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Etrusco A, Buzzaccarini G, Laganà AS, Chiantera V, Vitale SG, Angioni S, D’Alterio MN, Nappi L, Sorrentino F, Vitagliano A, Difonzo T, Riemma G, Mereu L, Favilli A, Peitsidis P, D’Amato A. Use of Diode Laser in Hysteroscopy for the Management of Intrauterine Pathology: A Systematic Review. Diagnostics (Basel) 2024; 14:327. [PMID: 38337843 PMCID: PMC10855490 DOI: 10.3390/diagnostics14030327] [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: 12/19/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Hysteroscopy currently represents the gold standard for the diagnosis and treatment of intrauterine pathologies. Recent technological progress has enabled the integration of diagnostic and operative time, leading to the "see and treat" approach. Diode laser technology is emerging as one of the most innovative and intriguing techniques in this context. Methods: A comprehensive search of the literature was carried out on the main databases. Only original studies reporting the treatment of intrauterine pathologies using diode laser were deemed eligible for inclusion in this systematic review (PROSPERO ID: CRD42023485452). Results: Eight studies were included in the qualitative analysis for a total of 474 patients undergoing laser hysteroscopic surgery. Eighty-three patients had female genital tract abnormalities, 63 had submucosal leiomyomas, 327 had endometrial polyps, and one patient had a scar pregnancy. Except for leiomyomas, whose technique already included two surgical times at the beginning, only seven patients required a second surgical step. Cumulative rates of intraoperative and postoperative complications of 2.7% and 0.6%, respectively, were reported. Conclusions: Diode laser through "see and treat" hysteroscopy appears to be a safe and effective method. However, additional studies with larger sample sizes and improved designs are needed to consolidate the evidence currently available in the literature.
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Affiliation(s)
- Andrea Etrusco
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
- Unit of Gynecologic Oncology, National Cancer Institute IRCCS Fondazione “G. Pascale”, 80131 Naples, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy; (L.N.); (F.S.)
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy; (L.N.); (F.S.)
| | - Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
| | - Tommaso Difonzo
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Liliana Mereu
- Unit of Obstetrics and Gynecology, Department of General Surgery and Medical-Surgical Specialism, University of Catania, P.O. “G. Rodolico”, Via Santa Sofia, 78, 95123 Catania, Italy;
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06135 Perugia, Italy;
| | - Panagiotis Peitsidis
- Department of Obstetrics and Gynecology, Helena Venizelou Hospital, 11521 Athens, Greece;
| | - Antonio D’Amato
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
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2
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Fontana V, Aboud GS, Sabbaj L. Herlyn-Werner-Wünderlich syndrome: Two case report. ARCH ARGENT PEDIATR 2024; 122:e202310138. [PMID: 38197594 DOI: 10.5546/aap.2023-10138.eng] [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] [Indexed: 01/11/2024]
Abstract
Herlyn-Werner-Wunderlich syndrome, also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), is a rare, congenital Müllerian duct anomaly characterized by the association of septate uterus, obstructed hemivagina, and ipsilateral renal agenesis. The most common clinical presentation is an abdominal mass secondary to hematocolpos, pain, and dysmenorrhea. It is associated with infertility, endometriosis, and menstrual and obstetric alterations. The ultrasound is the technique of choice for the initial assessment, while the magnetic resonance imaging remains the most accurate method for diagnosis. The resection of the vaginal septum is the recommended treatment. Here we describe 2 clinical cases to highlight the importance of an early diagnosis to prevent potential complications in the future.
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Affiliation(s)
- Victoria Fontana
- Clinical Pediatrics; Hospital General de Niños Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Gabriela S Aboud
- Clinical Pediatrics; Hospital General de Niños Ricardo Gutiérrez, City of Buenos Aires, Argentina
| | - Liliana Sabbaj
- Outpatient Clinic; Hospital General de Niños Ricardo Gutiérrez, City of Buenos Aires, Argentina
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3
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Lamari I, Ziogas AC, Thanasas I, Kotronis KV, Xydias EM. Spontaneous Pregnancy After Surgical Repair of Sub septate Uterus: A Case Report and Review of the Available Literature. Cureus 2023; 15:e43399. [PMID: 37706127 PMCID: PMC10495772 DOI: 10.7759/cureus.43399] [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] [Accepted: 08/12/2023] [Indexed: 09/15/2023] Open
Abstract
Septate uterus is the most common congenital uterine malformation. It has been associated with poor reproductive outcomes, such as infertility and recurrent miscarriage, in the context of both assisted and non-assisted reproduction, though the exact underlying pathophysiological reasons remain unclear. Diagnosis is based on two-dimensional and three-dimensional ultrasound, magnetic resonance imaging, or laparoscopic/hysteroscopic findings. Hysteroscopic repair of the uterine septum has been shown to confer several benefits to reproductive outcomes, though this fact remains in question, due to inconsistent and or low-quality evidence in the medical literature. An individualized approach to the treatment of infertility patients with septate uteri is imperative, given the plethora of possible underlying factors that may complicate management. In this report, we present the case of a patient with a subseptate uterus and a history of infertility, who, following hysteroscopic metroplasty, managed to conceive and ultimately successfully deliver a healthy child.
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Affiliation(s)
- Ioanna Lamari
- Department of Internal Medicine, Gennimatas General Hospital, Athens, GRC
- Faculty of Medicine, University of Thessaly, School of Health Sciences, Larissa, GRC
| | - Apostolos C Ziogas
- Department of Obstetrics and Gynaecology, IASO Thessalias Hospital, Larissa, GRC
- Faculty of Medicine, University of Thessaly, School of Health Sciences, Larissa, GRC
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | | | - Emmanouil M Xydias
- Faculty of Medicine, University of Thessaly, School of Health Sciences, Larissa, GRC
- Department of Obstetrics and Gynaecology, EmbryoClinic IVF, Thessaloniki, GRC
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Chang Y, Shen M, Wang S, Guo Z, Duan H. Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty. Front Endocrinol (Lausanne) 2023; 14:1063774. [PMID: 37361532 PMCID: PMC10285310 DOI: 10.3389/fendo.2023.1063774] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background Hysteroscopic metroplasty of the uterine septum has been the standard treatment strategy to improve reproductive outcomes, but there are still controversies about the appropriateness of metroplasty. In addition, there have been few studies of the factors related to reproductive outcomes of women after surgery. The study aimed to evaluate the reproductive outcomes and the associated risk factors that influence reproductive outcomes after hysteroscopic metroplasty of women with septate uterus and the desire to conceive. Methods This study was an observational study. Cases were screened by searching electronic patient files, and demographic factors were collected. We conducted telephone follow-ups to collect the postoperative reproductive outcomes. The primary outcome of this study was live birth, and secondary outcomes were ongoing pregnancy, clinical pregnancy, early miscarriage, and preterm birth. Demographic variables included patients' age, body mass index (BMI), the type of septum, infertility and miscarriage history, and complications including intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were collected to perform univariate and multivariate analyses to predict the risk factors of reproductive outcomes after surgery treatment. Results In total, 348 women were evaluated and followed up. There were 95 cases (27.3%, 95/348) with combined infertility, 195 cases (56.0%, 195/348) with miscarriage history, and cases combined with intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were 107 (30.7%, 107/348), 53 (15.2%, 53/348), 28 (8.0%, 28/348), and 5 (1.4%), respectively. Following surgery, the live birth rate and clinical pregnancy rate were significantly higher than prior to surgery (84.6% vs 3.7%, p= 0.000; and 78.2% vs 69.5%, p= 0.01, respectively), early miscarriage rate and preterm delivery rate were significantly lower (8.8% vs 80.6%, p= 0.000; and 7.0% vs 66.7%, p=0.000, respectively). After adjusting for body mass index, miscarriage history, and complications, multivariable logistic regression analysis revealed age ≥ 35 years and primary infertility as independent factors that affected postoperative clinical pregnancy (OR 4.025, 95% CI 2.063-7.851, p= 0.000; and OR 3.603, 95% CI 1.903-6.820, p= 0.000; respectively) and ongoing pregnancy (OR 3.420, 95% CI 1.812-6.455, p= 0.000; and OR 2.586, 95% CI 1.419-4.712, p= 0.002; respectively). Conclusions Hysteroscopic metroplasty could lead to improved reproductive outcomes of women with septate uterus. Both age and primary infertility were independent factors for postoperative reproductive outcomes. Trial registration Chi ECRCT20210343.
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Affiliation(s)
- Yanan Chang
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Minghong Shen
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Sha Wang
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zhengchen Guo
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Hua Duan
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
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Ouyang Y, Chen H, Gong F, Lin G, Li X. Septum Resection Prior to In Vitro Fertilization-Embryo Transfer: A Retrospective Controlled Study. J Ultrasound Med 2023; 42:1129-1137. [PMID: 36394304 DOI: 10.1002/jum.16128] [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] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To investigate the effectiveness of surgery for septate uterus in infertile patients before in vitro fertilization-embryo transfer (IVF-ET). METHODS The data of 937 infertile patients with septate uterus and achieved singleton pregnancy after IVF-ET from January 2014 to December 2015 were retrospectively analyzed. Thousand five hundred seventy-eight infertile patients with a normal uterus who achieved singleton pregnancy during the same period were selected as the control group. Patients with septate uterus were divided into two groups according to whether the septum was resected. The pregnancy and perinatal outcomes of the surgical group and the nonsurgical group were compared with the control group. The secondary infertility patients who were surgically corrected septa were also chosen as self-controls and an analysis was performed on their fertility outcomes pre- and post-surgery. RESULTS Compared with the control group, the surgical group had increased rates of early miscarriage, preterm delivery, and low birthweight and a significantly reduced live birth rate (P < .05). The outcomes of the nonsurgical and control groups were similar. Using secondary infertility patients who were surgically corrected septa as self-controls, after surgery, the rates of miscarriage and ectopic pregnancy were significantly lower and the live birth rate was significantly higher (P ≤ .001); however, perinatal mortality was not significantly different before and after surgery. CONCLUSIONS Patients with a septum depth greater than 10 mm or 5-10 mm associated with a history of unexplained recurrent miscarriage, IVF failure, or infertility might benefit from resection of the uterine septum with hysteroscopic metroplasty.
