FS) - A Prospective Multicenter Study to Evaluate the Current Female Genital Malformation Classifications. Geburtshilfe Frauenheilkd 2023; 83:827-834. [PMID: 37564897 PMCID: PMC10410643 DOI: 10.1055/a-2043-9982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/20/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction Genital malformations are a common clinical occurrence that can be represented using different classifications. Reproducibility is an essential quality characteristic for a classification, and it plays an important role, especially in consultations and the treatment of infertile patients and in obstetric management. The aim of this study is to demonstrate the reproducibility and clinical practicality of three commonly used classifications: the ESHRE/ESGE (European Society of Human Reproduction and Embryology/ European Society for Gynecological Endoscopy), VCUAM (Vagina Cervix Uterus Adnex-associated Malformation), and AFS (American Fertility Society) classifications. Materials and Methods Sixty-five patients with female genital malformations were included in this prospective, multicenter, exploratory, observational study. All participants underwent a clinical examination and a medical interview. The investigators were instructed to classify the presenting malformations according to the ESHRE/ESGE, VCUAM, and AFS classifications using a structured questionnaire. Investigators were asked whether the malformation could be reproducibly classified (yes/no) and about the grade (grade 1-5 from "very good" to "deficient") they would assign to each classification. Classification assessment was queried for vagina, cervix, uterus, adnexa, and associated malformations and was scored from 1 to 5. Results Reproducibility was rated as 80% (n = 52/65), 92.3% (n = 60/65), and 56.9% (n = 37/65) for the ESHRE/ESGE, VCUAM, and AFS classification, respectively. ESHRE/ESGE, VCUAM and AFS were rated as "very good" or "good" for 83.3%, 89.2%, and 10.8% of vaginal malformations; for 75.8%, 87.5%, and 24.2% of cervical malformations; and for 89.7%, 89.5%, and 86.2% of uterine malformations, respectively. VCUAM was rated as "very good" or "good" for 77.8% and 69.6% of adnexal malformations and associated malformations, respectively. ESHRE/ESGE and AFS were rated as "sufficient" or "deficient" for 100% and 75% of adnexal malformations and for 77.3% and 69.6% of associated malformations, respectively. Conclusion The prospective multicenter EVA ( E SHRE/ESGE | V CUAM | A FS) study revealed that the organ-based ESHRE/ESGE and VCUAM classifications of female genital malformations perform better in terms of reproducibility as well as in the assessment of individual compartments than the non-organ-based AFS classification.
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Affiliation(s)
- Stephanie Kiblboeck
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Johannes Kepler Universität Linz, Linz, Austria
| | - Peter Oppelt
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Johannes Kepler Universität Linz, Linz, Austria
| | - Patricia Oppelt
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim,
Germany
| | - Stefanie Ommer
- Department of Pediatric Surgery, University Hospital Jena, Jena, Germany
| | | | - Katharina Rall
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Kuralay Kongrtay
- Clinical Academic Department of Women’s Health, Corporate fund “University Medical Center”, Astana, Kazakhstan
| | - Helga Wagner
- Department of Applied Statistics, Johannes Kepler University Linz, Linz, Austria
- Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, Linz, Austria
| | - Philipp Hermann
- Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, Linz, Austria
| | - Philip Sebastian Trautner
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Johannes Kepler Universität Linz, Linz, Austria
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Csöbönyeiová M, Klein M, Feitscherová C, Pavlíková L, Kachlík D, Varga I. The Overview of Anatomical Variations and Congenital Anomalies of the Uterine Tubes and Their Impact on Fertility. Physiol Res 2022. [DOI: 10.33549/physiolres.935035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Anatomical variations and congenital anomalies of the uterine tubes (UTAVsCAs) are rare conditions, which are often undiagnosed, or accidentally diagnosed upon imaging, laparotomy, laparoscopy for unrelated condition, or during the Cesarean section. UTAVsCAs are often asymptomatic, but their clinical relevance lies in their possibly adverse impact on fertility. Since their rare occurrence, they are usually published as case reports. The most typically described are: agenesis of the uterine tubes (UTs), accessory UT (UT duplication), accessory UT ostium, and paratubal cysts (e.g. the hydatid cyst of Morgagni). UTAVsCAs are classified into an umbrella category of Müllerian duct anomalies (MDAs) which comprises anomalous development of all the organs developing from the paramesonephric (Müllerian) ducts, i.e., UTs, uterus and upper portion of the vagina. Interestingly, most of the classification systems of MDAs discuss solely the uterine and vaginal anomalies, while the UTs are often utterly ignored. This probably originates from the fact that UTs are no longer interesting for many clinicians as they think of UTs as superfluous organs whose function can be easily replaced in the in vitro fertilization (IVF) laboratory. Indeed, the modern reproductive medicine has been helping enormously with the conception of infertile couples. In many instances, the UTs are in fact successfully bypassed and a “test-tube” baby is born. Nevertheless, the UTs are still absolutely unique in providing suitable environment for fertilization and early embryo development - processes that hasn´t been still completely understood. This fact could partially explain why the success rate of IVF is “only” around 30-50 % depending on age. Therefore, the research of the UTAVsCAs is still clinically relevant in the context of reproductive medicine and should not be omitted from research endeavors.
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Affiliation(s)
| | | | | | | | | | - I Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic.
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Uncommon Surgical Emergencies in the Adult Gynecologic Patient: Two Cases of Missed Diagnosis of Outflow Tract Obstruction from Congenital Uterine Anomalies. Case Rep Obstet Gynecol 2022; 2022:3179656. [DOI: 10.1155/2022/3179656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022] Open
Abstract
Gynecologic emergencies may result from congenital uterine anomalies (CUAs) with outflow tract obstruction. Not limited to the “classic” presentation of an adolescent amenorrheic pain patient, such anomalies should be part of the differential diagnosis for adult female patients presenting with severe pelvic pain. Obstructed rudimentary noncommunicating cavitary horns may result in severe chronic or acute pain and necessitate urgent surgical management. While two-dimensional (2D) ultrasound is often the initial diagnostic tool, three-dimensional (3D) ultrasound and MRI can accurately delineate CUAs for definitive diagnosis. When excision of a rudimentary horn is required, a laparoscopic approach is preferable. This case series focuses on two adult patients with severe pelvic pain due to unicornuate uteruses with obstructed noncommunicating cavitated rudimentary horns. Both cases involve a delayed diagnosis, the inability to make the diagnosis at standard surgical observation, and the resultant need for urgent surgical management.
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10
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Zarfati A, Lucchetti MC. OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly or Herlyn-Werner-Wunderlich syndrome): Is it time for age-specific management? J Pediatr Surg 2022; 57:696-701. [PMID: 35487798 DOI: 10.1016/j.jpedsurg.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly or Herlyn-Werner-Wunderlich syndrome) is a rare Müllerian malformation. Usually, symptoms begin with worsening dysmenorrhea in post-menarche adolescents. The management in pre-menarche period is controversial and has only recently been subject of study. AIMS To review the experience of a pediatric tertiary center and to propose an age-specific management protocol for patients diagnosed before menarche. METHODS A retrospective cohort study (review of medical records - period 2009-2021). RESULTS Twenty-eight patients were diagnosed (mean age 11.9 years), seven (25%) before menarche, one (3%) perinatally. One patient had Floating-Harbor syndrome. Twenty-three patients had ipsilateral renal agenesis, while five had a multicystic-dysplastic kidney. The contralateral kidney showed hypertrophy in 25 patients, pelvicalyceal ectasia in 8 and dysplasia in 1. Twenty-four patients were symptomatic. Three of the seven diagnosed prior to menarche had symptoms. All post-menarche diagnosed patients were symptomatic. Twenty-six patients underwent surgery (one-stage drainage, vaginal septal resection, and vaginoplasty). Asymptomatic pre-menarche patients were followed-up until surgery after menarche onset. No patient underwent surgery prior to menarche solely for OHVIRA diagnosis. At follow-up (median 3.5 years, 3 lost to follow-up), eighteen patients were asymptomatic, one developed endometriosis, one had impaired renal function, two needed reoperations. CONCLUSIONS Pre-menarche OHVIRA patients, without symptoms, should undergo regular follow-up until the onset of menarche. Surgery must be considered in post-menarche or symptomatic patients. Post-operative, long-term follow-up is required, evaluating both renal and gynecological issues. LEVEL-OF-EVIDENCE IV.
