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Mohamed SEM, Elawad MF, Mohamed MA, Hussain SA, Al-Rashid AA. Splenogonadal fusion in a female: A case report of a rare congenital anomaly. Radiol Case Rep 2024; 19:1409-1412. [PMID: 38292784 PMCID: PMC10827536 DOI: 10.1016/j.radcr.2023.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
We present a case of an 18-year-old female referred for an MRI pelvis to evaluate suspected uterine anomaly by ultrasound. The MRI showed a complete septate uterus and in addition, an elongated tubular structure (isointense to the spleen) extending from the left ovary in the left retroperitoneal region/left paracolic gutter to the under-splenic surface. CT abdomen and pelvis revealed this to be a similarly enhancing structure as the spleen and appears as a tubular retroperitoneal structure connecting the left ovary to the spleen with associated vasculature joining the splenic vein cranially and the ovarian vessels caudally consistent with splenogonadal fusion.
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Affiliation(s)
| | | | - Maysa A. Mohamed
- Body Imaging Department, HGH, Hamad Medical Corporation, Doha, Qatar
| | | | - Amal A. Al-Rashid
- Department of Radiology-College of Medicine, Qatar University, Hamad Medical Corporation, Doha, Qatar
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Zhang J, Kang J, Song X, Yang S, Yang Y, Qiao J, Ma C. Effects of hysteroscopic septum incision versus expectant management on IVF outcomes in women with complete septate uterus: a retrospective study. BMC Womens Health 2024; 24:202. [PMID: 38555467 PMCID: PMC10981310 DOI: 10.1186/s12905-024-03022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE This retrospective study aimed to assess the impact of hysteroscopic septum incision on in vitro fertilization (IVF) outcomes among infertile women diagnosed with a complete septate uterus and no history of recurrent pregnancy loss. METHODS The study was conducted at a tertiary reproductive center affiliated with a university hospital and involved 78 women with a complete septate uterus. Among them, 34 women underwent hysteroscopic septum incision, while 44 women opted for expectant management. The primary outcome measure was the live birth rate, while secondary outcomes included clinical pregnancy rate, preterm birth rate, miscarriage rate, and ongoing pregnancy rate. RESULTS Women who underwent hysteroscopic septum incision demonstrated a comparable likelihood of achieving a live birth compared to those managed expectantly (25% vs. 25%, Relative Risk (RR): 1.000, 95% Confidence Interval (CI): 0.822 to 1.216). No preterm births occurred in either group. The clinical pregnancy rate, ongoing pregnancy rate, and miscarriage rate showed no significant differences between the surgical group and the expectant management group. Subgroup analyses based on the type of embryo transferred also revealed no significant differences in outcomes. CONCLUSIONS Hysteroscopic septum incision does not appear to yield improved IVF outcomes compared to expectant management in infertile women with a complete septate uterus and no history of recurrent pregnancy loss.
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Affiliation(s)
- Jiajia Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jia Kang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Xueling Song
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Shuo Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Yan Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
- Beijing Advanced Innovation Center for Genomics, Beijing, China.
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China.
| | - Caihong Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.
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Kalaitzopoulos DR, Themeli MZ, Grigoriadis G, Alterio MD, Vitale SG, Angioni S, Daniilidis A. Fertility, pregnancy and perioperative outcomes after operative hysteroscopy for uterine septum: a network meta-analysis. Arch Gynecol Obstet 2024; 309:731-744. [PMID: 37354236 DOI: 10.1007/s00404-023-07109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Septate uterus is a congenital malformation associated with adverse reproductive and pregnancy outcomes. It remains controversial whether hysteroscopic septoplasty should be recommended for the treatment of septate uterus, and it is also unclear if different hysteroscopic methods have more favorable outcomes. This study aims to compare the available hysteroscopic techniques of septoplasty for fertility, reproductive, and perioperative outcomes. METHODS This systematic review and meta-analysis was conducted following PRISMA guidelines. We searched Medline, Scopus, and Cochrane databases up to April 2023 without language restrictions. Eligible studies had to compare two or more different methods of hysteroscopic septoplasty in women with septate uterus and report on fertility and pregnancy outcomes after a follow-up. Perioperative outcomes were also examined. Data extraction was performed by two independent reviewers using a standardized form. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Form and Revised Cochrane risk-of-bias tool (RoB 2). RESULTS Out of 561 studies identified, 9 were included in the systematic review and meta-analysis. The comparison of different hysteroscopic septoplasty techniques based on the energy used showed higher pregnancy rates after mechanical septoplasty in comparison to electrosurgery, while miscarriage and live birth rates were comparable. Laser vs. electrosurgery and mechanical techniques of septoplasty had comparable pregnancy, miscarriage, and live birth rates. The network meta-analysis after comparing every different method used showed significantly higher clinical pregnancy rate in scissor group in comparison to resectoscope. No significant differences were found among the techniques regarding miscarriage rate and live birth rate. CONCLUSION In summary, this systematic review and network meta-analysis suggests that hysteroscopic septoplasty with scissors is associated with higher pregnancy rates compared to resectoscope. However, the limited evidence available and small sample sizes in the included studies indicate that these findings should be interpreted with caution. Further studies are required to determine the effectiveness of various hysteroscopic techniques and guide clinical decision-making in the management of this condition.
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Affiliation(s)
- Dimitrios Rafail Kalaitzopoulos
- Department of Obstetric and Gynecology, Cantonal Hospital of Schaffhausen, Geissbergstrasse 81, 8208, Schaffhausen, Switzerland.