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Affiliation(s)
- Yan Ouyang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
| | - Hui Chen
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
| | - Fei Gong
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
| | - Ge Lin
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
| | - Xihong Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
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Alcázar JL, Carriles I, Cajas MB, Costa S, Fabra S, Cabrero M, Castro E, Tomaizeh A, Laza MV, Monroy A, Martinez I, Aguilar MI, Hernani E, Castellet C, Oliva A, Pascual MÁ, Guerriero S. Diagnostic Performance of Two-Dimensional Ultrasound, Two-Dimensional Sonohysterography and Three-Dimensional Ultrasound in the Diagnosis of Septate Uterus-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13040807. [PMID: 36832295 PMCID: PMC9955687 DOI: 10.3390/diagnostics13040807] [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: 01/10/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The septate uterus is the most common congenital uterine anomaly, and hysteroscopy is the gold standard for diagnosing it. The goal of this meta-analysis is to perform a pooled analysis of the diagnostic performance of two-dimensional transvaginal ultrasonography, two-dimensional transvaginal sonohysterography, three-dimensional transvaginal ultrasound, and three-dimensional transvaginal sonohysterography for the diagnosis of the septate uterus. METHODS Studies published between 1990 and 2022 were searched in PubMed, Scopus, and Web of Science. From 897 citations, we selected eighteen studies to include in this meta-analysis. RESULTS The mean prevalence of uterine septum in this meta-analysis was 27.8%. Pooled sensitivity and specificity were 83% and 99% for two-dimensional transvaginal ultrasonography (ten studies), 94% and 100% for two-dimensional transvaginal sonohysterography (eight studies), and 98% and 100% for three-dimensional transvaginal ultrasound (seven articles), respectively. The diagnostic accuracy of three-dimensional transvaginal sonohysterography was only described in two studies, and we did not calculate the pooled sensitivity and specificity for this method. CONCLUSION Three-dimensional transvaginal ultrasound has the best performance capacity for the diagnosis of the septate uterus.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Isabel Carriles
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - María Belén Cajas
- Department of Obstetrics and Gynecology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
| | - Susana Costa
- Department Obstetrics and Gynecology, Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal
| | - Sofia Fabra
- Department of Obstetrics and Gynecology, Hospital Universitario Infanta Sofia, 28702 Madrid, Spain
| | - Maria Cabrero
- Department of Obstetrics and Gynecology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
| | - Elena Castro
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Aida Tomaizeh
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain
| | - María Victoria Laza
- Department of Obstetrics and Gynecology, Hospital Universitario Materno-Infantil, 06010 Badajoz, Spain
| | - Alba Monroy
- Department of Obstetrics and Gynecology, Hospital Universitario Materno-Infantil, 06010 Badajoz, Spain
| | - Irene Martinez
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain
| | - Maria Isabel Aguilar
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain
| | - Elena Hernani
- Department of Obstetrics and Gynecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain
| | - Cristina Castellet
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain
| | - Agustin Oliva
- Department of Obstetrics and Gynecology, Hospital Universitario San Carlos, 28040 Madrid, Spain
| | - María Ángela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain
| | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, 09042 Cagliari, Italy
- Dipartimento di Scienze Chirurgiche, University of Cagliari, 09124 Cagliari, Italy
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Zhang B, Wu S, Zhao X, Tan L, Xu D. Treatment of septate uterus. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:1487-1494. [PMID: 36481626 PMCID: PMC10930620 DOI: 10.11817/j.issn.1672-7347.2022.220501] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Although there is insufficient evidence supporting the link between septate uterus and infertility, there are many studies demonstrated the effect of spetal incision on pregnancy in women diagnosed with septate uterus associated with infertility. Hysteroscopic metroplasty can significantly improve the reproductive performance of those with septate uterus. Some Müllerian malformations can be healed by surgery. The accurate diagnosis and appropriate therapeutic approch are fundamental for successful treatment. Any attempt at surgical correction of uterine abnormalities must be aimed at preserving or improving reproductive function. Among congenital uterine anomalies, septate uterus is the most amenable to simple hysteroscopic treatment. The resection of the septum is performed as standard treatment worldwide.
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Affiliation(s)
- Baiyu Zhang
- Jiangwan Research Institute, Central South University, Changsha Jiangwan Maternity Hospital, Changsha 410008.
| | - Susu Wu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Lin Tan
- Jiangwan Research Institute, Central South University, Changsha Jiangwan Maternity Hospital, Changsha 410008.
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Zhang B, Wu S, Zhao X, Zhu X, Xu D. Diagnosis of septate uterus. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:1479-1486. [PMID: 36481625 PMCID: PMC10930624 DOI: 10.11817/j.issn.1672-7347.2022.220507] [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] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 12/13/2022]
Abstract
The septate uterus is the most common structural uterine anomalies and it is associated with the poor reproductive outcome. It is believed to be the result of the failure in resorption of the tissue connecting the 2 paramesonephric ducts prior to the 20th embryonic week. The true prevalence of uterine septum is difficult to ascertain, as many uterine septal defects are asymptomatic. The septate uterus is usually diagnosed during an infertility evaluation and affects reproductive health by impairing fertility and increasing adverse pregnancy outcomes. The variations in uterine and cervical/vaginal anomalies collectively referred to as Müllerian anomalies. No consistent gold standard for the diagnosis of Müllerian anomalies exists. The preferred diagnostic method for Müllerian anomalies is two-dimensional ultrasound, other methods such as three-dimensional ultrasound, magnetic resonance imaging, hysterosalpingo contrast sonography, hysterosalpingography, hysteroscopy, and laparoscopy are also used to improve accuracy.
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Affiliation(s)
- Baiyun Zhang
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
- Department of Ultrasonography, Hunan Guangxiu Hospital, Changsha 410205, China.
| | - Si Wu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Xiuting Zhu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
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Shen M, Duan H, Chang Y, Lin Q, Chen C, Wang S. Impact of concomitant intrauterine adhesions on pregnancy outcomes and obstetric complications in women with a septate uterus. Int J Gynaecol Obstet 2022; 159:875-881. [PMID: 35574630 DOI: 10.1002/ijgo.14260] [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: 12/09/2021] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore the impact of concomitant intrauterine adhesions (IUAs) on pregnancy outcomes and obstetric complications in women with a septate uterus. METHODS This retrospective cohort included women with a septate uterus, with or without IUAs, between 2015 and 2019 in our hospital. The main outcomes were clinical pregnancy rate, live-birth rate, and obstetric complications. RESULTS A total of 336 women with a septate uterus-105 women (31.3%) with IUAs and 231 (68.7%) women without IUAs-were analyzed. The rates of clinical pregnancy and live birth among women with moderate-to-severe IUAs were significantly decreased compared with those among women without IUAs (69.9% vs. 76.6%, odds ratio [OR] 0.51; 95% confidence interval [CI] 0.27-0.99, P = 0.046, and 57.0% vs. 67.1%, OR 0.53; 95% CI 0.30-0.95, P = 0.032, respectively). However, these rates were similar between women with mild IUAs and women without IUAs. Women with moderate-to-severe IUAs had a higher incidence of abnormal placentation than women with a septum only (13.2% vs. 1.3%, P = 0.001). CONCLUSION Concomitant moderate-to-severe IUAs significantly reduce the rates of clinical pregnancy and live birth and increase the risk of abnormal placentation in subsequent pregnancies in women with a septate uterus.
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Affiliation(s)
- Minghong Shen
- Department of Minimally Invasive Gynecologic Center, Beijing Maternal and Child Health Care Hospital, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.,Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian Province, China
| | - Hua Duan
- Department of Minimally Invasive Gynecologic Center, Beijing Maternal and Child Health Care Hospital, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yanan Chang
- Department of Minimally Invasive Gynecologic Center, Beijing Maternal and Child Health Care Hospital, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Qi Lin
- Department of Minimally Invasive Gynecologic Center, Beijing Maternal and Child Health Care Hospital, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chao Chen
- Department of Minimally Invasive Gynecologic Center, Beijing Maternal and Child Health Care Hospital, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Sirui Wang
- Department of Minimally Invasive Gynecologic Center, Beijing Maternal and Child Health Care Hospital, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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Gong Y, Xie Y, Chen L, Sui L. Cervical Cancer in a Septate Uterus with Double Cervix and Double Vagina: A Case Report and Review of the Literature. Int J Womens Health 2022; 14:345-351. [PMID: 35300285 PMCID: PMC8921829 DOI: 10.2147/ijwh.s350768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/23/2021] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Septate uterus with duplicate cervices and double vagina is a rare Müllerian duct anomaly mostly found in labor or gynecological examination. We present a case of a 40-year-old asymptomatic parous patient diagnosed with double cervix and complete vaginal septum. She was admitted to hospital due to abnormal histopathology of suspicious cervical squamous papillary carcinoma post-salpingectomy. Her genital malformation was seriously addressed due to the cervical lesion. The diagnosis of cervical cancer in the left cervix and LSIL in the right cervix was made after LEEP conization. She received laparoscopic hysterectomy with salpingectomy and partial vagina wall resection for radical resection of the lesion. We report this case to present irregular findings during colposcopy, hysterectomy, and histopathology.