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Affiliation(s)
- Angelo Zarfati
- Department of Pediatric Surgery, Bambino Gesù Pediatric Hospital, Piazza di Sant'Onofrio, 4, Roma 00165, Italy; University of Rome Tor Vergata, Via Cracovia, 50, Roma 00133, Italy.
| | - Maria Chiara Lucchetti
- Department of Pediatric Surgery, Bambino Gesù Pediatric Hospital, Piazza di Sant'Onofrio, 4, Roma 00165, Italy
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11
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Fedele F, Parazzini F, Vercellini P, Bergamini V, Fedele L. Reconstructive surgery for congenital atresia of the uterine cervix: a systematic review. Arch Gynecol Obstet 2022:10.1007/s00404-022-06825-5. [DOI: 10.1007/s00404-022-06825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/11/2022] [Indexed: 11/02/2022]
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12
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Fontana E, Parma M, Fedele F, Girardelli S, Parazzini F, Candiani M. Forty-two normomenstruating adolescents with Müllerian obstructive anomalies: Presentation, pitfalls in the dagnosis and surgical management. Acta Obstet Gynecol Scand 2022; 102:92-98. [PMID: 36285343 PMCID: PMC9780719 DOI: 10.1111/aogs.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 07/03/2022] [Accepted: 08/18/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION We analyzed the frequency, presentation and pitfalls in the diagnosis and surgical management of a large group of normomenstruating adolescents with obstructive reproductive tract anomalies. MATERIAL AND METHODS Retrospective analysis of prospectively collected data. Of the 143 outpatients referred for severe dysmenorrhea and persistent pelvic pain, 42 (29.3%) young women with obstructive Müllerian anomalies and regular menstrual flow were identified. These patients were divided into four groups: (1) patients with duplicate uterine cavities, obstructed hemivagina and ipsilateral renal agenesis (n = 34); (2) patients with unicornuate uterus and noncommunicating cavitated rudimentary horn (n = 5); (3) patients with accessory cavitated uterine mass (n = 2); (4) patients with partially obstructed transverse vaginal septum (n = 1). All 42 patients were conservatively treated via laparoscopy and 35/42 patients had also vaginal surgery. RESULTS Of the four groups, patients in groups 2 and 3 (n = 7) were conservatively managed by laparoscopy alone; for patients in groups 1 and 4 (n = 35), laparoscopy and the vaginal approach were used. Patients of group 1 were treated by resecting the obstructed vaginal septum with drainage of retained collections. In patients in group 2, surgery consisted of the removal of the rudimentary horn. Patients of group 3 were treated by the removal of myometrial neoformations. In the patient in group 4, treatment consisted of removal of the septum. All surgical procedures were successful and no major complications were recorded. Follow-up reports highlighted the disappearance of obstruction and clear improvement in pain symptoms. CONCLUSIONS Unilateral obstructive anomalies of the female genital tract are difficult to identify. Early diagnosis allows the preservation of reproductive activity and avoids potential complications.
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Affiliation(s)
- Eleonora Fontana
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly,Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Marta Parma
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Francesco Fedele
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly,Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Serena Girardelli
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Fabio Parazzini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Massimo Candiani
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
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Ball S, Fisher J. Adolescent abdominal pain due to rare mullerian duct anomaly. Am J Emerg Med 2022; 59:218.e1-218.e3. [PMID: 35780004 DOI: 10.1016/j.ajem.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
Abdominal pain is a common presenting complaint to the Emergency Department (ED). Often, rare etiologies can be discovered in the work up of this common complaint. Here we present the case of an adolescent female who presented with abdominal pain and was found to have obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) or Herlyn-Werner-Wunderlich Syndrome. A 12 year old female with known renal agenesis presented with 5 days of left sided abdominal pain that then developed into right lower quadrant pain. She had regular menses for the last 2 years. Ultrasound (US) showed a fluid collection in the lower uterine segment and a complex cystic structure anterior to the uterus. Magnetic resonance imaging (MRI) showed the patient to have didelphys uterus with "severe dilatation of the cervix/vaginal canal… extending from the right uterine horn" and left-sided ovarian and Fallopian tube torsion. She was taken to the operating room where she underwent vaginal septum excision and a left salpingo-oopherectomy. OHVIRA includes the triad of obstructed hemivagina, uterine didelphys, and ipsilateral renal agenesis. This occurs due to embryologic arrest of the mullerian and mesonephric ducts at 8 weeks of gestation. Most abnormalities are right sided which leads to right lower abdominal and pelvic pain approximately 4 months post-menarche. Diagnosis of OHVIRA is made utilizing US and CT scans. MRI can also be useful to further delineate specific anatomy. It is important for the emergency physician to be aware of this entity as most patients don't present to care until acute, severe symptoms develop. This makes it more likely for them to seek care in the ED as opposed to the outpatient setting.
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Affiliation(s)
- Seth Ball
- Kirk Kerkorian School of Medicine at UNLV, Department of Emergency Medicine, Children's Hospital of Nevada at University Medical Center, 901 Rancho Lane, Suite 135, Las Vegas, NV 89106, USA.
| | - Jay Fisher
- Kirk Kerkorian School of Medicine at UNLV, Department of Emergency Medicine, Children's Hospital of Nevada at University Medical Center, 901 Rancho Lane, Suite 135, Las Vegas, NV 89106, USA
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14
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Magnetic resonance imaging of Müllerian anomalies in girls: concepts and controversies. Pediatr Radiol 2022; 52:200-216. [PMID: 34152437 DOI: 10.1007/s00247-021-05089-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Female Müllerian anomalies are the result of failure of formation, fusion or resorption of the Müllerian ducts and are relatively common, with a prevalence of 5.5-7.0% in the general population. While some of these anomalies are asymptomatic, those presenting with obstruction require accurate identification for optimal clinical management including potential surgical treatment. MRI is a useful adjunct to sonography in the evaluation of Müllerian anomalies, typically allowing a more complete characterization of the malformation. Technical aspects, embryologic concepts and controversies regarding classification systems are highlighted in this review. Several Müllerian anomalies are discussed and illustrated in more detail utilizing various cases with pelvic MRI studies.
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Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification: A Systematic Review and Meta-analysis. Obstet Gynecol 2022; 139:138-148. [PMID: 34856567 DOI: 10.1097/aog.0000000000004627] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy). DATA SOURCES MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles. METHODS OF STUDY SELECTION Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers. TABULATION, INTEGRATION, AND RESULTS Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption. CONCLUSION Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021244487.
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Tian W, Chen N, Liang Z, Song S, Wang Y, Ye Y, Duan J, Zhu L. Clinical Features and Management of Endometriosis among Patients with MRKH and Functional Uterine Remnants. Gynecol Obstet Invest 2021; 86:518-524. [PMID: 34736265 DOI: 10.1159/000520593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the clinical features of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) patients with functional uterine remnants and endometriosis in a large cohort of Chinese patients. DESIGN This was a retrospective study. PARTICIPANTS This study had a cohort of 511 MRKH patients. A total of 34 MRKH patients with functional remnant were finally included. SETTING Tertiary referring hospitals in China. METHODS Patients with MRKH diagnosed and treated at Peking Union Medical College Hospital from January 2009 to January 2020 were recruited. A cohort of 511 MRKH patients were retrospectively screened and a total of 34 MRKH patients with functional remnant were finally included. Relevant clinical data were reviewed retrospectively from medical charts. RESULTS Of 34 patients with MRKH and functional uterine remnants, 23 (68%) had endometriosis. These patients had a greater mean age at MRKH diagnosis than patients without endometriosis (15.9 ± 3.3 years vs 13.2 ± 3.5 years; P=0.03). Similarly, these patients experienced a longer time between age at onset of symptoms and age at operation than patients without endometriosis (45.5 ± 39.6 years vs 19.8 ± 13.2 years; P =0.04). In addition, the CA125 level was significantly higher in patients with endometriosis than in those without it (64.9 ± 85.9 U/ml vs 25.5 ± 19.1 U/ml; P = 0.03). LIMITATIONS The number of patients with MRKH analyzed in this study was low as we restricted inclusion to patients with at least one functional uterine remnant or endometriosis. CONCLUSIONS It is reasonable to monitor the uterine remnant of patients with MRKH closely, regardless of age, to achieve early intervention. The level of CA125 might be helpful to differentiate active uterine remnants with endometriosis and schedule individualized treatments.
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Affiliation(s)
- Weijie Tian
- Department of Obstetrics and Gynaecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, China
| | - Na Chen
- Department of Obstetrics and Gynaecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, China
| | - Ze Liang
- Department of Obstetrics and Gynaecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, China
| | - Shuang Song
- Department of Obstetrics and Gynaecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, China
| | - Yuan Wang
- Department of Obstetrics and Gynaecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, China
| | - Yang Ye
- Department of Obstetrics and Gynaecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, China
| | - Jiali Duan
- Department of Obstetrics and Gynaecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynaecology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, China
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Rousseau L, Brichant G, Timmermans M, Nisolle M, Tebache L. Daily practice management of septate uterus: reproductive outcome after septoplasty. Facts Views Vis Obgyn 2021; 13:253-259. [PMID: 34555879 PMCID: PMC8823278 DOI: 10.52054/fvvo.13.3.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Septate uterus is the most common uterine malformation found in women presenting poor reproductive history. Hysteroscopic septoplasty (HS) restores the uterine anatomy in a safe procedure. Objectives The goal of our study is to determine the reproductive outcomes after HS of symptomatic septate uterus. Materials and Methods In a retrospective observational single centre study the reproductive outcomes and complications after HS were evaluated in 31 women with symptomatic septate uterus. The patients were separated into two groups according to the symptoms - infertility or recurrent pregnancy loss (RPL). Main outcome measures were the pregnancy and live birth rate and secondarily the complication rate. Furthermore, the results were analysed depending on the need of assisted reproductive techniques (ART). Results The treatment has resulted in an overall pregnancy rate of 71% for both groups. The spontaneous pregnancy rate is 45% and 8 pregnancies resulted from ART (26%). The overall first live birth rate is 51.6%. A decrease has been noticed in the miscarriage rate from 95.24% to 24% (p<0.001) in the overall population. Conclusions In patients with a symptomatic septate uterus hysteroscopic septoplasty is a safe and effective procedure. The favourable results pointing out the benefits of surgery on the reproductive outcomes as well as the relatively simple and safe technique of HS make the intervention attractive.