| | - Maria Zografou Themeli
- Department of Obstetrics and Gynecology, Evangelisches Krankenhaus Oberhausen, Virchowstrasse 20, 46047, Oberhausen, Germany
| | - Georgios Grigoriadis
- 2nd University Department in Obstetrics and Gynecology, School of Medicine, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maurizio D Alterio
- University Department in Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | | | - Stefano Angioni
- University Department in Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | - Angelos Daniilidis
- 1st University Department in Obstetrics and Gynecology, School of Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Zhou Q, Bai Y, Chen F, Zhang H, Chen L, Zhang G, Wang Y, Sui L. 3D reconstruction of the uterus and automatic segmentation of the uterine cavity on 3D magnetic resonance imaging: A preliminary study. Heliyon 2024; 10:e23558. [PMID: 38170061 PMCID: PMC10758877 DOI: 10.1016/j.heliyon.2023.e23558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose To determine the differences in 3D shape features between septate uterus (SU) and normal uterus and to train a network to automatically delineate uterine cavity on 3D magnetic resonance imaging (MRI). Methods A total of 43 patients (22 cases of partial septate uterus and 21 cases of complete septate uterus) were included in the experimental group. Nine volunteers were recruited as a control group. The uterine cavity (UC), myometrium (UM), and cervical canal of the uterus were segmented manually using ITK-SNAP software. The three-dimensional shape features of the UC and UM were extracted by using PyRadiomics. The recurrent saliency transformation network (RSTN) method was used to segment the UC. Results The values of four 3D shape features were significantly lower in the control group than in the partial septate group and the complete septate group, while the values of two features were significantly higher (p < 0.05). The UCs of the three groups were significantly different in terms of flatness and sphericity. The values of six features were significantly lower in the UMs of the control group than in those of the partial septate group and the complete septate group (p < 0.05). After the deep learning networks were trained, the Dice similarity coefficient (DSC) scores of the four folds for different thresholds were all over 80 %. The average volume ratio between predictions and manual segmentation was 101.2 %. Conclusions Based on 3D reconstruction, 3D shape features can be used to comprehensively evaluate septate uterus and provide a reference for subsequent research. The UC can be automatically segmented on 3D MRI using the RSTN method.
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Affiliation(s)
- Qing Zhou
- Department of Radiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Yunhao Bai
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, 200241, China
| | - Fang Chen
- Cervical Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - He Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Limei Chen
- Cervical Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Guofu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Yan Wang
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, 200241, China
| | - Long Sui
- Cervical Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
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Xiong W, Tan X, Liu Y, Liu J, Dong X, Wang Z, Chen H. Comparison of clinical outcomes and second-look hysteroscopy of the complete and incomplete septate uterus after hysteroscopic septoplasty. Arch Gynecol Obstet 2024; 309:227-233. [PMID: 37816880 DOI: 10.1007/s00404-023-07243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 09/17/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Septate uterus is the most common congenital uterine malformation. This retrospective cohort study compared clinical outcomes and second-look hysteroscopy findings in patients with complete and incomplete septate uteri after septoplasty. METHODS We reviewed the medical records of patients with a septate uterus who underwent hysteroscopic septoplasty and second-look hysteroscopy at the West China Second University Hospital between September 2013 and September 2021. Information regarding pregnancy outcomes was collected through telephone interviews. The independent samples t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test were used to explore the differences between the complete and incomplete septate uterus groups. RESULTS A total of 64 patients were enrolled in this study. There was no significant difference in intrauterine adhesion (IUA) rates (16.7% and 32.1%), pregnancy rates (44.1% and 42.9%), term delivery rates (35.3% and 32.1%), premature delivery rates (2.9% and 0), placenta previa rates (2.9% and 3.6%), placenta implantation/adhesion rates (5.9% and 3.6%), and premature rupture of membranes rates (2.9% and 0) between the complete and the incomplete group after hysteroscopic septoplasty (P > 0.05). Endometrial polyps in the septate uterus were common, with an incidence of 33.3% and 25% in the complete and incomplete groups, respectively (P > 0.05). CONCLUSION The pregnancy outcomes of complete and incomplete septate uteri after hysteroscopic septoplasty were similar. There was no statistical difference in IUAs after surgery. Different treatment strategies may not be required for complete or incomplete septate uteri.
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Affiliation(s)
- Wei Xiong
- Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China
| | - Xin Tan
- Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China
| | - Yana Liu
- Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China
| | - Jie Liu
- Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China
| | - Xue Dong
- Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China
| | - Zhilin Wang
- Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China
| | - Hengxi Chen
- Day Surgery Department, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China.
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, 610041, China.
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Omoto A, Ishikawa H, Inoue M, Morimoto S, Koga K, Shozu M. Metroplasty increases the take-home baby rate by reducing pregnancy loss without changing the chance of conception in women with septate uterus: a retrospective, single-center, observational study. BMC Pregnancy Childbirth 2023; 23:860. [PMID: 38098016 PMCID: PMC10720111 DOI: 10.1186/s12884-023-06191-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/11/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Although abdominal or hysteroscopic metroplasty for septate uterus is considered to reduce pregnancy loss and increase the take-home baby (THB) rate in women with a history of recurrent pregnancy loss, there exists an inherent risk of impaired fertility. This study aimed to clarify the reproductive outcomes of women with septate uterus who underwent abdominal and hysteroscopic metroplasty in a single center. METHODS This retrospective observational study enrolled 27 women who underwent metroplasty between 2007 and 2019. The analysis included women with septate uterus [European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) type U2)] or septate-bicornuate uterus (ESHRE/ESGE type U3b) who underwent either abdominal or hysteroscopic metroplasty. Women who did not have an immediate desire to conceive were excluded from the analysis. As a rule, we recommended pregnancy without surgery for women who had not experienced repeated pregnancy loss. Abdominal metroplasty (ABM) was performed using the modified Tompkins' method and hysteroscopic metroplasty was performed using hysteroscopic transcervical resection of the septum [transcervical metroplasty (TCM)]. The conception ratio was calculated as the number of women who achieved ≥ 1 conception/total number of women, the pregnancy loss ratio was calculated as the number of women who experienced ≥ 1 pregnancy loss/the number of women who conceived, and the THB ratio was calculated as the number of women who achieved ≥ 1 THB/total number of women. RESULTS Seventeen women underwent ABM and 10 women underwent TCM. Thirty-three conceptions and 26 babies were taken home after surgery. ABM did not change the ≥ 1 conception ratio (76% vs. 83% before and after surgery, respectively; RR = 1.08, p = 0.80). Meanwhile, ABM decreased the ≥ 1 pregnancy loss ratio (100% vs. 36%, RR = 0.36, p < 0.001) and increased the ≥ 1 THB ratio (12% vs. 71%, RR = 6.00, p < 0.01). Similarly, TCM did not change the ≥ 1 conception ratio, decreased the ≥ 1 pregnancy loss ratio, and increased the ≥ 1 THB ratio. CONCLUSIONS Both abdominal and hysteroscopic metroplasty for septate uterus increased the THB rate by preventing pregnancy loss without affecting the chance of pregnancy. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Akiko Omoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hiroshi Ishikawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Mariko Inoue
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Obstetrics and Gynecology, Chiba Kaihin Municipal Hospital, Chiba, 261- 0012, Japan
