Müllerian Anomalies Prevalence Diagnosed by Hysteroscopy and Laparoscopy in Mexican Infertile Women: Results from a Cohort Study

Septate uterus discovery during an emergency cesarean section in the North Eastern of the Democratic Republic of Congo: A case report and review of the literature

INTRODUCTION AND IMPORTANCE

Septate uterus is the commonest of congenital structural uterine anomaly with highest failure rate reproductive. It is secondary to incomplete resorption of the Müllerian duct during embryogenesis. Pregnancy in septate uterus carries with it maternal-fetal risk. The importance of this report is to provide data and encourage report of similar conditions in this region.

CASE PRESENTATION

A 25-Year-old, female booked G7P3A3 at 39 weeks and 4 days with history of miscarriages and preterm delivery for second, fourth and fifth pregnancies. She had an emergency cesarean section on the last one due to a contracted pelvis on a term pregnancy. Delivered a male baby of 3000 g, APGAR score of 9, 10, 10 respectively at the first, fifth and tenth minutes. Intraoperative findings revealed a partial septate uterus. The abdominopelvic cavity organs were anatomically normal.

CLINICAL DISCUSSION

Septate uterus is associated with adverse obstetric outcomes, like recurrent miscarriages, premature delivery, fetal malposition, intrauterine growth retardation, postpartum hemorrhage. 9-35 % of women with this malformation may experience infertility. Although the efficacy of septoplasty and preconception interventions has not been fully established in improving obstetric outcomes, in current medical practice these procedures are suggested.

CONCLUSION

Septate uterus as congenital uterus malformations, should be suspected in any women with obstetric complications high risk such as miscarriage, preterm delivery and malpresentation.

Management of postpartum hemorrhage in a patient with bicornuate uterus using the B-Lynch suture. Case report and review of the literature

Objectives

To describe the use of the B-Lynch suture in a case of postpartum hemorrhage of a woman with bicornuate uterus, and to carry out a review of the literature on PPH control strategies in patients with müllerian anomalies, maternal outcomes in terms of hemorrhage control, as well as early and late complications.

Material and methods

Case report of a patient with bicornuate uterus who presented to a regional referral hospital with postpartum hemorrhage following a cesarean section, which was successfully controlled using the B-Lynch suture. A search was conducted in the PubMed, Embase, Medline, Google Scholar and LILACS databases. The MeSh terms used were: “Uterine Atony,” “Postpartum Hemorrhage,” “Immediate Postpartum Hemorrhage,” “Bicornuate Uterus,” “Müllerian Anomalies,” “Müllerian Duct Abnormalities”. Case reports and case series of patients with müllerian malformations and PPH not responding to initial pharmacological management in whom conservative surgical procedures were used to control bleeding were included. A narrative analysis of the findings was carried out based on study characteristics, techniques used and complications.

Results

Five studies were selected, 4 case reports and 1 case series which included 12 women with uterine malformations who developed PPH and in whom surgical management (uterine compression sutures) or devices (intrauterine balloon) were used for hemorrhage control. Bleeding was successfully controlled in 11 cases, with hysterectomy required only in one case (8.3 %). No long-term complications were reported.

Conclusions

The literature on PPH management in women with müllerian uterine malformations is limited to case reports in which either compression sutures or medical devices such as intrauterine balloons were used. The B-Lynch-type compression suture appears to be a good option for controlling PPH in these women in order to preserve fertility, with a low rate of complications. Further documentation of these types of cases is needed in order to build the evidence regarding the usefulness of this technique for controlling postpartum uterine bleeding in this population.

Concurrent Diagnosis of Adenomyosis and Congenital Uterine Anomalies: A Review

Background: Adenomyosis and congenital uterine anomalies (CUAs) can compromise reproductive potential and may coexist in the same patient, especially in cases of infertility. This review (CRD42022382850) aims to evaluate the published cases of concurrent adenomyosis and syndromic and nonsyndromic CUAs. Methods: A literature search for suitable articles published in the English language was performed using the following databases from inception to 30 November 2022: MEDLINE, EMBASE, Global Health, the Cochrane Library, Health Technology Assessment Database, and Web of Science. Articles including both CUAs and adenomyosis, with data about their potential relationship, were included. Results: The literature search retrieved 14 articles that met the purpose of this review and summarized the most recent findings regarding the concurrent diagnosis of adenomyosis and CUAs. Conclusions: Adenomyosis can be found in both syndromic and nonsyndromic CUAs, and may arise from several etiologies. The hypothesis that obstructions in CUAs increase uterine pressure and promote the development of adenomyosis remains to be further elucidated, and additional findings may also play a role. The patient's genetic, epigenetic, and hormonal patterns, as well as normal physiological processes, such as pregnancy, may influence the growth of adenomyosis.