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18
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Rotem R, Barg M, Sela HY, Grisaru-Granovsky S, Rottenstreich M. Vacuum-assisted vaginal deliveries among parturients with congenital uterine anomalies; risk factors and outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 265:113-118. [PMID: 34482235 DOI: 10.1016/j.ejogrb.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the maternal and neonatal outcomes associated with vacuum-assisted vaginal delivery (VAVD) in a subset of parturients with congenital uterine anomalies. STUDY DESIGN A retrospective database study was conducted at a single tertiary center between 2005 and 2019. Parturients with known congenital uterine anomalies who had vaginal deliveries were enrolled, whereas parturients with failed VAVD, didelphic uterus, and delivery after intrauterine fetal death were excluded. Various maternal and neonatal outcomes were compared between parturients who achieved spontaneous vaginal delivery (SVD) and those who delivered via VAVD. The maternal composite outcome was calculated for each group and included one or more of the following: post-partum hemorrhage, hemoglobin drop ≥ 4 gr/dL, blood transfusions, retained placental products, and obstetric anal sphincter injuries. Univariate analysis was performed followed by multivariate logistic regression analysis controlling for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS After the application of the exclusion criteria, 332 parturients were found eligible. Of those, 289 (87%) had SVD and 43 (13%) had VAVD. VAVD was more common among primiparous parturients and epidural analgesia users. Parturients with VAVD had higher rates of third-degree perineal tear, postpartum hemorrhage, and blood transfusions. The maternal composite outcome was significantly more prevalent in the VAVD group (44.2% vs. 20.8%, p < 0.01). After controlling for potential confounders, the maternal composite outcome was found to be independently associated with VAVD (aOR 2.3, 95% CI 1.10-4.60). The neonatal results were overall comparable, except for scalp trauma and Erb's palsy/clavicular fracture, which were more prevalent in the VAVD group. CONCLUSION In a special population of parturients with congenital uterine anomalies, VAVD was found to be associated with significantly higher rates of adverse maternal outcomes and perinatal birth trauma. These findings should be presented to parturients during consultations about modes of delivery.
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Affiliation(s)
- Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Moshe Barg
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel; Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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19
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Surgical treatment of uterine septum to improve reproductive outcomes - resect or not? Fertil Steril 2021; 116:298-305. [PMID: 34274115 DOI: 10.1016/j.fertnstert.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
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20
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Congenital Obstructive Müllerian Anomaly: The Pitfalls of a Magnetic Resonance Imaging-Based Diagnosis and the Importance of Intraoperative Biopsy. J Clin Med 2021; 10:jcm10112414. [PMID: 34072446 PMCID: PMC8198439 DOI: 10.3390/jcm10112414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
A retrospective cohort study of the concordance between the magnetic resonance imaging (MRI) diagnosis and final diagnosis in patients with Müllerian duct anomalies (MDAs) was conducted, and diagnostic clues were suggested. A total of 463 cases of young women who underwent pelvic MRIs from January 1995 to February 2019 at Seoul Asan Medical Center were reviewed. Interventions consisted of clinical examinations, abdominal or transvaginal/rectal ultrasound, MRI, and operative procedures, including hysteroscopy and laparoscopy. The concordance of the diagnosis between the results obtained with MRI and those obtained with surgeries was evaluated. It was found that a total of 225 cases (48.6%) showed genital tract anomalies on MRI. Among them, 105 cases (46.7%) underwent reconstructive surgery. Nineteen cases (8.4%) revealed discrepancies between the final diagnosis after surgery and the initial MRI findings and eleven cases (57.9%) had cervical anomalies. Incorrect findings associated with the MRIs were particularly evident in biopsied cases of cervical dysgenesis. A combination of physical examination, ultrasound, and MRI is suitable for preoperative work-up in the diagnoses of congenital obstructive anomalies. However, it is recommended that a pathologic confirmation of tissue at the caudal leading edge be made in obstructive genital anomalies, in cases of presumptive vaginal or cervical dysgenesis.
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21
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Deenadayal M, Günther V, Alkatout I, Freytag D, Deenadayal-Mettler A, Deenadayal Tolani A, Sinha R, Mettler L. Critical Role of 3D ultrasound in the diagnosis and management of Robert's uterus: a single-centre case series and a review. Facts Views Vis Obgyn 2021; 13:41-49. [PMID: 33889860 PMCID: PMC8051191 DOI: 10.52054/fvvo.13.1.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A septate uterus with a non-communicating hemicavity was first described by Robert in 1969/70 as a specific malformation of the uterus. The condition is commonly associated with a blind uterine hemicavity, unilateral haematometra, a contralateral unicornuate uterine cavity and a normal external uterine fundus. The main symptoms are repetitive attacks of pain at four-weekly intervals around menarche, repeated dysmenorrhea, recurrent pregnancy loss and infertility. In this report, we review the disease, its diagnosis and treatment, and describe five cases of Robert's uterus. Three dimensional (3D) ultrasound (US) imaging was performed by the transvaginal route in four cases. In the fifth case of a 13-year-old girl, we avoided the vaginal route and magnetic resonance imaging (MRI) and 3D transrectal US yielded the correct diagnosis. The following treatment procedures were undertaken: laparoscopic endometrectomy, hysteroscopic septum resection, laparoscopic uterine hemicavity resection and total laparoscopic hysterectomy (TLH). The diagnosis and optimum treatment of Robert's uterus remains difficult for clinicians because of its rarity. A detailed and careful assessment by 3D US should be performed, followed by hysteroscopy in combination with laparoscopy, to confirm the diagnosis.
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Affiliation(s)
- M Deenadayal
- Mamata Fertility Hospital, 9-1-192, St Marys Rd, Telangana 500003, Hyderabad, India
| | - V Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - I Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - D Freytag
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - A Deenadayal-Mettler
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - A Deenadayal Tolani
- Mamata Fertility Hospital, 9-1-192, St Marys Rd, Telangana 500003, Hyderabad, India
| | - R Sinha
- Apollo Health City, Gynaecology, Road No 72, Hyderabad, Telangana 500033, Hyderabad, India
| | - L Mettler
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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Blavier F, Faron G, Cools W, Blockeel C, Santos-Ribeiro S, Done E, Ranisavljevic N, Rayssiguier R, Fuchs F, Gucciardo L. Corpus luteum score, a simple Doppler examination to prognose early pregnancies. Eur J Obstet Gynecol Reprod Biol 2021; 258:324-331. [PMID: 33524776 DOI: 10.1016/j.ejogrb.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/04/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In early pregnancies, miscarriages and inconclusive ultrasound scans considering location and viability are very common. In several previous studies, serum progesterone levels predicted viability of pregnancy and, in recent ones, failed Pregnancies of Unknown Location (PUL), completion of miscarriage and complications. Corpus luteum, secreting progesterone in early pregnancy, was less studied. Some publications showed correlations between corpus luteum aspects and diagnosis of miscarriage but it was not evaluated for other outcomes in early pregnancy, such as failed PUL, completion of miscarriage or complications. We aimed to assess if Doppler examination of corpus luteum could also predict all these outcomes: failed PUL, diagnosis and completion of miscarriages and complications. STUDY DESIGN A single operator prospectively described and/or collected pictures of Doppler signal in the wall of the corpus luteum at most consultations in our early pregnancy unit and established a three-level score. All suspected or confirmed non-viable pregnancies with this score or/and serum progesterone levels were registered retrospectively. With logistic regressions, AIC/BIC, likelihood ratios, ROC curves, Mann-Whitney and Fisher exact tests, we evaluated the ability of the score, alone, to predict failed PUL, diagnosis and completion of miscarriages and the complications, and, combined, to improve previously published predictions. RESULTS From 277 included pregnancies, 186 (67.1 %) miscarried. Of these, 159/186 (85.5 %) fully evacuated without surgery: 114/186 (61.3 %) within 20 days after the first diagnosis and 45/186 (24.2 %) after more than 20 days. Twenty-seven patients (14.5 %) underwent surgical evacuation, including ten complications, five haemorrhages and five suspected infections. Logistic regression correlated strongly the corpus luteum score with failed PUL (p < 0.0001) and miscarriages (p < 0.0001). Moreover, rates of complications and swift non-surgical completions of miscarriage were respectively 0 % and 92 % with scores of 0, versus 6 % and 44 % with scores of 1, versus 16 % and 0 % with scores of 2. Combined with serum progesterone levels, this score improved most predictions. Adding parity or history of miscarriage in predictive models even increased these performances. CONCLUSIONS Corpus luteum score, alone, can predict failed PUL, diagnosis and completion of miscarriages and their complications. Combining this score with other factors (mainly serum progesterone levels) improves most predictions.