| | - Sachi Morimoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Obstetrics and Gynecology, Matsudo City General Hospital, Matsudo, 270- 2296, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Makio Shozu
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Evolution and Reproductive Biology, Medical Mycology Research Center, Chiba University, Chiba, 260-8673, Japan
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Fayek B, Yang EC, Liu YD, Bacal V, AbdelHafez FF, Bedaiwy MA. Uterine Septum and Other Müllerian Anomalies in a Recurrent Pregnancy Loss Population: Impact on Reproductive Outcomes. J Minim Invasive Gynecol 2023; 30:961-969. [PMID: 37506876 DOI: 10.1016/j.jmig.2023.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/03/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
STUDY OBJECTIVE To study the impact of Müllerian anomalies on reproductive outcomes in a recurrent pregnancy loss (RPL) population and to evaluate the effect of surgical correction of uterine septum on the odds of achieving live birth in RPL patients with a septate uterus. DESIGN A retrospective cohort study. SETTING A specialized RPL clinic at a tertiary center. PATIENTS RPL patients with ≥ 2 pregnancy losses before 20 weeks' gestation who attended a specialized RPL clinic. INTERVENTION We aimed to assess the association between a possible risk factor (Müllerian anomalies) and reproductive outcomes and that between having surgery for septate uterus and achieving a live birth. MEASUREMENTS AND MAIN RESULTS The primary outcome is live birth rate in RPL patients with Müllerian anomalies compared with those without; secondary outcome measures include rates of full-term live birth, preterm live birth, first and second trimester pregnancy loss, and stillbirth. After adjusting for patient age at the initial RPL visit, the number of pregnancy losses, and the presence of any other abnormal RPL investigation, the odds of achieving live birth were on average 49.4% lower for patients with a septate uterus than those without Müllerian anomalies (odds ratio, 0.51; 95% confidence interval, 0.30-0.86) in the studied cohort (n = 377). A subanalysis of 72 patients with septate uterus demonstrated a higher likelihood of live birth in those who underwent septum resection (46/72; 63.9%) than those who elected to go for expectant management (26/72; 36.1%), yet this study was underpowered to establish a significant difference (52.2% vs 34.6%; p = .22). CONCLUSION In RPL patients, having a septate uterus significantly decreased the chances of achieving live birth. Patients with septate uterus who received hysteroscopic septum division had a higher tendency to achieve more live births than those who elected expectant management. However, our study was underpowered to detect a statistically significant difference.
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Affiliation(s)
- Bahi Fayek
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynecology (Dr. Fayek), Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Emily C Yang
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yang Doris Liu
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Bacal
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology (Dr. Bacal), University of Toronto, Toronto, ON, Canada; Mount Sinai Fertility (Dr. Bacal), Toronto, ON, Canada
| | - Faten F AbdelHafez
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynecology (Dr. AbdelHafez), Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A Bedaiwy
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
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Lan Z, He R, Long Y, Zhou S, Xia G, Jing F, Xi M, Ouyang Y. Reproductive outcomes after uterine septum resection in patients with recurrent miscarriage or infertility: a retrospective study in Chinese women. Arch Gynecol Obstet 2023; 307:609-17. [PMID: 36217037 DOI: 10.1007/s00404-022-06794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 09/01/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Septate uterus is the most common structural uterine anomaly, which is related to the adverse pregnancy outcomes in women of childbearing age. This article provides a retrospective review of hysteroscopic uterine septum resection performed in our hospital during recent years, focusing on the patients with recurrent miscarriage and primary infertility, and also to identify which patients are more likely to benefit from the surgery. METHODS This is a single-center retrospective study. Cases of women who underwent hysteroscopic septum resection at West China Second Hospital of Sichuan University from January 2014 to December 2019, retrieved through the medical record system, were divided into three groups: Group A was the recurrent miscarriage group, Group B had a history of pregnancy with spontaneous abortion once at most, and Group C was the primary infertility group. Each patient was followed up by telephone about further pregnancy, miscarriage and live birth for at least 1 year. RESULTS A total of 176 surgical patients were included in this study. Group A, B, and C include 42, 74, and 60 cases, respectively. The postoperative pregnancy rates of the three groups were 71.4, 82.4, and 75.0%; live births rates were 50.0, 74.3, and 71.7%; and spontaneous abortion rates were 21.4, 17.6, and 13.3%. 62 patients had a complete uterine septum and 114 had a partial uterine septum. For patients with complete septate uterus, the preoperative pregnancy rate was 54.84% and the pregnancy rate increased to 85.48% after surgery; and yet the preoperative and postoperative pregnancy rates in patients with partial septate uterus were close (from 71.9 to 72.8%). CONCLUSIONS After uterine septum resection, the pregnancy rate and spontaneous abortion rate in RSA patients were not significantly different from the other two groups, but the live birth rate was still significantly lower. Patients with complete uterine septum may benefit more from surgery. The surgical indications should be carefully and strictly evaluated.
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Kakinuma K, Kakinuma T, Kaneko A, Kagimoto M, Takeshima N, Ohwada M, Yanagida K. Natural Pregnancy Associated with Uterine Inversion after Combined Laparoscopic and Hysteroscopic Septum Resection: A Case Report. J Obstet Gynaecol India 2022; 72:382-384. [PMID: 36457431 PMCID: PMC9701277 DOI: 10.1007/s13224-022-01640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, 537-3, Iguchi, Tochigi, Nasushiobara, 327-2763 Japan
| | - Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, 537-3, Iguchi, Tochigi, Nasushiobara, 327-2763 Japan
| | - Ayaka Kaneko
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, 537-3, Iguchi, Tochigi, Nasushiobara, 327-2763 Japan
| | - Masataka Kagimoto
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, 537-3, Iguchi, Tochigi, Nasushiobara, 327-2763 Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, 537-3, Iguchi, Tochigi, Nasushiobara, 327-2763 Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, 537-3, Iguchi, Tochigi, Nasushiobara, 327-2763 Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International Health and Welfare Hospital, 537-3, Iguchi, Tochigi, Nasushiobara, 327-2763 Japan
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10
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Althagafi NFA, Galal M, Abdul Rab S, Alkhudari A, Raheel HM. Primary omental pregnancy in a sub septate uterus: A novel case report and literature review. Ann Med Surg (Lond) 2022; 84:104924. [PMID: 36582853 PMCID: PMC9793226 DOI: 10.1016/j.amsu.2022.104924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Ectopic pregnancy is defined as a pregnancy in which the fertilized ovum implants itself in a location other than the uterine endometrium. Abdominal ectopic pregnancies involve the implantation and development of the embryo within the peritoneal cavity. Primary omental pregnancies are the rarest form of abdominal pregnancy and possibly the rarest extrauterine gestation. Case presentation We report the first case of a primary omental pregnancy in a subseptate uterus in literature. Our patient, a 33-year-old female, G8P4+3, presented with nausea, severe abdominal pain, and vaginal spotting at 6 weeks' gestational age. She had mild tenderness below the umbilicus, with positive cervical and right adnexal tenderness. 2D-ultrasound revealed a subseptate uterus, normal ovaries and fallopian tubes, absence of a gestational sac, and a 4x3x2.5 cm mass in the right adnexa. A mini-laparotomy was performed due to suspicion of ruptured tubal pregnancy, revealing a primary omental pregnancy which was managed via partial omentectomy. Clinical discussion Ectopic pregnancies have ambiguous presentations, however correct diagnosis and management is crucial to prevent complications. A high index of suspicion must be exercised to make an accurate diagnosis of primary omental pregnancy. A subseptate uterus is a subtype of the most common uterine anomaly and should be investigated via 3D-ultrasound and magnetic resonance imaging as it causes increased risk of primary omental implantation. Conclusion Correct identification of subseptate or septate uteri is vital. Greater research is needed to elucidate the association between septate or subseptate uteri and ectopic pregnancy, particularly primary omental pregnancy.