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Affiliation(s)
- Yingxin Gong
- Cervical Diseases Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yu Xie
- Cervical Diseases Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Limei Chen
- Cervical Diseases Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People's Republic of China
| | - Long Sui
- Cervical Diseases Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People's Republic of China
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Oppelt P, Binder H, Birraux J, Brucker S, Dingeldein I, Draths R, Eckoldt F, Füllers U, Hiort O, Hoffmann D, Hoopmann M, Hucke J, Korell M, Kühnert M, Ludwikowski B, Mentzel HJ, Mon OʼDey D, Rall K, Riccabona M, Rimbach S, Schäffeler N, Shavit S, Stein R, Utsch B, Wenzl R, Wieacker P, Zeino M. Diagnosis and Therapy of Female Genital Malformations (Part 2). Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/052, May 2019). Geburtshilfe Frauenheilkd 2021; 81:1329-1347. [PMID: 34899046 DOI: 10.1055/a-1471-4988] [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: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 10/19/2022] Open
Abstract
Objectives Female genital malformations may be present in the form of individual entities, they may involve neighboring organs or they may occur in the context of complex syndromes. Given the anatomical structures of the vulva, vagina, uterus and uterine appendages, the clinical picture of malformations varies greatly. Methods This S2k-guideline was developed by representative members from different medical specialties and professions as part of the guidelines program of the DGGG, SGGG and OEGGG. The recommendations and statements were developed and voted on using a structured consensus process with neutral moderation. Recommendations This guideline is the first comprehensive summary of female genital malformations from infancy to adulthood which covers clinical examinations, diagnostic workups and treatment options. Additional chapters have been included on complex urogenital malformations, vascular malformations, psychosomatic care, and tumor risk.
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Affiliation(s)
- Peter Oppelt
- Universitätsklinik für Gynäkologie, Geburtshilfe & gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Linz, Austria
| | - Helge Binder
- Universitätsklinik für Gynäkologie, Geburtshilfe & gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Linz, Austria
| | - Jacques Birraux
- Klinik für Kinderchirurgie, Universitätsklinikum Genf, Genf, Switzerland
| | | | - Irene Dingeldein
- Universitätsklinik für Frauenheilkunde, Insel Spital, Bern, Switzerland
| | | | - Felicitas Eckoldt
- Klinik für Kinderchirurgie, Universitätsklinikum Jena, Jena, Germany
| | | | - Olaf Hiort
- Hormonzentrum für Kinder und Jugendliche - Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Dorit Hoffmann
- Klinik für Kinder- und Jugendmedizin, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Jürgen Hucke
- Klinik für Frauenheilkunde und Geburtshilfe, Agaplesion Bethesda Krankenhaus, Wuppertal, Germany
| | - Matthias Korell
- Klinik für Gynäkologie und Geburtshilfe, Johanna Etienne Krankenhaus, Neuss, Germany
| | - Maritta Kühnert
- Klinik für Geburtshilfe und Perinatalmedizin, Universitätsklinikum Marburg, Marburg, Germany
| | - Barbara Ludwikowski
- Klinik für Kinderchirurgie und -urologie, Kinder- und Jugendkrankenhaus auf der Bult, Hannover, Germany
| | - Hans-Joachim Mentzel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany
| | - Dan Mon OʼDey
- Klinik für Plastische, Rekonstruktive und Ästhestische Chirurgie und Handchirurgie, Luisenspital Aachen, Aachen, Germany
| | | | - Michael Riccabona
- Klinische Abteilung für Kinderradiologie, Universitätsklinikum Graz, Graz, Austria
| | - Stefan Rimbach
- Abteilung für Gynäkologie und Geburtshilfe, Krankenhaus Agatharied, Hausham, Germany
| | - Norbert Schäffeler
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Sandra Shavit
- Klinik für Kinderchirurgie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Raimund Stein
- Zentrum für Kinder-, Jugend- und Rekonstruktive Urologie, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Boris Utsch
- Abteilung für Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum Gießen/Marburg, Gießen, Germany
| | - Rene Wenzl
- Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria
| | - Peter Wieacker
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Germany
| | - Mazen Zeino
- Universitätsklinik für Kinderchirurgie, Insel Spital, Bern, Switzerland
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12
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Abstract
Amniotic band syndrome is an unusual congenital condition characterized by manifestations of disfigurement and disablement. Patients with this condition may experience an array of clinical deformities, including constriction rings, digital defects, and even visceral defects. Although this disease has been identified for centuries, its etiology is still unknown. The present male patient was born by cesarean section at 34 weeks and 4 days of gestation. At birth, an amniotic band that encircled and constricted his right upper limb was observed. Four hours after the amniotic band was cut off, amputation was performed because the right limb remained insensate. The patient suffered from amniotic band syndrome and presented with a gangrenous limb leading to amputation at birth, which is extremely rare. Moreover, the patient’s mother suffered from a uterine septum, which has not been previously reported in this situation. Timely surgical treatment avoided further tissue necrosis threating the patient’s life. This rare case of amniotic band syndrome provides new clinical evidence for the “extrinsic theory”.
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Affiliation(s)
- Tian He
- Department of Orthopedics Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China.,Department of Joint Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinnan, Shandong, P.R. China
| | - Hao Xu
- Department of Neurosurgery Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China
| | - Ping Sui
- Department of Oncology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China
| | - Xin Wang
- Department of Orthopedics Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China
| | - Yujie Sun
- Department of Orthopedics Surgery, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong, P.R. China
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13
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Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, Spinder T, Jansen FW, Mulders AGMGJ, Padmehr R, Clark TJ, van Vliet HA, Stephenson MD, van der Veen F, Mol BWJ, van Wely M, Goddijn M. Septum resection versus expectant management in women with a septate uterus: an international multicentre open-label randomized controlled trial. Hum Reprod 2021; 36:1260-1267. [PMID: 33793794 PMCID: PMC8058590 DOI: 10.1093/humrep/deab037] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Does septum resection improve reproductive outcomes in women with a septate uterus? SUMMARY ANSWER Hysteroscopic septum resection does not improve reproductive outcomes in women with a septate uterus. WHAT IS KNOWN ALREADY A septate uterus is a congenital uterine anomaly. Women with a septate uterus are at increased risk of subfertility, pregnancy loss and preterm birth. Hysteroscopic resection of a septum may improve the chance of a live birth in affected women, but this has never been evaluated in randomized clinical trials. We assessed whether septum resection improves reproductive outcomes in women with a septate uterus, wanting to become pregnant. STUDY DESIGN, SIZE, DURATION We performed an international, multicentre, open-label, randomized controlled trial in 10 centres in The Netherlands, UK, USA and Iran between October 2010 and September 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with a septate uterus and a history of subfertility, pregnancy loss or preterm birth were randomly allocated to septum resection or expectant management. The primary outcome was conception leading to live birth within 12 months after randomization, defined as the birth of a living foetus beyond 24 weeks of gestational age. We analysed the data on an intention-to-treat basis and calculated relative risks with 95% CI. MAIN RESULTS AND THE ROLE OF CHANCE We randomly assigned 80 women with a septate uterus to septum resection (n = 40) or expectant management (n = 40). We excluded one woman who underwent septum resection from the intention-to-treat analysis, because she withdrew informed consent for the study shortly after randomization. Live birth occurred in 12 of 39 women allocated to septum resection (31%) and in 14 of 40 women allocated to expectant management (35%) (relative risk (RR) 0.88 (95% CI 0.47 to 1.65)). There was one uterine perforation which occurred during surgery (1/39 = 2.6%). LIMITATIONS, REASONS FOR CAUTION Although this was a major international trial, the sample size was still limited and recruitment took a long period. Since surgical techniques did not fundamentally change over time, we consider the latter of limited clinical significance. WIDER IMPLICATIONS OF THE FINDINGS The trial generated high-level evidence in addition to evidence from a recently published large cohort study. Both studies unequivocally do not reveal any improvements in reproductive outcomes, thereby questioning any rationale behind surgery. STUDY FUNDING/COMPETING INTEREST(S) There was no study funding. M.H.E. reports a patent on a surgical endoscopic cutting device and process for the removal of tissue from a body cavity licensed to Medtronic, outside the scope of the submitted work. H.A.v.V. reports personal fees from Medtronic, outside the submitted work. B.W.J.M. reports grants from NHMRC, personal fees from ObsEva, personal fees from Merck Merck KGaA, personal fees from Guerbet, personal fees from iGenomix, outside the submitted work. M.G. reports several research and educational grants from Guerbet, Merck and Ferring (location VUMC) outside the scope of the submitted work. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER Dutch trial registry: NTR 1676. TRIAL REGISTRATION DATE 18 February 2009. DATE OF FIRST PATIENT’S ENROLMENT 20 October 2010.
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Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - C R Kowalik
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - A G M G J Mulders
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - R Padmehr
- Department of Obstetrics and Gynaecology, Avicenna Research Institute, Tehran, Iran
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - H A van Vliet
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, the Netherlands
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois at Chicago, Chicago, IL, USA
| | - F van der Veen
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, VIC, Australia
| | - M van Wely
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, the Netherlands
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14
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Casadio P, Magnarelli G, La Rosa M, Alletto A, Arena A, Fontana E, Morra C, Talamo MR, Fabbri M, Giovannico K, Virgilio A, Raimondo D, Guasina F, Paradisi R, Seracchioli R. Uterine Fundus Remodeling after Hysteroscopic Metroplasty: A Prospective Pilot Study. J Clin Med 2021; 10:jcm10020260. [PMID: 33445663 PMCID: PMC7828148 DOI: 10.3390/jcm10020260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/12/2020] [Revised: 12/30/2020] [Accepted: 01/02/2021] [Indexed: 11/16/2022] Open
Abstract
The septate uterus is the most common congenital uterine malformation and is treated by hysteroscopic metroplasty. There are few studies on the fundal uterine changes that occur after surgery. We designed a pilot prospective observational study to evaluate by three-dimensional transvaginal ultrasound (3D-TVS) the changes not only of the internal fundal uterine profile, but also of the external one, after hysteroscopic metroplasty. Sixty women who underwent hysteroscopic metroplasty for partial or complete uterine septum (U2a and U2b subclasses of ESHRE/ESGE classification) were enrolled. We performed 3D-TVS after surgery confirming optimal removal of the septum. However, at ultrasound follow-up after three months, we observed a significant increase (p < 0.001) in the residual septum (Zr) (3.7 mm (95% CI: 3.1-4.4)), the myometrial wall thickness (Y) (2.5 mm (95% CI: 2.0-3.0)) and the total fundal wall thickness (Y + Zr) (6.2 mm (95% CI: 5.5-6.9)). Forty-three patients (72%) required a second step of hysteroscopic metroplasty. Moreover, the shape of uterine fundus changed in 58% of cases. We actually observed a remodeling of the uterine fundus with modifications of its external and internal profiles. Therefore, we propose to always perform a second ultrasound look at least three months after the metroplasty to identify cases that require a second- step metroplasty.