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Affiliation(s)
- Frederic Blavier
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium; Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.
| | - Gilles Faron
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Wilfried Cools
- Interfaculty Centre for Data Processing and Statistics, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Christophe Blockeel
- Centre for Reproductive Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | | | - Elisa Done
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Noemie Ranisavljevic
- ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Romy Rayssiguier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Florent Fuchs
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Leonardo Gucciardo
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
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Acién P, Acién M. Disorders of Sex Development: Classification, Review, and Impact on Fertility. J Clin Med 2020; 9:jcm9113555. [PMID: 33158283 PMCID: PMC7694247 DOI: 10.3390/jcm9113555] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
In this review, the elements included in both sex determination and sex differentiation are briefly analyzed, exposing the pathophysiological and clinical classification of disorders or anomalies of sex development. Anomalies in sex determination without sex ambiguity include gonadal dysgenesis, polysomies, male XX, and Klinefelter syndrome (dysgenesis and polysomies with a female phenotype; and sex reversal and Klinefelter with a male phenotype). Other infertility situations could also be included here as minor degrees of dysgenesis. Anomalies in sex determination with sex ambiguity should (usually) include testicular dysgenesis and ovotesticular disorders. Among the anomalies in sex differentiation, we include: (1) males with androgen deficiency (MAD) that correspond to those individuals whose karyotype and gonads are male (XY and testes), but the phenotype can be female due to different hormonal abnormalities. (2) females with androgen excess (FAE); these patients have ovaries and a 46,XX karyotype, but present varying degrees of external genital virilization as a result of an enzyme abnormality that affects adrenal steroid biosynthesis and leads to congenital adrenal hyperplasia; less frequently, this can be caused by iatrogenia or tumors. (3) Kallman syndrome. All of these anomalies are reviewed and analyzed herein, as well as related fertility problems.
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Affiliation(s)
- Pedro Acién
- Department of Gynecology, Miguel Hernández University, San Juan Campus, 03550 San Juan, Alicante, Spain;
- Correspondence: ; Tel.: +34-670-097-518, +34-965-919-385; Fax: +34-965-919-550
| | - Maribel Acién
- Department of Gynecology, Miguel Hernández University, San Juan Campus, 03550 San Juan, Alicante, Spain;
- Obstetrics and Gynecology, San Juan University Hospital, San Juan Campus, 03550 San Juan, Alicante, Spain
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Kozłowski M, Nowak K, Boboryko D, Kwiatkowski S, Cymbaluk-Płoska A. Herlyn-Werner-Wunderlich Syndrome: Comparison of Two Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7173. [PMID: 33007989 PMCID: PMC7579596 DOI: 10.3390/ijerph17197173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Herlyn-Werner-Wunderlich Syndrome is a rare malformation syndrome characterized by uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. Symptoms appear most often after menarche and are secondary to hematocolpos. We compare clinical symptoms, diagnosis and treatment of two patients, a 13-year-old and a 17-year-old. CASE REPORT Despite the non-uniform clinical symptoms, it should be noted that in both patients, the 13-year-old and the 17-year-old, hematocolpos, which was probably the cause of lower abdominal pain, was diagnosed with ultrasound. The diagnosis was complemented by laparoscopy, which determined the diagnosis of malformation of uterus didelphys with obstructed hemivagina. The patients had a history of kidney agenesis, which, after gynecological diagnosis, turned out to be ipsilateral. In the 13-year-old, agenesis was diagnosed by uroscintigraphy, while in the 17-year-old it was diagnosed by urography. Incision and drainage of the residual vagina was performed in the course of therapeutic management. In both cases, the clinical situation required a repeated widening of the orifice. CONCLUSIONS Lower abdominal pain accompanying hematocolpos suggested Herlyn-Werner-Wunderlich Syndrome (HWWS) as the cause of symptoms. 3D transvaginal ultrasound enabled the determination of a congenital uterine defect with high probability, although inconclusive cases required confirmation by laparoscopy. Incision of the blocked vagina and drainage of hematocolpos were the key components of treatment. The treatment of HWWS is a multi-step process.
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Affiliation(s)
- Mateusz Kozłowski
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.N.); (D.B.); (A.C.-P.)
| | - Katarzyna Nowak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.N.); (D.B.); (A.C.-P.)
| | - Dominika Boboryko
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.N.); (D.B.); (A.C.-P.)
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.N.); (D.B.); (A.C.-P.)
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Davidesko S, Wainstock T, Sheiner E, Landau D, Walfisch A. Maternal history of recurrent pregnancy loss increases the risk for long-term pediatric respiratory morbidity of the offspring. Pediatr Pulmonol 2020; 55:1765-1770. [PMID: 32426952 DOI: 10.1002/ppul.24813] [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: 01/21/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND While the etiology in many cases of recurrent pregnancy loss (RPL) is unclear, recent evidence suggests possible immunological dysfunction, which is also implicated in the pathophysiology of many pediatric respiratory diseases. OBJECTIVE We sought to investigate whether maternal history of RPL is associated with long-term respiratory morbidity of the offspring. STUDY DESIGN A population based cohort analysis was performed comparing the risk of long-term respiratory morbidity (up to the age of 18 years) of children born to mothers with and without a history of RPL (defined as two or more losses). Respiratory morbidity included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital medical records. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. A Kaplan-Meier survival curve was constructed to compare cumulative respiratory morbidity, and a Cox proportional hazards model was used to control for confounders. RESULTS During the study period, 242 187 newborns met the inclusion criteria; 5% (n = 12 182) of which were offspring to mothers with a history of RPL. Respiratory morbidity was significantly more common in the exposed group (6.0% vs 4.8%, P < .001). Specifically, offspring to mothers with a history of RPL had higher rates of obstructive sleep apnea and asthma (P < .05). The Kaplan-Meier survival curve exhibited a higher cumulative incidence of total respiratory morbidity in offspring of mothers with a history of RPL (Log rank P < .001). In the Cox regression, maternal history of RPL was independently associated with increased pediatric respiratory morbidity of the offspring with an adjusted hazard ratio of 1.24 (95 % confidence interval [95%CI], 1.15-1.34, P < .001). CONCLUSION Maternal history of RPL is associated with a higher risk of future pediatric respiratory morbidity of the offspring; possibly explained by a common immunological etiology.
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Affiliation(s)
- Sharon Davidesko
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Serum progesterone levels could predict diagnosis, completion and complications of miscarriage. J Gynecol Obstet Hum Reprod 2020; 49:101721. [DOI: 10.1016/j.jogoh.2020.101721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/16/2019] [Accepted: 02/16/2020] [Indexed: 11/19/2022]
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Toth B, Baston-Büst DM, Behre HM, Bielfeld A, Bohlmann M, Bühling K, Dittrich R, Goeckenjan M, Hancke K, Kliesch S, Köhn FM, Krüssel J, Kuon R, Liebenthron J, Nawroth F, Nordhoff V, Pinggera GM, Rogenhofer N, Rudnik-Schöneborn S, Schuppe HC, Schüring A, Seifert-Klauss V, Strowitzki T, Tüttelmann F, Vomstein K, Wildt L, Wischmann T, Wunder D, Zschocke J. Diagnosis and Therapy Before Assisted Reproductive Treatments. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Register Number 015-085, February 2019) - Part 1, Basic Assessment of the Woman. Geburtshilfe Frauenheilkd 2019; 79:1278-1292. [PMID: 31875858 DOI: 10.1055/a-1017-3389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Supporting and counselling couples with fertility issues prior to starting ART is a multidisciplinary diagnostic and therapeutic challenge. The first German/Austrian/Swiss interdisciplinary S2k guideline on "Diagnosis and Therapy Before Assisted Reproductive Treatments (ART)" was published in February 2019. This guideline was developed in the context of the guidelines program of the German Society of Gynecology and Obstetrics (DGGG) in cooperation with the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Aims One third of the causes of involuntary childlessness are still unclear, even if the woman or man have numerous possible risk factors. Because the topic is still very much taboo, couples may be socially isolated and often only present quite late to a fertility center. At present, there is no standard treatment concept, as currently no standard multidisciplinary procedures exist for the diagnostic workup and treatment of infertility. The aim of this guideline is to provide physicians with evidence-based recommendations for counselling, diagnostic workup and treatment. Methods This S2k guideline was developed on behalf of the Guidelines Commission of the DGGG by representative members from different professional medical organizations and societies using a structured consensus process. Recommendations The first part of this guideline focuses on the basic assessment of affected women, including standard anatomical and endocrinological diagnostic procedures and examinations into any potential infections. Other areas addressed in this guideline are the immunological workup with an evaluation of the patient's vaccination status, an evaluation of psychological factors, and the collection of data relating to other relevant factors affecting infertility. The second part will focus on explanations of diagnostic procedures compiled in collaboration with specialists from other medical specialties such as andrologists, human geneticists and oncologists.