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Affiliation(s)
| | - Maad Galal
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Saleha Abdul Rab
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Corresponding author. College of Medicine, Alfaisal University, Takhassusi Road, Riyadh, 11533, Saudi Arabia.
| | - Anas Alkhudari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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11
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Tang J, Jiang L, Zhang J, Xiao S, Li X, Zhou J. Effect of hyteroscopic uterine septum resection on pregnancy outcomes. J Gynecol Obstet Hum Reprod 2021; 51:102275. [PMID: 34852309 DOI: 10.1016/j.jogoh.2021.102275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the reproductive outcome following hysteroscopic resection versus usual care in nulliparous women with a septate uterus. METHODS A retrospective cohort study of nulliparous women with a history of uterine septum and had singleton pregnancies at >20 weeks gestation between Jan. 2016 and Dec. 2019 were conducted. Follow-up was performed through medical record reviews and telephone conversations. The primary outcome was preterm birth at<37weeks gestation, and the secondary outcomes include cesarean delivery, malpresentation, preeclampsia, and birth weight<10th percentile for gestational age. Multivariate logistic regressions were performed to evaluate the effect of hysteroscopic resection on primary and secondary outcomes, after controlling for potential confounding factors. RESULTS Totally 198 women were included in this study, among which 112 women underwent a hysteroscopic resection and 86 women received usual care. Preterm birth incidence (7.1% vs. 18.6%, P = 0.03) and malpresentation (10.7% vs. 23.3%, P = 0.03) was significantly lower in women treated with hysteroscopic resection compared with those received usual care. Multivariate logistic regression indicated that hysteroscopic resection was significantly associated with decreased risks of preterm birth (OR = 0.36, 95% CI: 0.13-0.68; P < 0.01) and malpresentations (OR = 0.47, 95% CI: 0.25-0.71; P < 0.01), after controlling for potential confounding factors. CONCLUSION Hysteroscopic resection could significantly reduce the risks of preterm birth and malpresentations compared to usual care for nulliparous women with a septate uterus.
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12
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Carrera M, Pérez Millan F, Alcázar JL, Alonso L, Caballero M, Carugno J, Dominguez JA, Moratalla E. Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2021; 29:465-475. [PMID: 34648934 DOI: 10.1016/j.jmig.2021.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this systematic review with meta-analysis is to evaluate the impact of hysteroscopic metroplasty on adverse reproductive outcomes such as miscarriage, preterm birth, and fetal malpresentation in patients with history of infertility or previous poor obstetrical outcomes. DATA SOURCES A systematic electronic search from inception each database up to April 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, the CGF Specialized Register of Controlled Trials, Google Scholar, and trial registries. A combination of the following keywords was used: uterine septum, septate uterus, congenital uterine malformation, class 2 uterus, class V uterus, metroplasty, hysteroscopic, pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, live birth, preterm birth, cesarean section, 'cesarean delivery, and fetal malpresentation. METHODS OF STUDY SELECTION Studies comparing reproductive outcomes between women undergoing hysteroscopic resection of the uterine septum and those with expectant management were included. Eligible population consisted of infertile women, women with poor obstetrical history, or women without previous pregnancy failures and a diagnosis of septate uterus. TABULATION, INTEGRATION, AND RESULTS The systematic electronic search retrieved 1076 studies; after elimination of duplicates, 688 titles and abstracts were screened, and 55 were assessed for eligibility. Eleven studies were included in the quantitative synthesis: one randomized controlled trial and 10 observational studies involving reproductive outcomes from 1589 patients with either complete or partial uterine septum. The pooled OR for miscarriage was 0.45, (95% CI, 0.22-0.90). When the analysis was performed considering subgroups according to the type of septum, pooled OR in complete septum subgroup was 0.16 (95% CI, 0.03-0.78), OR = 0.36 (95% CI, 0.19-0.71) in the partial septum subgroup and 0.58 (95% CI, 0.20-1.67) in those studies not differentiating between complete or partial septum. No significant differences were found between the 2 groups in OR of clinical pregnancy, term live birth, or risk of cesarean delivery. There was a significant decrease in the frequency of preterm birth in patients who underwent partial septum resection (OR = 0.30, 95% CI, 0.11-0.79). This difference was detected neither in patients with complete septum nor in studies not differentiating between partial or complete septum. The risk of fetal malpresentation was also significantly reduced (OR = 0.32, 95% CI, 0.16-0.65). CONCLUSION The results of the present meta-analysis support that hysteroscopic metroplasty is effective in reducing the risk of miscarriage in patients with complete or partial uterine septum, although these data should be confirmed with a well-designed randomized controlled trial.
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Affiliation(s)
- Maria Carrera
- Hospital Universitario Doce de Octubre (Dr. Carrera)
| | | | | | | | - Miguel Caballero
- Hospital General Universitario Gregorio Marañón (Drs. Millan and Caballero)
| | - Jose Carugno
- Minimally Invasive Gynecology Division, University of Miami, Miami, Florida (Dr. Carugno).
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Kisu I, Nakamura K, Shiraishi T, Iijima T, Iijima M, Matsuda K, Hirao N. Inappropriate surgery in a patient with misdiagnosed Robert's uterus. BMC Womens Health 2021; 21:264. [PMID: 34217289 PMCID: PMC8254971 DOI: 10.1186/s12905-021-01404-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Robert's uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert's uterus, resulting in an invasive and disadvantageous surgery. CASE PRESENTATION A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert's uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient's symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient's uterus susceptible to uterine rupture in any future pregnancy. CONCLUSIONS Although the early diagnosis of Robert's uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.