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Affiliation(s)
- Paolo Casadio
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Giulia Magnarelli
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
- Correspondence:
| | - Mariangela La Rosa
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Andrea Alletto
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Alessandro Arena
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Enrico Fontana
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Ciro Morra
- Department of Gynecology and Obstetrics, Maggiore Hospital, 40133 Bologna, Italy; (C.M.); (M.R.T.)
| | - Maria Rita Talamo
- Department of Gynecology and Obstetrics, Maggiore Hospital, 40133 Bologna, Italy; (C.M.); (M.R.T.)
| | - Matilde Fabbri
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Kevin Giovannico
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Agnese Virgilio
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Diego Raimondo
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Francesca Guasina
- Department of Gynecology and Obstetrics, Santa Chiara Regional Hospital, 38122 Trento, Italy;
| | - Roberto Paradisi
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
| | - Renato Seracchioli
- Gynecology and Human Reproduction Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (P.C.); (M.L.R.); (A.A.); (A.A.); (E.F.); (M.F.); (K.G.); (A.V.); (D.R.); (R.P.); (R.S.)
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15
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Yi S, Jiang J. Clinical characteristics and management of patients with complete septate uterus, double cervix, obstructed hemivagina, and ipsilateral renal agenesis. J Obstet Gynaecol Res 2021; 47:1497-1501. [PMID: 33410178 DOI: 10.1111/jog.14662] [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: 09/15/2020] [Revised: 12/18/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022]
Abstract
AIM To analyze the clinical characteristics and management of patients with complete septate uterus, double cervix, obstructed hemivagina, and ipsilateral renal agenesis. METHODS This retrospective study reviewed the medical records of 17 patients with complete septate uterus, double cervix, obstructed hemivagina, and ipsilateral renal agenesis admitted to the Third Xiangya Hospital of Central South University between June 2007 and December 2019. RESULTS The median age at surgery was 23 years. The most common presenting complaint was infertility. Seven (41.2%) patients were misdiagnosed previously. The obstruction was complete in five patients. All 17 patients underwent vaginoplasty, in which seven adolescent girls underwent vaginoscopic vaginal septum resections. Eight patients underwent hysteroscopic resections of the uterine septum for infertility or spontaneous miscarriage. Laparoscopy was performed in seven patients for specific indications, and only one patient was found to have pelvic endometriosis during the laparoscopy. During the follow-up, seven patients wished to conceive, and there were five living infants (four cesarean deliveries at term and one preterm vaginal delivery). CONCLUSION Complete septate uterus with double cervix, obstructed hemivagina, and ipsilateral renal agenesis is an variant of obstructed hemivagina and ipsilateral renal agenesis syndrome. Consequently, healthcare providers should be aware of this potential variant.
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Affiliation(s)
- Shuijing Yi
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianfa Jiang
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Changsha, China
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16
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Lin Y, Liu M, He S, Yang M, Wu Q. The effectiveness of uterine parametrics measured by three-dimensional transvaginal sonography in the diagnosis of uterine cavity distortions. Ann Transl Med 2020; 8:1486. [PMID: 33313231 PMCID: PMC7729365 DOI: 10.21037/atm-20-6755] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To analyze the application values of quantitative parametrics measured by three-dimensional transvaginal sonography (3D-TVS) in the diagnosis of uterine cavity distortions. Methods A retrospective analysis was performed on consecutive 113 patients with septate uteruses, as diagnosed consistently by both 3D-TVS and hysteroscopic surgery, between Jan 2016 and Jan 2018. The intrauterine quantitative parametrics were compared between an infertility group and a miscarriage group. Receiver operating characteristic (ROC) curve analysis and evaluation indicators of diagnostic tests were plotted to analyze the relationships between parametrics and uterine cavity distortions. Results There were no significant differences in septum width, septum length, uterine angle, remaining uterine cavity length, and distortion rate between the infertility and miscarriage groups (P>0.05). The distortion rate was positively correlated with septum length, but showed a negative correlation with uterine angle and remaining uterine cavity length (all P<0.05). The area under the curve (AUC) of septum length for predicting a distortion rate higher than 50% was 0.969; with a cutoff value of 2.15 cm, and a diagnostic accuracy of 97.14%, sensitivity was 81.80% and specificity was 98.90%, respectively. Patients with lower septum length coupled with a higher remaining uterine cavity length had a lower risk of uterine cavity distortion. Conclusions Septum length was shown to have the most important effect on uterine cavity distortion of all the uterine parametrics measured by 3D-TVS. Patients with septum lengths higher than 2.15 cm indicated a distortion rate of more than 50%, and tend to experience adverse pregnancy outcomes.
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Affiliation(s)
- Yan Lin
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
| | - Min Liu
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
| | - Suhui He
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
| | - Minmin Yang
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
| | - Qiumei Wu
- Department of Ultrasound, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China
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17
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Rikken JFW, Verhorstert KWJ, Emanuel MH, Bongers MY, Spinder T, Kuchenbecker W, Jansen FW, van der Steeg JW, Janssen CAH, Kapiteijn K, Schols WA, Torrenga B, Torrance HL, Verhoeve HR, Huirne JAF, Hoek A, Nieboer TE, van Rooij IAJ, Clark TJ, Robinson L, Stephenson MD, Mol BWJ, van der Veen F, van Wely M, Goddijn M. Septum resection in women with a septate uterus: a cohort study. Hum Reprod 2020; 35:1578-1588. [PMID: 32353142 PMCID: PMC7368397 DOI: 10.1093/humrep/dez284] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Does septum resection improve reproductive outcomes in women with a septate uterus? SUMMARY ANSWER In women with a septate uterus, septum resection does not increase live birth rate nor does it decrease the rates of pregnancy loss or preterm birth, compared with expectant management. WHAT IS KNOWN ALREADY The septate uterus is the most common uterine anomaly with an estimated prevalence of 0.2-2.3% in women of reproductive age, depending on the classification system. The definition of the septate uterus has been a long-lasting and ongoing subject of debate, and currently two classification systems are used worldwide. Women with a septate uterus may be at increased risk of subfertility, pregnancy loss, preterm birth and foetal malpresentation. Based on low quality evidence, current guidelines recommend removal of the intrauterine septum or, more cautiously, state that the procedure should be evaluated in future studies. STUDY DESIGN, SIZE, DURATION We performed an international multicentre cohort study in which we identified women mainly retrospectively by searching in electronic patient files, medical records and databases within the time frame of January 2000 until August 2018. Searching of the databases, files and records took place between January 2016 and July 2018. By doing so, we collected data on 257 women with a septate uterus in 21 centres in the Netherlands, USA and UK. PARTICIPANTS/MATERIALS, SETTING, METHODS We included women with a septate uterus, defined by the treating physician, according to the classification system at that time. The women were ascertained among those with a history of subfertility, pregnancy loss, preterm birth or foetal malpresentation or during a routine diagnostic procedure. Allocation to septum resection or expectant management was dependent on the reproductive history and severity of the disease. We excluded women who did not have a wish to conceive at time of diagnosis. The primary outcome was live birth. Secondary outcomes included pregnancy loss, preterm birth and foetal malpresentation. All conceptions during follow-up were registered but for the comparative analyses, only the first live birth or ongoing pregnancy was included. To evaluate differences in live birth and ongoing pregnancy, we used Cox proportional regression to calculate hazard rates (HRs) and 95% CI. To evaluate differences in pregnancy loss, preterm birth and foetal malpresentation, we used logistic regression to calculate odds ratios (OR) with corresponding 95% CI. We adjusted all reproductive outcomes for possible confounders. MAIN RESULTS AND THE ROLE OF CHANCE In total, 257 women were included in the cohort. Of these, 151 women underwent a septum resection and 106 women had expectant management. The median follow-up time was 46 months. During this time, live birth occurred in 80 women following a septum resection (53.0%) compared to 76 women following expectant management (71.7%) (HR 0.71 95% CI 0.49-1.02) and ongoing pregnancy occurred in 89 women who underwent septum resection (58.9%), compared to 80 women who had expectant management (75.5%) (HR 0.74 (95% CI 0.52-1.06)). Pregnancy loss occurred in 51 women who underwent septum resection (46.8%) versus 31 women who had expectant management (34.4%) (OR 1.58 (0.81-3.09)), while preterm birth occurred in 26 women who underwent septum resection (29.2%) versus 13 women who had expectant management (16.7%) (OR 1.26 (95% CI 0.52-3.04)) and foetal malpresentation occurred in 17 women who underwent septum resection (19.1%) versus 27 women who had expectant management (34.6%) (OR 0.56 (95% CI 0.24-1.33)). LIMITATIONS, REASONS FOR CAUTION Our retrospective study has a less robust design compared with a randomized controlled trial. Over the years, the ideas about the definition of the septate uterus has changed, but since the 257 women with a septate uterus included in this study had been diagnosed by their treating physician according to the leading classification system at that time, the data of this study reflect the daily practice of recent decades. Despite correcting for the most relevant patient characteristics, our estimates might not be free of residual confounding. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that septum resection, a procedure that is widely offered and associated with financial costs for society, healthcare systems or individuals, does not lead to improved reproductive outcomes compared to expectant management for women with a septate uterus. The results of this study need to be confirmed in randomized clinical trials. STUDY FUNDING/COMPETING INTEREST(S) A travel for JFWR to Chicago was supported by the Jo Kolk Studyfund. Otherwise, no specific funding was received for this study. The Department of Obstetrics and Gynaecology, University Medical Centre, Groningen, received an unrestricted educational grant from Ferring Pharmaceutical Company unrelated to the present study. BWM reports grants from NHMRC, personal fees from ObsEva, personal fees from Merck, personal fees from Guerbet, other payment from Guerbet and grants from Merck, outside the submitted work. The other authors declare no conficts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - K W J Verhorstert
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Eindhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - W Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Hospital Zwolle, Zwolle, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands
| | - K Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - W A Schols
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - B Torrenga
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
| | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, the Netherlands
| | - J A F Huirne
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T E Nieboer
- Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - I A J van Rooij
- Department of Obstetrics and Gynaecology, Elisabeth Hospital Tweesteden, Tilburg, the Netherlands
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - L Robinson
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois, CA, USA
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - F van der Veen
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M van Wely
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
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Detti L, Christiansen ME, Levi D’Ancona R, Gordon JC, Van de Velde N, Peregrin-Alvarez I. Restoration of Uterine Cavity Measurements after Surgical Correction. J Imaging 2020; 6:58. [PMID: 34460651 PMCID: PMC8321055 DOI: 10.3390/jimaging6070058] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: We sought to define the uterine and uterine cavity dimensions of subseptate uteri before and after hysteroscopic surgical incision, and compare them to those obtained in normal uteri with 3-D ultrasound. Methods: Two cohorts of consecutive women with normal-appearing uterine cavity and women diagnosed with uterine subseptations, before and after undergoing hysteroscopic incision. 3-D ultrasound was used to measure the uterine cavity width, length, and area on a frozen coronal view of the uterus. Results: A total of 215 women were included: 89 in the normal, and 126 in the subseptate uterus, groups. Uterine length and height were similar in the pre-operative, post-operative subseptate uteri, and in the normal uteri, while the uterine width was significantly greater in the pre-operative (5.1 + 0.8 cm) than post-operative (4.7 + 0.8 cm) and normal uterus (4.6 + 0.7 cm; p < 0.001) groups. The pre-operative uterine cavity length (3.3 + 0.5 cm), width (3.2 + 0.7 cm), and area (4.4 + 1.2 cm2), were significantly greater than the post-operative ones (length 2.9 + 0.4 cm; width 2.6 + 0.6 cm; area 3.7 + 0.8 cm; overall p < 0.001), and became similar to the dimensions of the normal uterus. Of the patients who subsequently conceived, 2.6% miscarried in the corrected subseptation group and 28.8% miscarried in the normal uterus group. Conclusions: We defined the ultrasound dimensions of the uterine cavity in subseptate uteri and their change after surgical correction. Uterine cavity length, width, and area show very little variability in adult normal uteri, while they are increased in uteri with a subseptation greater than 5.9 mm in length, and regain normal measurements after surgical correction.