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Affiliation(s)
- Bettina Toth
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | | | - Hermann M Behre
- Zentrum für Reproduktionsmedizin und Andrologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | | | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach, Lörrach, Germany
| | - Kai Bühling
- Abteilung für gynäkologische Endokrinologie, Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Katharina Hancke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm, Ulm, Germany
| | - Sabine Kliesch
- Centrum für Reproduktionsmedizin und Andrologie, Abteilung für Klinische und Operative Andrologie, Universitätsklinik Münster, Münster, Germany
| | | | - Jan Krüssel
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ruben Kuon
- Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jana Liebenthron
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Verena Nordhoff
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | | | - Nina Rogenhofer
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ludwig-Maximilians-Universität München, München, Germany
| | | | - Hans-Christian Schuppe
- Klinik und Poliklinik für Urologie, pädiatrische Urologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH - Standort Gießen, Gießen, Germany
| | - Andreas Schüring
- UKM Kinderwunschzentrum, Universitätsklinikum Münster, Münster, Germany
| | - Vanadin Seifert-Klauss
- Klinik und Poliklinik für Frauenheilkunde, Technische Universität München, München, Germany
| | - Thomas Strowitzki
- Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Frank Tüttelmann
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Germany
| | - Kilian Vomstein
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | - Ludwig Wildt
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | - Tewes Wischmann
- Institut für medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Dorothea Wunder
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinik Lausanne, Lausanne, Switzerland
| | - Johannes Zschocke
- Sektion für Humangenetik, Medizinische Universität Innsbruck, Innsbruck, Austria
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Khunda SS, Hmod T, Abbas R, Khunda A. A rare case of cervical dysplasia. J OBSTET GYNAECOL 2019; 40:1174-1175. [PMID: 31775547 DOI: 10.1080/01443615.2019.1672040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Rasha Abbas
- Medical City Teaching Hospital, Baghdad, Iraq
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Abstract
INTRODUCTION Endometriosis is a common disease in women of reproductive age. In addition to causing pain, it may also reduce fertility. The coexistence of endometriosis and congenital uterine anomalies (CUA) has been frequently reported in the published literature. The present report is a review of existing studies on the subject and our own hitherto unpublished data. EVIDENCE ACQUISITION The electronic search was conducted using the Pubmed database with specific keyword combinations including endometriosis, adenomyosis, infertility, Müllerian malformations/anomalies, and septate uterus. The principal aspects addressed in the present study were: diagnosis, management, and classification of CUA, their impact on fertility and coexistence with endometriosis. EVIDENCE SYNTHESIS Endometriosis and CUA are frequently detected in the exploration of infertility, because both of these are liable to impair fertility. Endometriosis is associated with obstructive anomalies and nonobstructive malformations, especially those concerning the septate uterus. The diagnosis and management of CUA have been discussed for several years. Various classification systems have been proposed. CONCLUSIONS The analysis of the existing literature has revealed the absence of any consensus about the management, diagnosis, and classification of CUA, especially with regard to the septate uterus. We need to find and speak a common language in order to avoid inappropriate or unnecessary surgery and optimize the individual patient's treatment. The combined presence of endometriosis or adenomyosis and CUA is a reason to perform precise diagnostic imaging investigations and early surgery for the purpose of enhancing the chances of pregnancy in infertile patients. Further research is needed on the subject.
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Affiliation(s)
- Damaris Freytag
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Liselotte Mettler
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Nicolai Maass
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Veronika Günther
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany
| | - Ibrahim Alkatout
- Clinic for Obstetrics and Gynecology, UKSH Campus Kiel, Kiel, Germany -
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Müllerian Anomalies Prevalence Diagnosed by Hysteroscopy and Laparoscopy in Mexican Infertile Women: Results from a Cohort Study. Diagnostics (Basel) 2019; 9:diagnostics9040149. [PMID: 31627332 PMCID: PMC6963274 DOI: 10.3390/diagnostics9040149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Abstract
Background: To evaluate the prevalence of Müllerian anomalies (MAs) in a cohort of infertile Mexican women candidates for infertility treatments (intrauterine insemination or IVF (In vitro fertilization) cycles). Methods: We performed a retrospective observational study on a cohort of consecutive women, who underwent hysteroscopy and laparoscopy as part of the basic infertility workup from 2002 to 2014, at our center. Our aim was to calculate the prevalence of MAs and each subtype. Results: A total of 4005 women were included in the study. The MA prevalence was 4.4% (95% CI; 3.8–5.1; n = 177). Among women with MAs, the prevalence of different MA types was: septate uterus 54.2% (n = 96), arcuate uterus 15.8% (n = 28), bicornuate uterus 10.7% (n = 19), unicornuate uterus 8.5% (n = 15), didelphys uterus 6.2% (n = 11) and hypoplasia/agenesis 3.4% (n = 6), unclassifiable 1.1% (n = 2). Women with MAs who achieved pregnancy were: 33.3% (n = 59). The MA associated with the highest pregnancy rate was septate uterus after hysteroscopic correction, at 38.5% (37/96). Conclusions: The prevalence of MAs among infertile Mexican women can be considered as low, but not negligible. The septate uterus is the most common MA in women with infertility.
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Theodoridis TD, Pappas PD, Grimbizis GF. Surgical management of congenital uterine anomalies (including indications and surgical techniques). Best Pract Res Clin Obstet Gynaecol 2019; 59:66-76. [PMID: 30910446 DOI: 10.1016/j.bpobgyn.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/02/2019] [Accepted: 02/11/2019] [Indexed: 11/17/2022]
Abstract
The prevalence of congenital uterine anomalies (CUA) is reported to be 4.3-6.7% in the general population, 3.4%-8% in the infertile population, and 12.6-18.2% of those with recurrent miscarriages. They are the result of abnormal formation, differentiation, and fusion of the Müllerian or paramesonephric ducts during fetal life. To date, various classification systems have been proposed for the categorization of CUA, but the recently introduced ESHRE/ESGE classification seems to be a new, clear, and systematic categorization, which could be the basis for clinicians to rely on when they refer to CUA and their clinical impact either generally or concerning pregnancy outcomes. CUA are apparently related to an impaired reproductive outcome, while their exact clinical impact as well as the effectiveness of their treatment remain considered controversial. Surgery is indicated in women presenting with symptoms related to specific uterine anomalies, especially in those with fertility problems. In this review, indications, surgical techniques for the repair of CUA according to their classification, and fertility and pregnancy outcomes before and after surgery will be thoroughly reviewed.
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Affiliation(s)
- Theodoros D Theodoridis
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece.
| | - Panagiotis D Pappas
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification: a diagnostic accuracy study. Arch Gynecol Obstet 2019; 299:779-789. [DOI: 10.1007/s00404-019-05050-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
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Diagnosis and Treatment in a Tertiary Hospital of a Series of Complex Genital Malformations Corresponding to Double Uterus with Obstructed Hemivagina and Ipsilateral Renal Agenesis. Int J Reprod Med 2019; 2018:3806856. [PMID: 30631773 PMCID: PMC6304653 DOI: 10.1155/2018/3806856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/06/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022] Open
Abstract
Aim To evaluate the clinical features, diagnostic routine, treatment, and prognosis of patients with double uterus with obstructed hemivagina and ipsilateral renal agenesis at a University Hospital. Methods A retrospective study analyzing the medical charts of outpatients with similar complex genital malformations seen at the University Hospital of the Ribeirão Preto Medical School from 1994 to 2015. Results Fourteen patients were included in this retrospective study, all presenting with double uterus with obstructed hemivagina and ipsilateral renal agenesis. The main symptom was dysmenorrhea occurring shortly after menarche, and pelvic ultrasound was the examination of choice. The treatment consisted of resection of the vaginal septum, complemented by an abdominal approach in 5 cases. Complications of the syndrome observed in this case series included severe endometriosis, pelvic abscess, need for hysterectomy, and salpingectomy. Conclusions Severe dysmenorrhea shortly after menarche is a typical symptom of this kind of malformation, even though the diagnosis of patients who present with fistulization of the vaginal septum can be delayed due to milder clinical features. Pelvic ultrasound can be considered the first-choice examination in diagnostic routine. Relief of pain and prevention of complications can be achieved successfully in most cases by resection of the vaginal septum.
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Cheong YL, Laksmi NK. Herlyn–Werner–Wunderlich Syndrome: Case report of a newborn presenting with interlabial cyst. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818797141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A newborn with Herlyn–Werner–Wunderlich Syndrome presented with interlabial cyst. The cyst was punctured and instilled with contrast medium for cystography to demonstrate the anatomy. Simple resection of the hemivagina septum at the same sitting resolved the obstruction. Early interventions done to clinch diagnosis and institute treatment would help to prevent future complications associated with menses retention and preserve fertility.