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Affiliation(s)
- Iori Kisu
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan. .,Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan.
| | - Kanako Nakamura
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Tetsuro Shiraishi
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Tomoko Iijima
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Moito Iijima
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Kiyoko Matsuda
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Nobumaru Hirao
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
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14
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Chen HX, Lv SG, Zhang YN, Yu Q, Du J, Yan L, Chen ZJ. Effect of hysteroscopic septum resection on subsequent in vitro fertilization-intracytoplasmic sperm injection outcomes in cases of primary infertility. J Gynecol Obstet Hum Reprod 2021; 50:102149. [PMID: 33872814 DOI: 10.1016/j.jogoh.2021.102149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Women with septate uteri are at risk for subfertility, recurrent miscarriage, and preterm birth. It is not clear if hysteroscopic septum resection is beneficial to subsequent in vitro fertilization-intracytoplasmic sperm injection o (IVF/ICSI) outcomes in women with primary infertility. STUDY DESIGN We analyzed all 278 women with uterine septum and primary infertility between January 2011 and January 2019. In this retrospective cohort study, the patients were divided into a surgery group and an expectant (non-surgery) group. RESULTS Among them, 87 had a complete and 191 a partial septate uterus. The IVF-ET characteristics of the two groups showed no significant differences in the patients' age, body mass index, or basal follicle-stimulating hormone, luteinizing hormone, and estradiol levels (P>0.05). The miscarriage rate in those who underwent hysteroscopic septum resection, however, was significantly reduced (5.1% vs. 12.9%, P = 0.035). In contrast, the live birth rate between the two groups revealed no significant difference (51.4% vs. 43.6%, P = 0.1771), nor did the obstetric and neonatal outcomes (P>0.05). CONCLUSIONS Hysteroscopic septum resection can be recommended prior to IVF/ICSI.
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Affiliation(s)
- Hui-Xiao Chen
- School of medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China; Department of Gynecology and Obstetrics, Liaocheng People's Hospital, Shandong Province, 252000, China
| | - Shang-Ge Lv
- School of medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China
| | - Ya-Nan Zhang
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China
| | - Qian Yu
- Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China
| | - Jing Du
- Department of Gynecology and Obstetrics, Liaocheng People's Hospital, Shandong Province, 252000, China
| | - Lei Yan
- School of medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China.
| | - Zi-Jiang Chen
- School of medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China; Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong, 250012, China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, 250012, China
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15
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Liu Y, Wang S, Hong Y, Wang J, Niu J, Li X, Li H, Wang Y. Pregnancy in the blind hemi-cavity of Robert's uterus: a case report. Radiol Case Rep 2021; 16:1085-1088. [PMID: 33717388 PMCID: PMC7921196 DOI: 10.1016/j.radcr.2021.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/01/2022] Open
Abstract
Robert's uterus is a rare Müllerian malformation first characterized by a French gynecologist Héléne Robert in 1969. It represents an asymmetric division of the uterine cavity. A 45-year-old female patient presented with vaginal bleeding and vague abdominal pain for the course of 20 days, with a blood human chorionic gonadotropin level of 10331.00 mIU/mL, and a gestational sac in the right uterine horn without a fetal heart beat revealed by the ultrasound. Ectopic pregnancy in the right uterine horn seemed to be the most likely diagnosis. Laparoscopic and hysteroscopic attempts to terminate the pregnancy failed. A pelvic magnetic resonance imaging (MRI) performed after the surgery demonstrated Robert's uterus with pregnancy in the blind hemicavity. When a pregnancy sac has been revealed by an ultrasound but nothing has been found by a hysteroscopy, a possibility of uterine malformation should be considered. Radiologists and gynecologists should consider the application of MRI for diagnosis of congenital Müllerian uterine anomalies.
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Affiliation(s)
- Yan Liu
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Shanshan Wang
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Yue Hong
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Jia Wang
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Junqiao Niu
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Xiaojuan Li
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Hui Li
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Yan Wang
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
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16
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Xiao F, Gao S, Tang X, Chen Y, Fang F. Oblique Cervical Septum with Complete Uterine Septum: Diagnosis and Treatment of a Rare Case. J Pediatr Adolesc Gynecol 2021; 34:84-87. [PMID: 32473321 DOI: 10.1016/j.jpag.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Müllerian anomalies take many forms of manifestation. The oblique cervical septum with a complete uterine septum (OCSCUS), as a rare form of Müllerian anomaly, has never been reported in the literature. CASE A 10-year-old female adolescent presented with progressive abdominal pain after the onset of menarche was diagnosed as OCSCUS using magnetic resonance imaging and treated with hysteroscopic dissection of the uterine part of the septum. SUMMARY AND CONCLUSION Greater awareness of the OCSCUS will lead to earlier detection and is the key to alleviating patient suffering and avoiding potentially severe complications, such as endometriosis and infertility. For the treatment of OCSCUS, hysteroscopic dissection of the uterine part of the septum is a minimally invasive treatment choice with low surgical risk.
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Affiliation(s)
- Fengyi Xiao
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Shujun Gao
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xindi Tang
- Shaoxing Shangyu Maternal and Child Health Hospital, Shaoxing, China
| | - Yisong Chen
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Fang Fang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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17
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Ryu S, Baek HW, Lee I, Won YB, Kim H, Lee JH, Yun BH, Park JH, Seo SK, Cho S, Choi YS, Lee BS. Operative hysteroscopy-assisted pregnancy termination after failed surgical abortion in missed abortion of woman with complete septate uterus. Obstet Gynecol Sci 2020; 63:102-6. [PMID: 31970135 DOI: 10.5468/ogs.2020.63.1.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/08/2019] [Accepted: 10/10/2019] [Indexed: 11/08/2022] Open
Abstract
First trimester surgical abortion is an effective and safe procedure. Although its failure is uncommon, congenital uterine anomaly may be considered as one of the etiologic factors in such cases. Here, we report a rare case of surgical abortion failure that was successfully managed by operative hysteroscopy-assisted dilatation and evacuation (D&E) under ultrasound guidance in a woman with complete uterine septum. The patient was referred to Severance Hospital after two consecutive surgical abortion failures even under ultrasound guidance. A missed abortion in a left-sided hemicavity of septate uterus was noted on ultrasonography. Ultrasound-guided D&E was unsuccessful because the curette could not reach the uterine cavity with the gestational sac. Operative hysteroscopy revealed insufficient communication with the left-sided cavity just above the cervical internal os of the uterine septum. After widening the communication, ultrasound-guided D&E was successfully performed.