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Affiliation(s)
- Laura Detti
- Cleveland Clinic, Department of Subspecialty Care for Women’s Health, Ob/Gyn Women’s Health Institute, Cleveland, OH 44195, USA
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Mary Emily Christiansen
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Roberto Levi D’Ancona
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Jennifer C. Gordon
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Nicole Van de Velde
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
| | - Irene Peregrin-Alvarez
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; (M.E.C.); (R.L.D.); (J.C.G.); (N.V.d.V.); (I.P.-A.)
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Luo LJ, Feng F, Li SH, Lu D, Li L, Zhou Q. Sequence variant in the CDC42BPB gene is potentially associated with Mullerian duct anomalies. J Obstet Gynaecol Res 2020; 46:684-693. [PMID: 32043305 DOI: 10.1111/jog.14211] [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: 10/12/2019] [Accepted: 01/26/2020] [Indexed: 01/03/2023]
Abstract
AIM Mullerian duct anomalies (MDA) are common female genital tract malformations. Genetic and environmental factors are important causes of MDA in women. Although many genes and mutations have been found to be associated with the pathogenesis of MDA, in most cases, the genetic pathogenic factors of MDA are still unknown. METHODS We first analyzed the three sisters using low coverage whole-genome sequencing. Then whole-exome sequencing was carried out in each patient. The identified sequence variant was confirmed by Sanger sequencing. In silico pathogenicity analysis and conservative analysis of the mutation site were also performed. Protein structural modeling was used to analyze the effect of the mutated amino acid. RESULTS We first analyzed the three sisters with septate uterus using low coverage whole-genome sequencing, but no possible pathogenic copy number variation was found. Then whole-exome sequencing was performed on the three sisters, and a rare homozygous variant, CDC42BPB:c.2012G>A:p.R671Q, was identified. All three patients were found with this variant. Sanger sequencing validated that this variant was segregated within the family. In silico pathogenicity analysis and conservative analysis of the mutation site suggested that the variant might be damaging. Protein structural analysis suggested that R671Q might weaken the electrostatic potential of this region, which may be a significant regulation target or protein interaction surface of CDC42BPB. CONCLUSION We demonstrated that CDC42BPB genetic variant might be potentially associated with the pathogenesis of MDA.
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Affiliation(s)
- Li-Jing Luo
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Fan Feng
- Department of Basic Medical Sciences, School of Medicine, Tsinghua University, Beijing, China
| | - Sheng-Hui Li
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Dan Lu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Lin Li
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Qi Zhou
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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Fox NS, Connolly CT, Hill MB, Klahr RA, Zafman KB, Rebarber A. Pregnancy outcomes in viable pregnancies with a septate uterus compared with viable pregnancies after hysteroscopic uterine septum resection. Am J Obstet Gynecol MFM 2019; 1:136-143. [PMID: 33345819 DOI: 10.1016/j.ajogmf.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/18/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Septate uterus is one of the more common Müllerian anomalies and is the anomaly most amenable to surgical correction. It is currently uncertain if hysteroscopic septum resection reduces the incidence of adverse pregnancy outcomes. OBJECTIVE The purpose of this study was to compare pregnancy outcomes in women who had reached at least 20 weeks gestation with those women with a uterine septum and those women who had undergone septum resection before pregnancy. STUDY DESIGN Retrospective cohort study of women with a history of uterine septum who were cared for by a large maternal-fetal medicine practice from 2005-2018. We included women with singleton pregnancies at >20 weeks gestation. Baseline characteristics and pregnancy outcomes were compared between women with a history of a hysteroscopic uterine septum resection and women with an unresected septum. Regression analysis was performed to control for differences in baseline characteristics. The analysis was repeated in nulliparous women only. RESULTS A total of 109 women (163 pregnancies) were included. In the entire population, pregnancy outcomes did not differ between the groups, aside from a higher rate of cesarean delivery in the resected septum group. In the 63 nulliparous women, septum resection was associated with later gestational ages at delivery (39.1 vs 37 weeks; P=.030), decreased preterm birth <37 weeks gestation (4.5% vs 31.6%; adjusted odds ratio, 0.154; 95% confidence interval, 0.027-0.877), and an increased incidence of cesarean delivery in women who attempted vaginal delivery (30.6% vs 0%; P=.012). There was no difference in the rates of small for gestational age, preeclampsia, blood transfusion, retained placenta, or morbidly adherent placenta. CONCLUSION In nulliparous women with viable pregnancies, hysteroscopic resection of a uterine septum is associated with a decreased incidence of preterm birth and an increased incidence of cesarean delivery. These findings need to be confirmed in a well-designed randomized trial before uterine septum resection is recommended routinely.
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Affiliation(s)
- Nathan S Fox
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY.
| | - Courtney T Connolly
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa B Hill
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rebecca A Klahr
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kelly B Zafman
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrei Rebarber
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY
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Abstract
In this study all women undergoing caesarean section were included regardless of the indication. After the foetus and placenta were delivered, the uterus was examined for the presence or absence of congenital malformation through digital palpation of uterine cavity and direct inspection of the fundus. Of the 653 caesarean sections included, uterine anomalies were diagnosed in 31 women (4.75%). Most of the anomalies were septate and sub-septate uterus (71%) followed by bicornuate uterus (19.4%), while the frequency of unicornuate uterus was 6.4% and uterine didelphys represented only 3.2%. In conclusion, an examination of the uterus internally and externally should be performed as a routine step during caesarean section. Impact statement What is already known on this subject? Most of the data of uterine anomalies has been derived from studies of patients with reproductive problems and not from those with a normal reproductive outcome. What do the results of this study add? Approximately 5% of women were found to have uterine anomalies when examined during caesarean section. If any were detected, we feel that the patient should be informed, as they may affect future reproductive performance and the choice of contraception. What are the implications of these findings for clinical practice and/or further research? An examination of the uterus internally and externally should be considered as a routine step during a caesarean section.
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Affiliation(s)
- Magdy A Mohamed
- a Department of Obstetrics and Gynaecology, Sohag Faculty of Medicine , Sohag University , Sohag , Egypt
| | - Mohamed Y AbdelRahman
- a Department of Obstetrics and Gynaecology, Sohag Faculty of Medicine , Sohag University , Sohag , Egypt
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Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Nakao T, Okada M. Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report. Oncol Lett 2018; 15:7273-7278. [PMID: 29725444 DOI: 10.3892/ol.2018.8179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/01/2017] [Accepted: 01/29/2018] [Indexed: 01/16/2023] Open
Abstract
Brachytherapy is a standard treatment modality for locally advanced cervical cancer. In patients with uterine anomalies, the radiation dose to the target volume and the organs at risk can vary depending on the positioning of the brachytherapy tandem implant. However, there have been few reports concerning the use of brachytherapy in patients with uterine anomalies. The present study reports the case of a 55-year-old woman with locally advanced squamous cell carcinoma of the cervix and complete septate uterus. The patient was treated with external-beam radiation therapy, cisplatin chemotherapy, and brachytherapy. Computed tomography-based planning was performed for image-guided brachytherapy with the tandem implant alternately in the right and left uterine canals and using the right and left point A. A comparison of the resulting dose-volume histograms revealed wide variations in the projected dose to the clinical target volume and organs at risk. Tandem implant positioning for brachytherapy was chosen to optimize the dose-volume distribution. At the point of writing, the patient has not experienced local recurrence.