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Affiliation(s)
- Yee Ling Cheong
- Department of Paediatric Surgery, KK Women’s & Children’s Hospital, Singapore
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ESHRE-ESGE versus ASRM classification in the diagnosis of septate uterus: a retrospective study. Arch Gynecol Obstet 2018; 298:845-850. [PMID: 30159673 DOI: 10.1007/s00404-018-4878-2] [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] [Received: 05/18/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy (ESHRE-ESGE) system is designed mainly for clinical orientation; its overdiagnosis of septate uteri was confirmed in a general population in comparison to the American Society of Reproductive Medicine (ASRM) supplemental classification proposed by Ludwin. However, the agreement among septate uterus recognition using the ESHRE-ESGE and the supplemental ASRM classifications and the rate of overdiagnosis of septate uterus by ESHRE-ESGE in infertile women remain unclear. METHODS We conducted a retrospective study of 53,540 infertile patients in our reproductive centre from June 2013 to December 2016, to compare septate uterus recognition using three systems. The data were analysed by the ESHRE-ESGE system, the ASRM by Salim and the ASRM by Ludwin separately. The concordance of diagnoses of septate uteri using these three systems was compared. RESULTS ESHRE-ESGE classification significantly increased the frequency of septate uteri (11.31%, 6056 vs. 7.20%, 3854 vs. 3.80%, 2034). Good agreement was observed between the ESHRE-ESGE and the ASRM by Salim (k = 0.686, p < 0.001) and between the ASRM by Salim and that by Ludwin (k = 0.671, p < 0.001), while moderate agreement was found between the ESHRE-ESGE and ASRM by Ludwin systems (k = 0.444, p < 0.001). These results suggest that Ludwin's criteria are the strictest, while the ESHRE-ESGE system is much more relaxed for septate uterus diagnosis. CONCLUSION A risk of overtreatment may also exist in infertile patients when using the ESHRE-ESGE system. Therefore, the ESHRE-ESGE system should be used with caution when guiding hysteroscopic metroplasty in infertile patients.
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Verma ML, Singh U, Ghosh I, Sankhwar PL. Uterine didelphys with one cervix obscured by blind hemivagina: a lesson in rarity. BMJ Case Rep 2018; 2018:bcr-2018-224994. [PMID: 30077979 DOI: 10.1136/bcr-2018-224994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 14-year-old girl presented with increasing cyclical pain, scanty menses, pelvic mass and absence of the left kidney. With both radiological and clinical examinations (examination under anaesthesia), diagnosis of bicornuate uterus with single cervix could be made while on laparotomy, and it turned out to be uterine didelphys, with one cervix obscured by blind hemivagina with haematometra and haematocolpos in the left horn, for which hemihysterectomy was done. Post procedure the patient was relieved of cyclical pain and is menstruating properly.
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Affiliation(s)
- Manju Lata Verma
- Obstetrics And Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Uma Singh
- Obstetrics And Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Indrani Ghosh
- Obstetrics And Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pushpa Lata Sankhwar
- Obstetrics And Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Grant C, Bayne CE, Kern NG, Peters CA. Atypical presentation of obstructed hemivagina and ipsilateral renal anomaly. Urol Case Rep 2018; 19:70-71. [PMID: 29888199 PMCID: PMC5991322 DOI: 10.1016/j.eucr.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Campbell Grant
- Department of Urology, The George Washington University, Washington, DC, USA
| | - Christopher E Bayne
- Division of Pediatric Urology, Children's National Medical Center, Washington, DC, USA
| | - Nora G Kern
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Craig A Peters
- Department of Urology, Children's Medical Center, The University of Texas Southwestern, Dallas, TX, USA
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Gupta N, Gandhi D, Gupta S, Goyal P, Li S, Kumar Y. A Variant of Herlyn-Werner-Wunderlich Syndrome Presenting With Acute Abdomen: A Case Report and Review of Literature. Glob Pediatr Health 2018; 5:2333794X18769817. [PMID: 29761137 PMCID: PMC5946351 DOI: 10.1177/2333794x18769817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/03/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nishant Gupta
- Columbia University Medical Centre, New York, NY, USA
| | | | - Sonali Gupta
- St. Vincent's Medical Center, Bridgeport, CT, USA
| | | | - Shuo Li
- Yale New Haven Health, New Haven, CT, USA
| | - Yogesh Kumar
- Columbia University at Bassett Healthcare, Cooperstown, NY, USA
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Female genital tract congenital malformations and the applicability of the ESHRE/ESGE classification: a systematic retrospective analysis of 920 patients. Arch Gynecol Obstet 2018; 297:1473-1481. [PMID: 29549434 DOI: 10.1007/s00404-018-4749-x] [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] [Received: 02/15/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Several classification systems for female genital tract anomalies exist but are of limited use in clinical practice. We, therefore, assessed the applicability and ease of use of the new ESHRE/ESGE classification, using only patient records. METHODS This retrospective, single-center, proof-of-principle study systematically analyzed the surgical reports and other hospital records of 920 inpatients and outpatients treated for confirmed female genital tract congenital malformations at a major German university hospital during 2003-2013. Using only this information, a non-expert (medical student) assigned patients to an ESHRE/ESGE class, rating ease of classification based on the time and the number of additional medical records required. Results were verified by an expert gynecologist, who also classified any malformations previously left unclassified. Data analysis used descriptive statistics. RESULTS The non-expert successfully classified 859/920 patients (93.4%), rating classification as "easy" for 836/859 (90.9%) and "moderately difficult" for 23/859 (2.5%) patients. The expert gynecologist successfully classified 60 (60/920, 6.5%) of the remaining 61 patients rated as "difficult" by the non-expert, but was unable to accurately subclassify 1 patient (1/920, 0.1%) because the operative report lacked the relevant details. 251/920 (27.3%) patients had associated non-Müllerian anomalies, most frequently renal (20.9%) and skeletal (9.1%) malformations. CONCLUSIONS The ESHRE/ESGE classification provides a generally applicable, comprehensive, and adequately specific classification of female genital tract congenital malformations. It offers an efficient basis for communication between non-experts and experts in the field and is, therefore, useful in clinical management and treatment planning.
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Demir Eksi D, Shen Y, Erman M, Chorich LP, Sullivan ME, Bilekdemir M, Yılmaz E, Luleci G, Kim HG, Alper OM, Layman LC. Copy number variation and regions of homozygosity analysis in patients with MÜLLERIAN aplasia. Mol Cytogenet 2018; 11:13. [PMID: 29434669 PMCID: PMC5797403 DOI: 10.1186/s13039-018-0359-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/16/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Little is known about the genetic contribution to Müllerian aplasia, better known to patients as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Mutations in two genes (WNT4 and HNF1B) account for a small number of patients, but heterozygous copy number variants (CNVs) have been described. However, the significance of these CNVs in the pathogenesis of MRKH is unknown, but suggests possible autosomal dominant inheritance. We are not aware of CNV studies in consanguineous patients, which could pinpoint genes important in autosomal recessive MRKH. We therefore utilized SNP/CGH microarrays to identify CNVs and define regions of homozygosity (ROH) in Anatolian Turkish MRKH patients. RESULTS Five different CNVs were detected in 4/19 patients (21%), one of which is a previously reported 16p11.2 deletion containing 32 genes, while four involved smaller regions each containing only one gene. Fourteen of 19 (74%) of patients had parents that were third degree relatives or closer. There were 42 regions of homozygosity shared by at least two MRKH patients which was spread throughout most chromosomes. Of interest, eight candidate genes suggested by human or animal studies (RBM8A, CMTM7, CCR4, TRIM71, CNOT10, TP63, EMX2, and CFTR) reside within these ROH. CONCLUSIONS CNVs were found in about 20% of Turkish MRKH patients, and as in other studies, proof of causation is lacking. The 16p11.2 deletion seen in mixed populations is also identified in Turkish MRKH patients. Turkish MRKH patients have a higher likelihood of being consanguineous than the general Anatolian Turkish population. Although identified single gene mutations and heterozygous CNVs suggest autosomal dominant inheritance for MRKH in much of the western world, regions of homozygosity, which could contain shared mutant alleles, make it more likely that autosomal recessively inherited causes will be manifested in Turkish women with MRKH.
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Affiliation(s)
- Durkadin Demir Eksi
- Department of Medical Biology, Alanya Alaaddin Keykubat University, Faculty of Medicine, Antalya, Turkey
| | - Yiping Shen
- Guangxi Maternal and Child Health Hospital, Nanning, China
- Department of Pathology, Harvard Medical School, Boston, MA 02115 USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115 USA
- Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127 China
| | - Munire Erman
- Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Lynn P. Chorich
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Megan E. Sullivan
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Meric Bilekdemir
- Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Elanur Yılmaz
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Guven Luleci
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Hyung-Goo Kim
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Ozgul M. Alper
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Lawrence C. Layman
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
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Mahdavi A, Mirfazaelian H, Younesi Asl L, Hasani Z, Bahreini M. Uterus Dysplasia Associated with Cervico-Vaginal Agenesis. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:326-327. [PMID: 29043712 PMCID: PMC5641468 DOI: 10.22074/ijfs.2018.5111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/04/2017] [Indexed: 11/05/2022]
Abstract
Müllerian ducts can form upper parts of normal female reproductive system and any failure in ductal fusion may result
in to müllerian duct anomalies (MDA). We present a case of MDA and a uterus dysplasia with no evidence of cervical
or upper vaginal tissue. This case showes the role of magnetic resonace imaging (MRI) on MDA diagnosis and urges
the need for a unified reliable and practical classification more compatible with clinical practice.