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18
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Abstract
Objective This study aimed to evaluate the reproductive outcomes of patients who
underwent hysteroscopic metroplasty for correction of a complete septate
uterus. Methods The study population comprised 92 women with complete septate uteri.
Hysteroscopic metroplasty and laparoscopy were performed simultaneously in
these patients. The postoperative reproductive outcome of each patient was
evaluated. Results In the primary infertility group, there were 32 (40%) pregnancies. In the
abortion group, the number of miscarriages decreased from 68 (94.44%) to 5
(10.42%), while the number of live births increased from 1 (1.39%) to 42
(87.50%) after resection compared with before resection. The cumulative
probability of pregnancy and that of live-birth pregnancy in the abortion
group were significantly higher than those in the primary infertility group
after surgery. Furthermore, resection of the cervical septum resulted in a
significantly higher cumulative probability of live birth compared with
preservation of the cervical septum. Conclusion Hysteroscopic uterine metroplasty may improve the reproductive performance of
a septate uterus. Resection of the cervical septum may increase the
probability of a live-birth pregnancy for patients with a cervical septum,
and this procedure could be recommended for cases of a complete uterine
septum.
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Affiliation(s)
- Zhenhong Wang
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jian An
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.,Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yanzhao Su
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Chaobin Liu
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Shunhe Lin
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jinna Zhang
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xi Xie
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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19
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Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, Spinder T, de Kruif JH, Bloemenkamp KWM, Jansen FW, Veersema S, Mulders AGMGJ, Thurkow AL, Hald K, Mohazzab A, Khalaf Y, Clark TJ, Farrugia M, van Vliet HA, Stephenson MS, van der Veen F, van Wely M, Mol BWJ, Goddijn M. The randomised uterine septum transsection trial (TRUST): design and protocol. BMC Womens Health 2018; 18:163. [PMID: 30290803 PMCID: PMC6173848 DOI: 10.1186/s12905-018-0637-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/23/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND A septate uterus is a uterine anomaly that may affect reproductive outcome, and is associated with an increased risk for miscarriage, subfertility and preterm birth. Resection of the septum is subject of debate. There is no convincing evidence concerning its effectiveness and safety. This study aims to assess whether hysteroscopic septum resection improves reproductive outcome in women with a septate uterus. METHODS/DESIGN A multi-centre randomised controlled trial comparing hysteroscopic septum resection and expectant management in women with recurrent miscarriage or subfertility and diagnosed with a septate uterus. The primary outcome is live birth, defined as the birth of a living foetus beyond 24 weeks of gestational age. Secondary outcomes are ongoing pregnancy, clinical pregnancy, miscarriage and complications following hysteroscopic septum resection. The analysis will be performed according to the intention to treat principle. Kaplan-Meier curves will be constructed, estimating the cumulative probability of conception leading to live birth rate over time. Based on retrospective studies, we anticipate an improvement of the live birth rate from 35% without surgery to 70% with surgery. To demonstrate this difference, 68 women need to be randomised. DISCUSSION Hysteroscopic septum resection is worldwide considered as a standard procedure in women with a septate uterus. Solid evidence for this recommendation is lacking and data from randomised trials is urgently needed. TRIAL REGISTRATION Dutch trial registry ( NTR1676 , 18th of February 2009).
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Affiliation(s)
- J F W Rikken
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - C R Kowalik
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - M H Emanuel
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - M Y Bongers
- Maxima Medical Centre, de Run 4600, 5504, DB, Veldhoven, The Netherlands
| | - T Spinder
- Leeuwarden Medical Centre, Henri Dunantweg 2, 8934, AD, Leeuwarden, the Netherlands
| | - J H de Kruif
- Canisius Wilhelmina Hospital, PO Box 9015, 6500, GS, Nijmegen, The Netherlands
| | - K W M Bloemenkamp
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - F W Jansen
- University Medical Centre Leiden, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - S Veersema
- University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
| | - A G M G J Mulders
- Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - A L Thurkow
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - K Hald
- Oslo University Hospital, P. O. Box 4950, Nydalen, N-0424, Oslo, Norway
| | - A Mohazzab
- Avicenna research institute Teheran, PO Box: 19615-1177, Teheran, Postal code: 1936773493, Iran
| | - Y Khalaf
- Guy's hospital, Great maze pond, London, SE1 9RT, UK
| | - T J Clark
- Birmingham women's hospital, Mindelsohn Way, Birmingham, West Midlands, B15 2TG, UK
| | - M Farrugia
- East Kent Hospitals University, Ethelbert road, Canterbury, Kent, CT1 3NG, UK
| | - H A van Vliet
- Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands
| | - M S Stephenson
- University of Illinois Hospital, 1740 W Taylor St, Chicago, IL, 60612, USA
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - M Goddijn
- Center for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100, DE, Amsterdam, The Netherlands.
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Ouyang Y, Yi Y, Gong F, Lin G, Li X. ESHRE-ESGE versus ASRM classification in the diagnosis of septate uterus: a retrospective study. Arch Gynecol Obstet 2018; 298:845-50. [PMID: 30159673 DOI: 10.1007/s00404-018-4878-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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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21
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Cho JH, Won HJ, Kim MK, Park JH, Hwang JY. New Ambulatory Hysteroscopic Septoplasty using Ballooning in a Woman with Complete Septate Uterus: A Case Report. Dev Reprod 2018; 22:105-109. [PMID: 29707689 PMCID: PMC5915762 DOI: 10.12717/dr.2018.22.1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 03/18/2018] [Accepted: 03/24/2018] [Indexed: 11/17/2022]
Abstract
A 40-year-old G1 P0 L0 A1 woman was referred to our clinic with 6-year history of
infertility. Before visiting the clinic, she had 3 cycles of
In-Vitro Fertilization (IVF) procedures (2 cycles of
Controlled Ovarian Stimulation-IVF and 1 cycle of frozen-thawed Embryo Transfer
(ET)) at other clinic. She had medical history of abortion at early gestation
following FET (frozen-thawed-ET). The patient had complete type of septate
uterus, double cervix and longitudinal vaginal septum. Vaginal septotomy was
done first and 1 month later, hysteroscopic septoplasty was followed using
ballooning filled with dye. After septoplasty, we inserted ballooning and left
for several days to compress septal endometrium on the septectomy area. All
procedures were done in the ambulatory operating room without laparoscopy or
admission. 3 months later, she had in vitro
fertilization-embryo transfer (IVF-ET) and FET procedures in our clinic. She had
successful pregnancy and now is at 22 weeks of gestation. New ambulatory
septoplasty using dye-filled ballooning is easy, safe and minimally invasive
surgery for treatment of complete septate uterus.