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Affiliation(s)
- Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Takehiro Nakao
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo 173-8610, Japan
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Han TT, Chen J, Wang S, Zhu L. Vaginal atresia and cervical agenesis combined with asymmetric septate uterus: A case report of a new genital malformation and literature review. Medicine (Baltimore) 2018; 97:e9674. [PMID: 29505013 PMCID: PMC5779782 DOI: 10.1097/md.0000000000009674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE A combination of Vaginal atresia and septate uterus as a novel genital malformation has been reported the first time. It offers a support for the bidirectional theory. PATIENT CONCERNS A 23-year-old woman presented with the inability to perform intercourse. The unprecedented variant was misdiagnosed by magnetic resonance imaging and ultrasonography as low vaginal atresia associated with complete septate uterus with functional endometrium in both the cavities. DIAGNOSES The correct diagnosis was made and confirmed intraoperatively as a genital malformation, vaginal atresia and cervical agenesis associated with septate uterus. INTERVENTION laparoscopic and hysteroscopic diagnosis the novel malformation never been reported and a vaginal stent was recommended postoperatively. OUTCOMES This rare clinical variant made misdiagnosis. Intraoperatively, unprecedented genital malformation was confirmed. There are no vaginal atresia cases in the literature with a septate functional uterus and single agenesis cervix. LESSONS Confirmed diagnosed by operation instead of depending on the imaging should be used for rare genital anomaly.
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Yavas G, Yavas C, Inan G. Locally advanced squamous cell cervical cancer in a patient with septate uterus. J Contemp Brachytherapy 2017; 9:487-9. [PMID: 29204170 DOI: 10.5114/jcb.2017.70996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/20/2017] [Accepted: 10/04/2017] [Indexed: 12/25/2022] Open
Abstract
A 33-year-old premenopausal multiparous woman with the history of septate uterus was referred to the hospital with menorrhagia and inter-menstrual bleeding occurring for the last 6 months. Work-up revealed a stage IIB cervical cancer. The patient underwent curative chemo/radiotherapy. The patient’s septate uterus presented several difficulties during application. Brachytherapy was applied using standard computed tomography-compatible tandem and ovoids. The high-risk clinical target volume (HR-CTV), intermediate risk CTV, and organs at risk were contoured according to the Groupe Européen de Curiethérapie – European Society for Radiology and Oncology (GEC-ESTRO) guidelines. Treatment was performed via 3-dimensional high-dose-rate technique with 192Ir, with brachytherapy dose of 28 Gy in 4 fractions/7 Gy each, prescribed to the HR-CTV. Treatment was well tolerated with manageable acute toxicities. To the best of our knowledge, the current case is the second case of septate uterus with locally advanced cervical carcinoma. Due to the lack of guidelines about brachytherapy applications in patients with uterine anomaly and owing to the anatomical anomaly, brachytherapy application is challenging in this patients population.
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McCormack CD, Furness DL, Dekker GA, Shand K, Roberts CT. 3D ultrasound findings in women attending a South Australian recurrent miscarriage clinic. Australas J Ultrasound Med 2016; 19:142-146. [PMID: 34760459 DOI: 10.1002/ajum.12032] [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] [Indexed: 11/10/2022] Open
Abstract
Background Women who suffer recurrent miscarriage are a heterogeneous group. Known causes include genetic and endocrine abnormalities, anti-phospholipid syndrome and autoimmune disease. Congenital uterine abnormalities (CUAs) such as bicornuate, unicornuate, septate and arcuate uterine abnormalities are known to negatively impact on pregnancy rates, and to increase the miscarriage rates of genetically normal pregnancies. In some countries, such as Britain, 3D ultrasound of the pelvis is offered routinely to women with recurrent miscarriages. Aim To determine the prevalence of CUAs and other pelvic pathology, in women attending a South Australian recurrent miscarriage clinic. Materials and methods 3D transvaginal ultrasounds performed during the luteal phase of the menstrual cycle were offered to all patients attending the recurrent miscarriage clinic, who had not previously had a hysteroscopy, laparoscopy, HyCoSy or MRI study of their pelvis. A Philips IUI 8 MHz transvaginal probe for freehand sweep, and dedicated 3D transvaginal probe was used. 3D scans provide a coronal view of the uterus, ideal for detecting abnormalities which may be missed during routine conventional 2D scanning. Results A total of 210 women were recruited, 200 results were available, and 29% were found to have a CUA. 15% had polycystic ovaries detected, 15% were found to have fibroids, 12% adenomyosis and 1.5% Asherman's syndrome. Conclusions 3D ultrasound evaluation of patients attending a recurrent miscarriage clinic detects CUAs, and has a high detection rate of other pelvic abnormalities that may contribute to recurrent miscarriages.
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Affiliation(s)
- Catherine D McCormack
- Robinson Research Institute School of Paediatrics and Reproductive Health University of Adelaide Adelaide South Australia Australia.,Department of Obstetrics Women's and Children's Hospital North Adelaide South Australia Australia
| | - Denise L Furness
- Robinson Research Institute School of Paediatrics and Reproductive Health University of Adelaide Adelaide South Australia Australia
| | - Gustaaf A Dekker
- Robinson Research Institute School of Paediatrics and Reproductive Health University of Adelaide Adelaide South Australia Australia
| | - Karen Shand
- Department of Obstetrics Women's and Children's Hospital North Adelaide South Australia Australia
| | - Claire T Roberts
- Robinson Research Institute School of Paediatrics and Reproductive Health University of Adelaide Adelaide South Australia Australia
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Ludwin A, Ludwin I, Martins WP. Robert's uterus: modern imaging techniques and ultrasound-guided hysteroscopic treatment without laparoscopy or laparotomy. Ultrasound Obstet Gynecol 2016; 48:526-529. [PMID: 27240758 DOI: 10.1002/uog.15976] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/07/2016] [Accepted: 05/24/2016] [Indexed: 06/05/2023]
Abstract
Robert's uterus is a unique malformation, described as a septate uterus with a non-communicating hemicavity, consisting of a blind uterine horn usually with unilateral hematometra, a contralateral unicornuate uterine cavity and a normally shaped external uterine fundus. The main symptom in affected young women is pelvic pain that becomes intensified near menses. We describe the case of a 22-year-old woman who was referred for diagnostic assessment and treatment of a congenital uterine anomaly. We used three-dimensional sonohysterography with volume-contrast imaging, HDLive rendering mode and automatic volume calculation (SonoHysteroAVC) for the diagnosis, surgical planning and postoperative evaluation. These imaging techniques provided a complete understanding of the internal and external uterine structures, enabling us to perform a minimally invasive hysteroscopic metroplasty, guided by transrectal ultrasound, and therefore avoiding the need for laparotomy/laparoscopy. The outcome of treatment was considered satisfactory; menstruation ceased to be painful and, after two hysteroscopic procedures, the communicating 0.3-cm3 hemicavity was visualized as a 3.6-cm3 normalized uterine cavity using the same imaging techniques. The findings of this case report raise questions about the embryological origin of Robert's uterus, the suitability of current classification systems, and the role of more invasive approaches (laparoscopy/laparotomy) and surgical procedures (horn resection/endometrectomy) that do not aim to improve uterine cavity shape and volume in women with this condition. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
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Oride A, Kanasaki H, Ishihara T, Kyo S. Rare case of complicated congenital anomalies of female reproductive organs with bilateral undescended ovaries. J Obstet Gynaecol Res 2016; 42:895-898. [PMID: 27075315 DOI: 10.1111/jog.12992] [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: 09/25/2015] [Accepted: 02/18/2016] [Indexed: 11/28/2022]
Abstract
Congenital anomalies of the female reproductive organs vary widely and the patients often have no symptoms related to them. We report an exceedingly rare case of complicated anomalies in the Müllerian duct and urogenital sinus. The patient was a 21-year-old woman evaluated for infertility, and the examination revealed the presence of a complete septate uterus. We found dual vaginal canals with right incomplete hymenal fenestration when we performed an examination during the patient's menstrual period. Laparoscopic findings showed bilateral undescended ovaries, absent utero-ovarian ligaments, and partial atresia of the left fallopian tube. We performed hymenotomy of the right vagina, resection of the vaginal septum and salpingostomy of the left fallopian tube. To the best of our knowledge, this is the first report to describe this complex combination of anomalies in the Müllerian duct and urogenital sinus. This case might provide us with information about the development of the female reproductive organs. © 2016 Japan Society of Obstetrics and Gynecology.
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Affiliation(s)
- Aki Oride
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Haruhiko Kanasaki
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Tomoko Ishihara
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Japan
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Ali O, Hakimi I, Chanana A, Habib MAB, Guelzim K, Kouach J, Rahali DM, Dehayeni M. [Term pegnancy on septate uterus: report of a case and review of the literature]. Pan Afr Med J 2015; 22:219. [PMID: 26955410 PMCID: PMC4760728 DOI: 10.11604/pamj.2015.22.219.7790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/24/2015] [Accepted: 09/21/2015] [Indexed: 11/11/2022] Open
Abstract
L'utérus cloisonné est la malformation utérine la plus fréquente, comptant pour 30 à 50% des cas, suivie par les malformations utérines de type utérus bicorne et utérus unicorne. Nous rapportons un cas d'utérus cloisonné total suspecté lors de l'examen obstétrical d'une parturiente en travail, et confirmé à l'exploration au cours d'une césarienne réalisé pour le même motif. L'intérêt de ce cas est de montrer le pronostic obstétrical chez les femmes fertiles porteuses de cette malformation utérine.