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Affiliation(s)
- Ali Mahdavi
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Mirfazaelian
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Younesi Asl
- Department of Radiology, Iran University of Medical Sciences, Tehran, Iran
| | - Zeynab Hasani
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Bahreini
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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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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Abstract
Müllerian duct anomalies, also called congenital uterine anomalies, are developmental structural disorders of the female genital tract. These anomalies are clinically relevant in patients with a history of infertility and pregnancy-related complications. The American Society for Reproductive Medicine classification system is the most well known, although newer systems, such as from the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy, are becoming more widely accepted. MR imaging remains the optimal imaging modality due to its superior multiplanar capability and spatial resolution. This review article describes the typical MR appearance of congenital uterine anomalies.
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Affiliation(s)
- Jeffrey D Olpin
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A071, Salt Lake City, UT 84132-2140, USA
| | - Aida Moeni
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A071, Salt Lake City, UT 84132-2140, USA
| | - Roderick J Willmore
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A071, Salt Lake City, UT 84132-2140, USA
| | - Marta E Heilbrun
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, #1A071, Salt Lake City, UT 84132-2140, USA.
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Detti L, Hickman H, Levi D'Ancona R, Wright AW, Christiansen ME. Relevance of Uterine Subseptations: What Length Should Warrant Hysteroscopic Resection? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:757-765. [PMID: 27943370 DOI: 10.7863/ultra.15.07073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Existing recommendations warrant correction of uterine subseptations longer than 10 mm. We assessed whether a different subseptation length is indicated for intervention by evaluating the postoperative decrease in cavity width. METHODS We conducted a prospective controlled cohort study at a university center. Healthy women and women with subseptations were evaluated with three-dimensional ultrasound before and after undergoing surgical resection of uterine subseptations by hysteroscopy. Measurement of the subseptum's length and width, and total cavity width, were obtained in both groups of women. We created a receiver operating characteristic curve using 7-mm cavity postoperative width change as the reference variable, and subseptation length as the outcome variable. Identifying a new subseptation length that warrants surgical intervention. RESULTS Seventy-six women with subseptations and 77 with healthy uteri were included in the study. In the subseptate group, 50 had a subseptum less than 10 mm, and 26 were greater than 10 mm. Uterine and uterine cavity widths were significantly greater than in healthy women. The postoperative cavity width (28 ± 0.9 mm) was correlated with the preoperative subseptum length (R = 0.42; P = .016) and width (R = 0.54; P = .001) and was similar to healthy uteri. The receiver operator characteristic curve identified 5.9 mm (sensitivity = 100%, specificity = 41.4%) as a new threshold length of subseptation, which shows a postoperative cavity adjustment comparable to a subseptation greater than 10 mm. CONCLUSIONS The relevance of subseptations shorter than 10 mm is currently undetermined and underestimated. Our data indicate a new subseptation cutoff length with postoperative remodeling and statistical relevance similar to longer subseptations. We propose a revision of the recommendations for surgical correction to include the objectively obtained subseptation length greater than or equal to 5.9 mm.
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Affiliation(s)
- Laura Detti
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
| | - Holly Hickman
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
| | - Roberto Levi D'Ancona
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
| | - Alicia W Wright
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
| | - Mary E Christiansen
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, Tennessee, USA
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Zafarani F, Ahmadi F, Shahrzad G. Hysterosalpingography in The Assessment of Congenital Cervical Anomalies. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:71-78. [PMID: 28670423 PMCID: PMC5347453 DOI: 10.22074/ijfs.2017.4716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 10/29/2016] [Indexed: 12/05/2022]
Abstract
Cervical abnormalities may be congenital or acquired. Congenital anomalies of the cervix are rarely isolated, and more commonly accompany other uterine anomalies. Various
imaging tools have been used in the assessment of Müllerian duct anomalies (MDAs).
Currently, magnetic resonance imaging (MRI) is the modality of choice for definitive
diagnosis and classification of these MDAs. Hysterosalpingography is a basic tool for
evaluation of infertility and allows us to detect a spectrum of anatomical malformations
of the utero-cervix in the setting of MDAs. It provides good outlines of the uterine cavity
and fallopian tubes, as well as the cervical canal and isthmus. However, hysterosalpingograms (HSG) cannot be performed in patients with isolated congenital maldevelopment
(agenesis/disgenesis) of the cervix. This part of pictorial review illustrates the various
radiographic appearances of congenital malformations of the utero-cervix with a brief
overview of the embryologic features. Accurate diagnosis of such cases is considered
essential for optimal treatment and categorization of each anomaly.
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Affiliation(s)
- Fatemeh Zafarani
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | - Firoozeh Ahmadi
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
| | - Gholam Shahrzad
- Department of Reproductive Imaging, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, Tehran, Iran
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Gao J, Zhang J, Tian W, Teng F, Zhang H, Zhang X, Wang Y, Xue F. Endometrial cancer with congenital uterine anomalies: 3 case reports and a literature review. Cancer Biol Ther 2017; 18:123-131. [PMID: 28118070 DOI: 10.1080/15384047.2017.1281495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Uterine malformation is a rare deformity in woman, and only a few cases concerning endometrial cancer arising in patients with congenital uterine anomalies have been reported. Herein, we present 3 cases of endometrial cancer with different congenital uterine anomalies, and review studies involving congenital uterine anomalies associated with endometrial cancer in the past 25 years, to identify similarities and differences in clinicopathologic characteristics and prognosis between endometrial cancer associated with uterine anomalies, and normal uterus. CASES Case 1 was a 75-year-old gravida 1, para 0, woman with carcinosarcoma (mixed well-differentiated endometrial adenocarcinoma and undifferentiated sarcoma) of the right cavity (grade III, and at least stage II ) of a uterus didelphys. The tumor recurred within 7 months after surgery, salvage radiotherapy was unsuccessful; the patient died 8 months after the surgery. Case 2 was a 63-year-old gravida 5, para 3, woman with a bicornuate uterus and uterus papillary serous carcinoma of the right horn (grade III, stage IIIC). She did not respond to the chemotherapy post surgery and died within 4 months. Case 3 was a 60-year-old gravida 0, para 0, woman with a complete septate uterus and an oblique vaginal septum of the upper region of the vagina with endometrioid adenocarchcinoma of the left cavity (grade II, stage IA). No adjuvant therapy was administered and the patient had recovered 2 y after the surgery. CONCLUSION Clinicians should be aware of the coexistence of uterine malignancies and uterine anomalies in patients presenting with persistent abnormal uterine bleeding, but with negative endometrial biopsy or failed in the operation of endometrial biopsy. In such cases, magnetic resonance imaging has an important role in the diagnosis of both malformation and malignancy, and an exploratory laparotomy should be performed to avoid delaying the diagnosis and treatment of cancers.
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Affiliation(s)
- Jinping Gao
- a Department of Obstetrics and Gynecology , Tianjin Medical University General Hospital , Tianjin , China
| | - Jintian Zhang
- a Department of Obstetrics and Gynecology , Tianjin Medical University General Hospital , Tianjin , China
| | - Wenyan Tian
- a Department of Obstetrics and Gynecology , Tianjin Medical University General Hospital , Tianjin , China
| | - Fei Teng
- a Department of Obstetrics and Gynecology , Tianjin Medical University General Hospital , Tianjin , China
| | - Huiying Zhang
- a Department of Obstetrics and Gynecology , Tianjin Medical University General Hospital , Tianjin , China
| | - Xuhong Zhang
- a Department of Obstetrics and Gynecology , Tianjin Medical University General Hospital , Tianjin , China
| | - Yingmei Wang
- a Department of Obstetrics and Gynecology , Tianjin Medical University General Hospital , Tianjin , China
| | - Fengxia Xue
- a Department of Obstetrics and Gynecology , Tianjin Medical University General Hospital , Tianjin , China
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47
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Fontana L, Gentilin B, Fedele L, Gervasini C, Miozzo M. Genetics of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Clin Genet 2016; 91:233-246. [PMID: 27716927 DOI: 10.1111/cge.12883] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 12/16/2022]
Abstract
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, also referred to as Müllerian agenesis, is the second most common cause of primary amenorrhea. It is characterized by congenital absence of the uterus, cervix, and the upper part of the vagina in otherwise phenotypically normal 46,XX females. MRKH syndrome has an incidence of about 1 in 4,500-5,000 newborn females and it is generally divided into two subtypes: MRKH type 1, in which only the upper vagina, cervix and the uterus are affected, and MRKH type 2, which is associated with additional malformations generally affecting the renal and skeletal systems, and also includes MURCS (MÜllerian Renal Cervical Somite) characterized by cervico-thoracic defects. MRKH syndrome is mainly sporadic; however, familial cases have been described indicating that, at least in a subset of patients, MRKH may be an inherited disorder. The syndrome appears to demonstrate an autosomal dominant inheritance pattern, with incomplete penetrance and variable expressivity. The etiology of MRKH syndrome is still largely unknown, probably because of its intrinsic heterogeneity. Several candidate causative genes have been investigated, but to date only WNT4 has been associated with MRKH with hyperandrogenism. This review summarizes and discusses the clinical features and details progress to date in understanding the genetics of MRKH syndrome.