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22
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Takahashi A, Kanao H, Takeshima N. Small-Diameter Hysteroscopic Metroplasty for a Septate Uterus after Open-Assisted Laparoscopic Radical Trachelectomy. J Minim Invasive Gynecol 2017; 25:949-950. [PMID: 29146391 DOI: 10.1016/j.jmig.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/17/2017] [Accepted: 11/04/2017] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To describe a 2-step fertility preservation technique for early-stage cervical cancer of a patient with a complete septate uterus. DESIGN A step-by-step demonstration and explanation of the technique in a surgical video (Canadian Task Force classification III). SETTING Center for cancer, a tertiary referral center. Institutional Review Board approval was not required for this kind of procedure. PATIENT A 37-year-old woman. The patient provided informed consent to use images and videos of the procedure. INTERVENTIONS Open-assisted laparoscopic radical trachelectomy (LRT) after metroplasty. MEASUREMENTS AND MAIN RESULTS A 37-year-old woman presented with early-stage cervical cancer and a complete septate uterus. She desired fertility preservation. After careful counseling and in accordance with her wishes for fertility-sparing surgery, open-assisted LRT after metroplasty were scheduled. First, LRT was successfully completed, and a cervical cerclage using permanent Ethibond sutures (Ethicon, Inc, Somerville, NJ) was doubly inserted around the level of the internal os with a Hegar size 8 dilator to maintain patency. At 6 months after this procedure, magnetic resonance imaging (MRI) revealed no sign of recurrence. Then, metroplasty without dilatation of the cervical os was performed using a small-diameter (5.2-mm) resectoscope system (Karl Storz GmbH & Co. KG, Tuttlingen, Germany), scissor forceps, bipolar electrode, and normal saline. A hysteroscope was inserted without gripping the neocervix, and the septum was then resected with scissor forceps. The septum was cut from the cervical to the fundal side. Finally, an intrauterine device was placed in the uterine cavity to prevent adhesion in the uterine cavity. Three months later MRI confirmed normal development of the whole endometrium. No intraoperative or postoperative complications occurred. CONCLUSIONS This 2-step fertility preservation technique with a small-diameter hysteroscopy presents an effective alternative to the traditional resectoscope technique. Further analyses with long-term follow-up are warranted to evaluate this surgical method.
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Affiliation(s)
| | - Hiroyuki Kanao
- Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan
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23
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John SK, Prabhu PS, Virmani S, Kumar V, Thotan SP. Misdiagnosed Roberts Uterus Leading to Surgical Misadventures. J Pediatr Adolesc Gynecol 2017; 30:508-10. [PMID: 28108213 DOI: 10.1016/j.jpag.2017.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Developmental anomalies of the Müllerian duct system are some of the most intriguing and challenging disorders that gynecologists and surgeons encounter in their practice. CASE We report on a 16-year-old adolescent girl with regular menstrual cycles, who presented with recurrent cyclical abdominal pain for which she had undergone 2 unsuccessful surgeries. When correctly diagnosed with the rare condition of "Robert's uterus," she underwent successful metroplasty and is completely asymptomatic at 2-year follow-up. SUMMARY AND CONCLUSION To avoid inappropriate management, gynecologists and surgeons should be aware of this rare entity while evaluating cases of severe dysmenorrhoea in previously normal menstruating young girls.
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Abstract
Background and Objectives: Since little is known regarding the correlation between different techniques used during hysteroscopic septoplasty and reproductives outcomes, we amied to evaluate the results of two different techniques of hysteroscopic septoplasty (HS). Methods: Data were retrospectively reviewed on 49 patients who underwent HS for symptomatic septate uterus from January 1, 2010, through April 30, 2014. The patients were divided into 2 groups based on the HS technique used. Group I consisted of 27 patients who underwent HS by monopolar hook cautery with the operating hysteroscope. Group II consisted of 22 patients who had the procedure performed with scissors and guided by an office hysteroscope. All the procedures in the both groups were performed in the operating room under general anesthesia. Pregnancy outcomes within the first year after HS for both groups were evaluated. Results: Reproductive outcomes were obtained from 44 patients who attempted to conceive after HS within the first year. In the 25 patients in group I, 23 had pregnancies, of which 15 (65.2%) continued to term, 3 (13%) ended in a preterm live birth, and 5 (21.7%) ended in loss of pregnancy (abortion). In the 19 patients in group II, there were 17 pregnancies, of which 11 (64.7%) continued to term, 2 (11.7%) ended in a preterm live birth, and 4 (23.5%) ended in first- or second-trimester abortion. The overall live-birth rate was 78.2% in group I and 76.4% in group II (P = .85). Conclusions: Our data show that the rates of pregnancy that reach term and overall rates of live births are similar between the 2 HS techniques. Additional studies are needed to evaluate the impact of the techniques on reproductive outcomes.
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Affiliation(s)
- Ozlem Dural
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Cenk Yasa
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ercan Bastu
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Sultan Can
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Gamze Yilmaz
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Faruk Buyru
- Istanbul University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Louden ED, Awonuga AO, Gago LA, Singh M. Rare Müllerian Anomaly: Complete Septate Uterus with Simultaneous Longitudinal and Transverse Vaginal Septa. J Pediatr Adolesc Gynecol 2015; 28:e189-91. [PMID: 26376072 DOI: 10.1016/j.jpag.2015.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND We present a patient with primary amenorrhea and a rare combination of anomalies. She was found to have a septate uterus, double cervix, and a longitudinal and a low transverse vaginal septum. CASE An 18-year-old girl with primary amenorrhea presented with severe monthly pelvic pain. Examination and imaging revealed a thin transverse vaginal septum, complete septate uterus, double cervix, and a longitudinal vaginal septum. The transverse and longitudinal vaginal septa were excised and repaired. SUMMARY AND CONCLUSION Although repetitive pregnancy loss and preterm birth are associated with various Müllerian duct anomalies, clinicians should also be suspicious of the presented anomaly in cases of primary amenorrhea and cyclic pelvic pain. To our knowledge, this is the only case of simultaneous septate uterus with longitudinal and transverse vaginal septum and the second case of combined longitudinal and transverse septum, which caused primary amenorrhea. This rare anomaly further supports the bidirectional regression theory of Müllerian development.