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Affiliation(s)
- Osman Ali
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'Instruction de Mohamed V, Rabat, Maroc
| | - Ihssane Hakimi
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'Instruction de Mohamed V, Rabat, Maroc
| | - Adil Chanana
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'Instruction de Mohamed V, Rabat, Maroc
| | - My Abdellah Baba Habib
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'Instruction de Mohamed V, Rabat, Maroc
| | - Khalid Guelzim
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'Instruction de Mohamed V, Rabat, Maroc
| | - Jaouad Kouach
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'Instruction de Mohamed V, Rabat, Maroc
| | - Driss Moussaoui Rahali
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'Instruction de Mohamed V, Rabat, Maroc
| | - Mohammed Dehayeni
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'Instruction de Mohamed V, Rabat, Maroc
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Unlu C, Celik O, Celik N, Otlu B. Expression of Endometrial Receptivity Genes Increase After Myomectomy of Intramural Leiomyomas not Distorting the Endometrial Cavity. Reprod Sci 2015; 23:31-41. [PMID: 26507873 DOI: 10.1177/1933719115612929] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was designed to investigate whether endometrial receptivity genes are altered in infertile patients with intramural leiomyomas (IM) not distorting the endometrial cavity undergoing myomectomy. We measured endometrial HOXA-10, HOXA-11, LIF, ITGB3, and ITGAV messenger RNA (mRNA) expressions levels before and after myomectomy/metroplasty during mid-luteal phase in participants with IM, submucosal leiomyomas (SM), and septate uterus and fertile participants without fibroids. Initial endometrial sampling was obtained at the time of surgery, and second sampling was obtained 3 months after myomectomy/metroplasty. Expressions of each gene were evaluated using real-time reverse transcriptase polymerase chain reaction (RT-PCR). A trend toward decreased endometrial HOXA-10, HOXA-11, and ITGAV mRNA expression was detected in both SM and IM groups before myomectomy when compared to both fertile group and septate uterus. However, the differences failed to show statistical significance. After myomectomy of IM, we have detected 12.8-fold increase in endometrial HOXA-10 mRNA expression and 9.0-fold increase in endometrial HOXA-11 mRNA expression. This increase in endometrial HOXA-10 and 11 mRNA expression was significant. Accordingly, 2 patients having intramural fibroids greater than 5 cm were able to remain pregnant after myomectomy. Conversely, submucosal myomectomy did not cause any significant effect on endometrial receptivity markers. Likewise, all markers of endometrial receptivity remained unchanged after metroplasty. Myomectomy of IM have favorable effect on endometrial HOXA-10 and 11 mRNA expression.
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Affiliation(s)
- Cihat Unlu
- Department of Obstetrics and Gynecology, School of Medicine, Acıbadem University, Istanbul, Turkey
| | - Onder Celik
- Department of Obstetrics and Gynecology, Usak, Turkey
| | - Nilufer Celik
- Department of Biochemistry, Behçet Uz Children's Hospital, İzmir, Turkey
| | - Baris Otlu
- Department of Medical Microbiology, School of Medicine, Inonu University, Malatya, Turkey
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Li J, Yu W, Wang M, Feng LM. Hysteroscopic treatment of Robert's uterus with laparoscopy. J Obstet Gynaecol Res 2015; 41:1491-4. [PMID: 26096713 DOI: 10.1111/jog.12735] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 10/13/2014] [Revised: 02/14/2015] [Accepted: 03/14/2015] [Indexed: 11/29/2022]
Abstract
Herein is described the case of a 26-year-old woman whose Robert's uterus was treated with hysteroscopy and who then successfully became pregnant and gave birth. The uterus anomaly was diagnosed on combined hysteroscopy and ultrasonography, which showed an asymmetric septate uterus with one blind cavity, causing menstrual retention. The surgery was uncomplicated, with satisfactory results. The patient underwent successful cesarean section delivery of a baby boy weighing 3250 g on 24 March 2014.
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Affiliation(s)
- Jing Li
- Department of Obstetrics and Gynecology, Beijing Tian Tan Hospital
| | - Wen Yu
- Department of Obstetrics and Gynecology, Beijing Tian Tan Hospital
| | - Ming Wang
- Department of Obstetrics and Gynecology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Li-min Feng
- Department of Obstetrics and Gynecology, Beijing Tian Tan Hospital
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Awasthi NK, Goel H, Mahapatra R, Pal D. Incomplete bladder duplication with multiple congenital anomalies: A rare presentation. Urol Ann 2015; 7:88-90. [PMID: 25657553 PMCID: PMC4310127 DOI: 10.4103/0974-7796.148628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/02/2013] [Accepted: 07/31/2013] [Indexed: 11/04/2022] Open
Abstract
We report a rare case of incomplete bladder duplication associated with multiple congenital malformation. The patient presented with a symptomatic left pelvi-ureteric junction obstruction which was surgically managed. To the best of our knowledge, this type of bladder duplication with such syndromic association is not yet reported in literature.
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Affiliation(s)
| | - Hemantkumar Goel
- Department of Urology, I. P. G. M. E. & R., Kolkata, West Bengal, India
| | | | - Dilipkumar Pal
- Department of Urology, I. P. G. M. E. & R., Kolkata, West Bengal, India
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Boubess I, Mahdi Y, Ramsiss H, Filali A, Alami MH, El Khannoussi B, Hachi H. Endometrial carcinoma located in the right septate uterus cavity: a case report. Pan Afr Med J 2015; 22:272. [PMID: 26958135 PMCID: PMC4765351 DOI: 10.11604/pamj.2015.22.272.7682] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/01/2015] [Indexed: 11/11/2022] Open
Abstract
Endometrial cancer in patients with uterine congenital malformations is exceptional and there are only a few rare cases published in the literature. We report the case of a 67 years-old patient with an endometrial cancer located in the right cavity of a complete septate uterus.
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Affiliation(s)
- Ikram Boubess
- National Centre of Reproductive Health, University of Hospital Ibn Sina, Rabat Morocco
| | - Youssef Mahdi
- Departement of Pathology, National Institute of Oncology, University Hospital Ibn Sina, Rabat Morocco
| | - Hanan Ramsiss
- National Centre of Reproductive Health, University of Hospital Ibn Sina, Rabat Morocco
| | - Adib Filali
- National Centre of Reproductive Health, University of Hospital Ibn Sina, Rabat Morocco
| | - Mohamad Hassan Alami
- National Centre of Reproductive Health, University of Hospital Ibn Sina, Rabat Morocco
| | - Basma El Khannoussi
- Departement of Pathology, National Institute of Oncology, University Hospital Ibn Sina, Rabat Morocco
| | - Hafid Hachi
- Pole of Gynecologic Breast Surgery, National Institute of Oncology, University Hospital Ibn Sina, Rabat Morocco
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Abstract
STUDY QUESTION Does the European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy (ESHRE–ESGE) classification of female genital tract malformations significantly increase the frequency of septate uterus diagnosis relative to the American Society for Reproductive Medicine (ASRM) classification? SUMMARY ANSWER Use of the ESHRE–ESGE classification, compared with the ASRM classification, significantly increased the frequency of septate uterus recognition. WHAT IS KNOWN ALREADY The ESHRE–ESGE criteria were supposed to eliminate the subjective diagnoses of septate uterus by the ASRM criteria and replace the complementary absolute morphometric criteria. However, the clinical value of the ESHRE–ESGE classification in daily practice is difficult to appreciate. The application of the ESHRE–ESGE criteria has resulted in a significantly increased recognition of residual septum after hysteroscopic metroplasty, with a possible risk of overdiagnosis of septate uterus and problems for its management. STUDY DESIGN, SIZE, AND DURATION A prospective observational study was performed with 261 women consecutively enrolled between June and September 2013. PARTICIPANTS/MATERIALS, SETTING, AND METHODS Non-pregnant women of reproductive age presented for evaluation to a private medical center. A gynecological examination and 3D ultrasonography were performed to assess the anatomy of the uterus, cervix and vagina. Congenital anomalies were diagnosed using the ASRM classification with additional morphometric criteria as well as with the ESHRE–ESGE classification. We compared the frequency and concordance of diagnoses of septate uterus and all congenital malformations of the uterus according to both classifications. The morphological characteristics of septate uterus recognized by both criteria were compared. MAIN RESULTS AND ROLE OF CHANCE Of the 261 patients enrolled in this study, septate uterus was diagnosed in 44 (16.9%) and 16 (6.1%) patients using the ESGE–ESHRE and ASRM criteria, respectively [relative risk (RR)ESHRE–ESGE:ASRM 2.74; 95% confidence interval (CI), 1.6–4.72; P < 0.01]. At least one congenital anomaly were diagnosed in 58 (22.2%) and 43 (16.5%) patients using the ESHRE–ESGE and ASRM classifications (RRESHRE–ESGE:ASRM, 1.35; 95% CI, 0.95–1.92, P = 0.1), respectively. The two criteria had moderate strength of agreement in the diagnosis of septate uterus (κ = 0.45, P < 0.01). There was good agreement in differentiation between anomaly and norm between the two assessment criteria (κ = 0.79, P < 0.01). The percentages of all congenital malformations and results of the differentiation between the anomaly and norm were obtained after excluding the confounding original ESHRE–ESGE criterion of dysmorphic uterus (internal indentation <50% uterine wall thickness). The morphology of septa identified by the ESHRE–ESGE [length of internal fundal indentation (mm): median 10.7; lower–upper quartile, 8.1–20] significantly differed (P < 0.01) from that identified by the ASRM criteria [length of internal fundal indentation (mm): median, 21.1; lower–upper quartile, 18.8–33.1]. Internal fundal indentation in 16 out of 44 (36.4%) cases was <1 cm in the septate uterus by ESHRE–ESGE and met the criteria for normal uterus by ASRM. LIMITATIONS AND REASONS FOR CAUTION The study participants were women who visited a diagnostic and treatment center specialized in uterine congenital malformations for a medical assessment, not from the general public. WIDER IMPLICATIONS OF THE FINDINGS Septate uterus diagnosis by ESHRE–ESGE was quantitatively dominated by morphological states corresponding to arcuate uterus or cases that were not diagnosed as congenital malformations by ASRM. Relative overdiagnosis of septate uterus by ESHRE–ESGE in these cases may lead to unnecessary overtreatment without the expected benefits. The ESHRE–ESGE classification criteria should be redefined due to confusions in the methodology. Until the criteria are revised, septate uterus should not be diagnosed using this classification system and it should not be used as an eligibility criterion for hysteroscopic metroplasty. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Jagiellonian University (grant no. K/ZDS/003821). The authors have no competing interests to declare.