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Affiliation(s)
- L Fontana
- Department of Pathophysiology & Transplantation, Università degli Studi di Milano, Milano, Italy
| | - B Gentilin
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - L Fedele
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - C Gervasini
- Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - M Miozzo
- Department of Pathophysiology & Transplantation, Università degli Studi di Milano, Milano, Italy.,Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Wang X, Zhang X, Liu S, Li G, Cui L, Qin Y, Chen ZJ. Novel mutations in the TP63 gene are potentially associated with Müllerian duct anomalies. Hum Reprod 2016; 31:2865-2871. [PMID: 27798044 DOI: 10.1093/humrep/dew259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 09/13/2016] [Accepted: 10/05/2016] [Indexed: 12/28/2022] Open
Abstract
STUDY QUESTION Are mutations and/or polymorphisms in the TP63 gene associated with human Müllerian duct anomalies (MDAs)? SUMMARY ANSWER The novel mutation c.*374 G > A in the TP63 gene resulted in decreased expression of TP63 by generating new binding sites with miR-1260a/miR-532-3p and revealed the potential association between TP63 and human MDAs. WHAT IS KNOWN ALREADY It has been shown that mice lacking Tp63 exhibit hypoplastic genitalia, a single cloacal opening, and persistence of columnar epithelium at lower genital tract sites. It has also been reported that a nonsense mutation in EMX2 results in decreased TP63 expression in a woman with MDAs. However, generally in humans the association between TP63 and MDAs is unknown. STUDY DESIGN, SIZE, DURATION A total of 200 unrelated Chinese women with MDAs and 200 unrelated Chinese women with a normal uterus and vagina, as controls, were recruited in the Center for Reproductive Medicine of Shandong University. All participants had a normal karyotype (46, XX). PARTICIPANTS/MATERIALS, SETTING, METHODS The 20 exons of the TP63 gene were sequenced in 200 cases and 200 controls. Putative binding sites for microRNAs were validated by dual luciferase activity assays. The role of microRNAs was further examined by western blot. MAIN RESULTS AND THE ROLE OF CHANCE Sequence analysis revealed 15 known single-nucleotide polymorphisms. Additionally, three novel heterozygous variants, c.387 G > C, c.*374 G > A and c.*749 G > A, were identified in three patients with MDAs, none of which were detected in controls. Variant c.*374 G > A, located in the 3' untranslated region, was highly conserved among mammals and predicted to create microRNAs binding sites, which was confirmed by dual luciferase activity assays. Western blot demonstrated that the binding with miR-1260a/miR-532-3p resulting from the variation c.*374 G > A decreased the expression of TP63. LARGE SCALE DATA N/A LIMITATIONS, REASONS FOR CAUTION: Further study is needed to uncover the role of the EMX2-TP63 pathway in the development of the Müllerian duct. WIDER IMPLICATIONS OF THE FINDINGS This study revealed the possible association between TP63 and MDAs and suggested a potential contribution of microRNA-regulated expression of genes in the etiology of MDAs. STUDY FUNDING/COMPETING INTERESTS This research was supported by National Basic Research Program of China (973 Program) (2012CB944700), the State Key Program of National Natural Science Foundation of China (81430029), the National Natural Science Foundation of China (81270662, 81471509), China Postdoctoral Science Foundation (2014M561939) and the Scientific Research Foundation of Shandong Province of Outstanding Young Scientists (BS2014YY013, 2014BSE27022). The authors have no competing interests.
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Affiliation(s)
- Xiaoyan Wang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University; Shandong Provincial Key Laboratory of Reproductive Medicine.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, 324 Jingwu Road, Jinan, 250021, China
| | - Xiruo Zhang
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University; Shandong Provincial Key Laboratory of Reproductive Medicine.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, 324 Jingwu Road, Jinan, 250021, China
| | - Shan Liu
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University; Shandong Provincial Key Laboratory of Reproductive Medicine.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, 324 Jingwu Road, Jinan, 250021, China.,Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Guangyu Li
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University; Shandong Provincial Key Laboratory of Reproductive Medicine.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, 324 Jingwu Road, Jinan, 250021, China
| | - Linlin Cui
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University; Shandong Provincial Key Laboratory of Reproductive Medicine.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, 324 Jingwu Road, Jinan, 250021, China
| | - Yingying Qin
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University; Shandong Provincial Key Laboratory of Reproductive Medicine.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, 324 Jingwu Road, Jinan, 250021, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University; Shandong Provincial Key Laboratory of Reproductive Medicine .,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, China.,The Key laboratory for Reproductive Endocrinology of Ministry of Education, 324 Jingwu Road, Jinan, 250021, China.,Center for Reproductive Medicine,Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200000, China
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Xu Z, Wu S, Xing Q, Wang X, Xiang H, Xu Y, Wang J, He X, Wang B, Cao Y. Genetic association between PAX2 and mullerian duct anomalies in Han Chinese females. J Assist Reprod Genet 2016; 34:125-129. [PMID: 27722936 DOI: 10.1007/s10815-016-0807-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/30/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The study aims to investigate the genetic association between paired box gene 2 (PAX2) and mullerian duct anomalies (MDA) in Chinese Han females. METHODS Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used to identify the genotypes of three tag single nucleotide polymorphisms (SNPs) in PAX2 in 362 MDA cases and 406 controls. RESULTS We found that one tag SNP (rs12266644) of PAX2 was associated with susceptibility to MDA. The genotype distributions of the SNP rs12266644 have a statistically significant difference in the MDA patients and controls with a p value = 0.008. In the dominant model, we also observed that the GT + TT genotype increased the risk for MDA (p = 0.015, OR = 1.637, 95 % CI = 1.096-2.443). CONCLUSION The polymorphism rs12266644 of PAX2 might be a risk factor for MDA in Chinese Han females.
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Affiliation(s)
- Zuying Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Shinan Wu
- Graduate School of Peking Union Medical College, Beijing, China.,Center for Genetics, National Research Institute for Family Planning, 12 Dahuisi Road, Haidian, Beijing, 100081, China
| | - Qiong Xing
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Xi Wang
- Center for Genetics, National Research Institute for Family Planning, 12 Dahuisi Road, Haidian, Beijing, 100081, China
| | - Huifen Xiang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Yuping Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Jing Wang
- Department of Medical Genetics, The Capital Medical University, Beijing, China
| | - Xiaojin He
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Binbin Wang
- Graduate School of Peking Union Medical College, Beijing, China. .,Center for Genetics, National Research Institute for Family Planning, 12 Dahuisi Road, Haidian, Beijing, 100081, China.
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China. .,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China. .,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China.
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Diagnostic imaging and cataloguing of female genital malformations. Insights Imaging 2016; 7:713-26. [PMID: 27507534 PMCID: PMC5028344 DOI: 10.1007/s13244-016-0515-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/13/2016] [Accepted: 07/20/2016] [Indexed: 11/27/2022] Open
Abstract
Abstract To help physicians and radiologists in the diagnosis of female genito-urinary malformations, especially of complex cases, the embryology of the female genital tract, the basis for Müllerian development anomalies, the current classifications for such anomalies and the comparison for inclusion and cataloguing of female genital malformations are briefly reviewed. The use of the embryological system to catalogue female genito-urinary malformations may ultimately be more useful in correlations with clinical presentations and in helping with the appropriate diagnosis and treatment. Diagnostic imaging of the different genito-urinary anomalies are exposed, placing particular emphasis on the anomalies within group II of the embryological and clinical classification (distal mesonephric anomalies), all of them associated with unilateral renal agenesis or dysplasia. Similarly, emphasis is placed on cases of cervico-vaginal agenesis, cavitated noncommunicated uterine horns, and cloacal and urogenital sinus anomalies and malformative combinations, all of them complex malformations. Diagnostic imaging for all these anomalies is essential. The best imaging tools and when to evaluate for other anomalies are also analysed in this review. Teaching points • The appropriate cataloguing of female genital malformations is controversial. • An embryological classification system suggests the best diagnosis and appropriate management. • The anomalies most frequently diagnosed incorrectly are the distal mesonephric anomalies (DMAs). • DMAs are associated with unilateral renal agenesis or renal dysplasia with ectopic ureter. • We analyse other complex malformations. Diagnostic imaging for these anomalies is essential.
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