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Affiliation(s)
- Erica D Louden
- Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan.
| | - Awoniyi O Awonuga
- Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan
| | | | - Manvinder Singh
- Wayne State University School of Medicine/Detroit Medical Center, Detroit, Michigan
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Kenda Šuster N, Gergolet M. Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor? ACTA ACUST UNITED AC 2015; 13:37-41. [PMID: 26918002 PMCID: PMC4753244 DOI: 10.1007/s10397-015-0916-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/15/2015] [Indexed: 11/25/2022]
Abstract
The aim of the study was to evaluate whether hysteroscopic metroplasty for septate uterus represents a risk factor of adverse outcome in pregnancy, during labor, and after delivery. This is a retrospective comparative study of obstetric complications of 99 patients who underwent hysteroscopic metroplasty in a 5-year period (study group) and 4155 women, who gave birth in the same hospital in the same period (control group). No difference in obstetric outcome (preterm labor, hemorrhage before and after delivery, mean weeks of gestation at delivery, mean birth weight, breech presentation, and cesarean section rate) between the two groups has been found. The results of this study suggest that patients who underwent hysteroscopic metroplasty for septate uterus are at no higher risk of adverse obstetric outcome at term and during labor, comparing to the general population. Though vaginal delivery seems to be safe, rare but serious complication, reported by several studies, like uterine rupture during pregnancy or labor, should always be taken into consideration.
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Affiliation(s)
- Nataša Kenda Šuster
- Department of Obsterics and Gynecology, University of Ljubljana, Šlajmerjeva 3, 1000 Ljubljana, Slovenia
| | - Marco Gergolet
- Casa di Cura Sanatorio Triestino, Via Rossetti 62, 34141 Trieste, Italy
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27
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Kim MS, Nam SY, Lee G. Complete septate uterus, obstructed hemivagina, and ipsilateral adnexal and renal agenesis in pregnancy. Obstet Gynecol Sci 2014; 57:310-3. [PMID: 25105105 DOI: 10.5468/ogs.2014.57.4.310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/05/2013] [Accepted: 12/26/2013] [Indexed: 11/24/2022] Open
Abstract
Most cases of double uterus with obstructed hemivagina and ipsilateral renal agenesis were diagnosed at adolescents after menarche. This is the first reported case of complete septate uterus with obstructed hemivagina and ipsilateral renal agenesis in addition to ipsilateral agenesis of fallopian tube and ovary in which the diagnosis was delayed until pregnancy. The pregnancy was uneventful in spite of intermittent vaginal spotting. During the cesarean section, the septum of the uterus was resected and about a 3-cm×3-cm window was made on the vaginal septum to allow an opening for the obstructed vaginal discharge. We followed the patient up for one and half years, and she has not had symptoms such as dysmenorrhea or abnormal vaginal bleeding.
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28
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Xu B, Xue M, Xu D. Hysteroscopic management of an oblique vaginal septum in a virgin girl with a rare variant of Herlyn-Werner-Wunderlich syndrome. J Minim Invasive Gynecol 2014; 22:7. [PMID: 25111519 DOI: 10.1016/j.jmig.2014.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/02/2014] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To demonstrate a technique for hysteroscopic diagnosis and management of a rare variant of Herlyn-Werner-Wunderlich syndrome (HWWS) in a virgin girl. DESIGN Presentation of a rare variant of HWWS and a step-by-step description of the technique using videos, images, and title slides (educative video) (Canadian Task Force classification III). SETTING HWWS is a congenital anomaly of the urogenital tract, typically characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Of HWWS cases, 11.5% are a rare variant of the syndrome, with a septate bicollis uterus and obstructed hemivagina. HWWS is often diagnosed in adolescent girls and virgin patients. Early diagnosis and treatment should be achieved using a convenient, minimally invasive, and effective surgical approach to prevent complications. INTERVENTIONS A 14-year-old virgin girl had aggressive cyclic dysmenorrhea for 7 months. We made a diagnosis of the non-classic HWWS variant: septate uterus with double cervix, obstructed right hemivagina with hematocolpos, and unilateral renal agenesis. Diagnostic hysteroscopy indicated a flat hemivaginal septum, left cervix, and uterine cavity, but no right cervix or other associated channel. Hysteroscopic incision of the bulging oblique vaginal septum was performed medially from the most prominent point of the septum up to the left cervix and then down to the low edge of the oblique septum. An inflated Foley catheter was placed in the right hemivagina for 2 days to prevent adhesion of the incised septum. Surgery was successful, and the intact hymen was preserved. The patient has been symptom-free for 4 months after surgery. CONCLUSION Hysteroscopic incision of the oblique vaginal septum is a convenient, minimally invasive, and effective approach for treating HWWS in adolescents with cyclic dysmenorrhea and hematocolpos.
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Affiliation(s)
- Bin Xu
- Department of Gynecology, Third Xiangya Hospital of Central South University, Hunan Province, China
| | - Min Xue
- Department of Gynecology, Third Xiangya Hospital of Central South University, Hunan Province, China
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital of Central South University, Hunan Province, China.
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29
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Comte F, Philip CA, Berthiller J, Schott AM, Golfier F, Raudrant D. [Hysteroscopic septoplasty: after miscarriages?]. ACTA ACUST UNITED AC 2014; 42:139-43. [PMID: 24559890 DOI: 10.1016/j.gyobfe.2014.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 01/15/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess reproductive outcome of women affected by septate uterus after surgical correction. PATIENTS AND METHODS It is a retrospective study. The setting is a French university hospital. Surgery was performed on 66 patients between 2000 and 2010. Hysteroscopic metroplasty was performed in every group once the diagnosis was made. There were two groups: 35 patients affected by septate uterus had past history of miscarriages, preterm and term deliveries. Thirty-six patients had never been pregnant. RESULTS In the group of 35 patients with a previous obstetric history, the rate of miscarriages was 57.1% before surgery and 10% after surgery. There was a significant gain of live birth ratio of 55% among women being pregnant after surgery compared to women being pregnant before surgery. For patients with no pregnancy before surgery, obstetrical results are the following ones: miscarriages 25.9%, preterm deliveries 11% and term deliveries 59.3%. DISCUSSION AND CONCLUSION Hysteroscopic septoplasty is an easy technique with few complications in our study. Hysteroscopic septoplasty is strongly recommended after recurrent miscarriages or premature deliveries. We use to propose surgery to every patient affected by septate uterus, even if they have never been pregnant.
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Affiliation(s)
- F Comte
- Service de gynécologie obstétrique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - C-A Philip
- Service de gynécologie obstétrique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - J Berthiller
- Pôle information médicale et recherche, site Lacassagne, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - A-M Schott
- Pôle information médicale et recherche, site Lacassagne, 162, avenue Lacassagne, 69424 Lyon cedex 03, France
| | - F Golfier
- Service de gynécologie obstétrique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - D Raudrant
- Service de gynécologie obstétrique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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