A "cluster" of ten uterine anomalies observed in a single center over a short period of 4 weeks: a case series

BACKGROUND

Uterine anomalies occur because of Müllerian duct maldevelopment. Few of them are associated with adverse obstetric outcome (Reyes-Muñoz et al. in Diagnostics. 2019;9:4. https://doi.org/10.3390/diagnostics9040149 ). Genital outflow tract obstructive uterine anomalies invariably present in the adolescent age group.

CASE DETAILS

We report a case series of uterine anomalies. Ten such cases presented like a "cluster" within a short span of just one month. Eight of these ten cases were diagnosed intraoperatively during cesarean section. One case was diagnosed during laparoscopic sterilization, and the other case was diagnosed before doing manual vacuum aspiration. There were four cases of bicornuate uterus, two cases each of unicornuate uterus and uterine didelphys, and one case each of septate uterus and arcuate uterus. All eight babies were healthy and without any obvious congenital anomalies. To the best of the authors' knowledge, literature regarding these anomalies has been mentioned mostly as case reports (Bruand et al. in Cureus. 2020;12:3. https://doi.org/10.7759/cureus.7191 ) and a few case series (Ross et al. in BMJ Case Rep. 2018. https://doi.org/10.1136/bcr-2017-221815 ). All women were of Kannadiga ethnicity and in the age range of 19-35 years. They were from places nearby to our institute within a range of approximately 250 km.

CONCLUSION

We describe herein almost all types of uterine anomalies. These rare uterine anomalies presented in a short span of just four weeks like a "cluster". This incidental finding is unusual. We need to design studies to understand the reasons for clustering of such cases in our clinical practice.

Magnetic resonance imaging of Müllerian anomalies in girls: concepts and controversies

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.

An evo-devo perspective of the female reproductive tract

The vertebrate female reproductive tract has undergone considerable diversification over evolution, having become physiologically adapted to different reproductive strategies. This review considers the female reproductive tract from the perspective of evolutionary developmental biology (evo-devo). Very little is known about how the evolution of this organ system has been driven at the molecular level. In most vertebrates, the female reproductive tract develops from paired embryonic tubes, the Müllerian ducts. We propose that formation of the Müllerian duct is a conserved process that has involved co-option of genes and molecular pathways involved in tubulogenesis in the adjacent mesonephric kidney and Wolffian duct. Downstream of this conservation, genetic regulatory divergence has occurred, generating diversity in duct structure. Plasticity of the Hox gene code and wnt signaling, in particular, may underlie morphological variation of the uterus in mammals, and evolution of the vagina. This developmental plasticity in Hox and Wnt activity may also apply to other vertebrates, generating the morphological diversity of female reproductive tracts evident today.

Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology

BACKGROUND

Combined hysteroscopy and laparoscopy is a valuable method for diagnosing and treating infertility and benign uterine pathology. Both procedures are minimally invasive, reliable, and safe, with a low complication rate.

AIM

In this review, we expose the efficiency and safety of hysterolaparoscopy in the management of infertility and other benign uterine pathologies.

METHOD

We performed a systematic literature review on several databases: PubMed®/MEDLINE, PMC, Crossref.org, and Web of Science in the last 10 years.

INCLUSION CRITERIA

Women of reproductive age with primary or secondary infertility and/or benign uterine pathology.

EXCLUSION CRITERIA

pre-puberty, menopause, couple with male infertility.

CONCLUSION

Hysterolaparoscopy is a useful tool to assess infertility and simultaneously diagnose and treat pelvic and uterine lesions.

Prevalence and pregnancy outcome of mullerian anomalies in infertile women: A retrospective study

Background:

Uterine anomalies arise if there is agenesis of one or two mullerian ducts, or absence of fusion or reabsorption of the septum between these ducts. The process may be partial or total and affect one or multiple parts of the tract.

Aims:

This study was done to assess the distribution of various types of mullerian anomalies in infertile women, their classification based on ESHRE and AFS, associated anomalies, types of diagnostic modalities used, surgical interventions done(if any), various types of infertility treatment used and their outcomes.

Setting and Design:

A retrospective analysis in a tertiary level hospital.

Materials and Methods:

This was a retrospective study in which the women found to have mullerian anomalies were recruited from infertility clinic from July 2019 to March 2020. They were classified according to ESHRE and AFS criteria and their records were analyzed after taking various factors like age, ovarian reserve, duration of infertility, treatment given , associated ovarian and tubal factors and pregnancy outcomes.

Statistical Analysis:

Analysis was performed in Excel.

Results:

There were 30 women with mullerian anomalies. Unicornuate uterus was most common anomaly. Four women required septoplasty in view of septate uterus. Five women had associated renal anomalies in form of shrunken kidney and ectopic kidney. Most of these women were considered for controlled ovarian stimulation followed by intrauterine insemination. In our study 16.6% women had successful pregnancy outcome.

Conclusion:

Mullerian anomalies continue to attract infertility specialist as they pose challenge in making clear diagnosis and its management as obstetrics outcomes are excellent after septum resection in women with septate uterus and conservative management in women with other anomalies. Proper work up of infertility and its management varies from case to case and associated factors like endometriosis, male factor, polycystic ovarian syndrome etc.

Effects of bicornuate uterus on pregnancy and obstetric outcomes of in vitro fertilization / intracytoplasmic sperm injection

OBJECTIVE

A bicornuate uterus results from failure of the Müllerian ducts to completely fuse. If patients with bicornuate uterus are diagnosed with infertility, they can conceive with help from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). With few studies on the reproductive performances of bicornuate uterus following IVF/ICSI treatment, the aim of present study is to investigate whether a bicornuate uterus would affect pregnancy rates and obstetric outcomes of infertile women.

STUDY DESIGN

A retrospective cohort study contained 232 women (58 with bicornuate uterus and 174 with normal uterus) was conducted. Patient data for IVF/ICSI treatment and follow-up were collected and analyzed. Cumulative pregnancy rate and cumulative live birth rate after one complete assisted reproductive technology (ART) cycle were the primary outcomes.

RESULTS

Baseline characteristics were comparable between the bicornuate uterus group and the control group. Ovarian response to stimulation and embryological results were similar between the two groups. In fresh embryo transfer cycles, embryo implantation rate (32.7 % vs. 42.9 %, P = 0.176), biochemical pregnancy rate (54.1 % vs. 64.9 %, P = 0.236), and clinical pregnancy rate (45.9 % vs. 58.8 %, P = 0.172) did not differ significantly between the bicornuate uterus group and the control group. Live birth rate (40.5 % vs. 43.9 %, P = 0.723), term delivery rate (93.3 % vs. 90.0 %, P = 0.696), cesarean section rate (73.3 % vs. 76.0 %, P = 0.833), and newborn birth weight (3.35 ± 0.56 vs. 3.32 ± 0.51, P = 0.524) also did not differ significantly between the two groups. In frozen-thawed embryo transfer cycles, there were no significant differences in outcomes between the two groups. Upon completion of one IVF/ICSI cycle, cumulative pregnancy rate (59.6 % vs. 71.0 %, P = 0.112) and cumulative live birth rate (58.2 % vs. 64.8 %, P = 0.375) were similar between the two groups.

CONCLUSION

There were no significant differences in ovarian responses, pregnancy outcomes, and obstetric outcomes after IVF/ICSI treatment between women with bicornuate uterus and women with normal uterus. Bicornuate uterus had no significant negative effects on cumulative IVF/ICSI outcomes of infertile patients.

Laparoscopic Hysterectomy and Bilateral Salpingectomy in a Patient with Microduplication Syndrome (20p13p12.1) and a Bicornuate Uterus: An Unreported Association

Trisomy 20p is a chromosomal anomaly resulting from whole or partial duplication of the short arm of chromosome 20. It is a rarely reported syndrome and it is estimated that there are only a few cases of this condition worldwide, which hampers the phenotypic characterization of this entity. Conversely, müllerian anomalies include a group of congenital malformations of the uterus, vagina, cervix, and fallopian tubes resulting from alterations in the embryological development of the müllerian ducts. We report a case of pure trisomy 20p diagnosed using array comparative genomic hybridization (CGH) accompanied by a müllerian anomaly in a female patient with abnormal growth pattern, round face, coarse hair, broad nose, long palpebral fissure, epicanthus, and megaureter.