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Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, ul. Kopernika 23, Krakow 31-501, Poland Ludwin & Ludwin Gynecology, Private Medical Center, Krakow 31-511, Poland
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, ul. Kopernika 23, Krakow 31-501, Poland Ludwin & Ludwin Gynecology, Private Medical Center, Krakow 31-511, Poland
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Sugiura-Ogasawara M, Lin BL, Aoki K, Maruyama T, Nakatsuka M, Ozawa N, Sugi T, Takeshita T, Nishida M. Does surgery improve live birth rates in patients with recurrent miscarriage caused by uterine anomalies? J OBSTET GYNAECOL 2014; 35:155-8. [PMID: 25058627 DOI: 10.3109/01443615.2014.936839] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We found that congenital uterine anomalies have a negative impact on reproductive outcome in recurrent-miscarriage couples, being associated with further miscarriage with a normal embryonic karyotype. There has been no study comparing live birth rates between patients with and without surgery. We conducted a prospective study to prove that surgery for a bicornuate or septate uterus might improve the live birth rate. A total of 170 patients with congenital uterine anomalies suffering two or more miscarriages were examined. The live birth rate after ascertainment of anomalies, cumulative live birth rate and infertility rate, were compared between patients with and without surgery. In patients with a septate uterus, the live birth rate (81.3%) at the first pregnancy after ascertainment of anomalies with surgery tended to be higher than that (61.5%) in those without surgery. The infertility rates were similar in both groups, while the cumulative live birth rate (76.1%) tended to be higher than without surgery (60.0%). Surgery showed no benefit in patients with a bicornuate uterus for having a baby, but tended to decrease the preterm birth rate and the low birth weight. The possibility that surgery has benefits for having a baby in patients with a septate uterus suffering recurrent miscarriage could not be excluded.
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Affiliation(s)
- M Sugiura-Ogasawara
- Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences
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Platta CS, Wallace C, Gondi V, Das R, Straub M, Al-Niaimi A, Applegate G, Bradley KA. Cervical brachytherapy technique for locally advanced carcinoma of the cervix in a patient with septate uterus. J Contemp Brachytherapy 2014; 6:76-81. [PMID: 24790625 DOI: 10.5114/jcb.2014.40768] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 11/18/2013] [Revised: 02/05/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe an approach to cervical brachytherapy in a patient with congenital septate uterus and locally advanced cervical carcinoma. Material and methods The patient is a 34-year-old female with septate uterus presenting with pelvic pain. Workup demonstrated a stage IIB cervical adenocarcinoma with imaging evidence of an involved right external iliac lymph node. The patient received whole pelvic radiation, with concurrent weekly cisplatin (40 mg/m2), to a dose of 45 Gy in 25 fractions followed by a parametrial boost of 5.4 Gy and an additional nodal boost of 9 Gy. Results The patient was initiated on cervical brachytherapy following fraction 23 of pelvic radiation. To conform to her septated uterus, a Rotte-Y tandem was used. Additionally, 2 CT-compatible ovoids were placed in the vaginal apex to enhance dose distribution and coverage of the target volume. Each fraction of brachytherapy was performed with CT-based planning. A high-risk clinical target volume (HR-CTV) and normal structures were defined and constrained per American Brachytherapy Society (ABS) and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines. The brachytherapy dose was 27.5 Gy in 5 fractions of 5.5 Gy each, prescribed to the HR-CTV. Conclusions Herein, we report the first documented case of cervical brachytherapy in a patient with septate uterus and locally advanced cervical carcinoma. Using CT-guided planning, in conjunction with the ABS and GEC-ESTRO guidelines, the patient was effectively treated with adapted cervical brachytherapy, meeting criteria for HR-CTV coverage and normal tissue tolerances.
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Detti L. Ultrasound assessment of uterine cavity remodeling after surgical correction of subseptations. Am J Obstet Gynecol 2014; 210:262.e1-6. [PMID: 24215853 DOI: 10.1016/j.ajog.2013.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/20/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the postoperative restoration of a normal uterine cavity, uterine cavity measurements were obtained in patients with arcuate or septate uteri in the periods before and after resection. STUDY DESIGN Twenty-eight women diagnosed with arcuate or septate uteri were evaluated with 3-dimensional ultrasound before and after undergoing surgical resection by hysteroscopic resection, in a university center. In addition to the conventional parameters, measurements of the subseptum's length and width, and cavity width, were obtained on a frozen coronal view of the uterus. Postoperatively, uterine cavity width was measured. RESULTS Twelve patients were diagnosed with arcuate uterus and 16 with septate uterus and subsequently underwent surgical correction. Of them, 50% had a retroverted uterus and 61% had a diagnosis of polycystic ovary syndrome (7/28, or 25%, had both). Uterine length, width, and height, before and after resection, were similar between arcuate and septate, as were the subsepti base widths, despite the different lengths. However, cavity width was significantly decreased after resection only in the septate uterus group: 3.6 cm, 95% confidence interval, 3.3-3.9, preoperatively vs 2.8 cm, 95% confidence interval, 2.5-3.1, postoperatively, respectively; P < .001. The postoperative difference in cavity width was directly correlated with the length of the subseptation (r -0.59, P = .05). CONCLUSION Postoperative measurements of the uterine cavity revealed a remarkable uterine remodeling capacity: we speculate this could represent the most important single change to explain improved pregnancy outcomes after surgical correction of subseptations.
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Ludwin A, Ludwin I, Kudla M, Pitynski K, Banas T, Jach R, Knafel A. Diagnostic accuracy of three-dimensional sonohysterography compared with office hysteroscopy and its interrater/intrarater agreement in uterine cavity assessment after hysteroscopic metroplasty. Fertil Steril 2014; 101:1392-9. [PMID: 24581576 DOI: 10.1016/j.fertnstert.2014.01.039] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 11/30/2013] [Revised: 12/31/2013] [Accepted: 01/18/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of three-dimensional sonohysterography (3D-SIS) and office hysteroscopy in uterine cavity assessment after hysteroscopic metroplasty (HM) and determine the interrater/intrarater agreement for 3D-SIS. DESIGN Prospective observational study. SETTING University hospital, private hospital, and clinic. PATIENT(S) One hundred forty-one women undergoing HM for septate uterus with a history of miscarriage and/or infertility. INTERVENTION(S) 3D-SIS and office hysteroscopy at 6-8 weeks after HM. MAIN OUTCOME MEASURE(S) Shape of the uterine cavity, length of the fundal notch (≥1 or <1 cm), and the presence of intrauterine adhesions were assessed, and the interrater/intrarater agreement of 3D-SIS was evaluated in 30 randomly selected patients. RESULT(S) Uterine abnormalities were detected with the use of hysteroscopy in 18 (12.8%) of 141 women. 3D-SIS was highly accurate (97.2%), sensitive (97%), and specific (100%), with a positive predictive value of 100% and a negative predictive value of 85%. The diagnostic values of hysteroscopy and 3D-SIS were not significantly different (McNemar test). 3D-SIS showed substantial interrater/intrarater agreement regarding overall uterine cavity evaluation (κ = 0.79 and 0.78, respectively). CONCLUSION(S) 3D-SIS demonstrated substantial interrater/intrarater agreement for the postoperative evaluation of the uterine cavity, being as diagnostically accurate as hysteroscopy. The use of second-look hysteroscopy may be limited to cases that require reoperation.
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Affiliation(s)
- Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Centermed Hospital and Clinic, Krakow, Poland; Ludwin and Ludwin Gynecology, Medical Center, Krakow, Poland.
| | - Inga Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Centermed Hospital and Clinic, Krakow, Poland; Ludwin and Ludwin Gynecology, Medical Center, Krakow, Poland
| | - Marek Kudla
- Department of Obstetrics and Gynecology, Medical University of Silesia, Katowice, Poland
| | - Kazimierz Pitynski
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | - Tomasz Banas
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | - Robert Jach
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | - Anna Knafel
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
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Abuzeid M, Ghourab G, Abuzeid O, Mitwally M, Ashraf M, Diamond M. Reproductive outcome after IVF following hysteroscopic division of incomplete uterine septum/arcuate uterine anomaly in women with primary infertility. Facts Views Vis Obgyn 2014; 6:194-202. [PMID: 25593694 PMCID: PMC4286858] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To determine reproductive outcome after in-vitro fertilization/embryo transfer (IVF-ET) in women with primary infertility following hysteroscopic septoplasty of incomplete uterine septum or arcuate uterine anomaly. METHODS This is a historical cohort study. The study group consisted of 156 consecutive patients who underwent a total of 221 cycles of IVF/ET following hysteroscopic septoplasty of an incomplete uterine septum or arcuate anomaly (Group 1). The control group included 196 consecutive patients with normal endometrial cavity on hysteroscopy who underwent a total of 369 cycles of IVF/ET (Group 2). The reproductive outcome after the first cycle of IVF-ET and the best reproductive outcome of all the cycles the patient underwent were calculated. In addition, we compared the reproductive outcome in the study group based on the type of the anomalies (septum versus arcuate). RESULTS In the first fresh cycle, following septoplasty, there were significantly higher clinical pregnancy and delivery rates in Group 1 (60.3% and 51.3% respectively) compared to Group 2 (38.8% and 33.2% respectively). However, there was no significant difference between the two groups in the clinical pregnancy (74.4% vs. 67.3%) or in the delivery (65.4% vs. 60.2%) rates per patient, respectively. There was no significant difference in the reproductive outcome after IVF-ET between patients who previously had arcuate uterine anomaly versus incomplete uterine septum. CONCLUSION Reproductive outcome of IVF-ET after hysteroscopic correction of incomplete uterine septum/arcuate uterine anomaly in women with primary infertility is no different from women with normal uterine cavity.
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Affiliation(s)
- M. Abuzeid
- Division of Reproductive Endocrinology and Infertility, Department of OB/GYN, Hurley. Medical Center, Two Hurley Plaza, Suite 209, Flint, Michigan 48503, USA. Michigan State University College of Human Medicine, Flint Campus, USA.
,IVF Michigan PC, 3950 Rochester Road, Suite 2300, Rochester Hills, Michigan 48307, USA.
| | - G. Ghourab
- IVF Michigan PC, 3950 Rochester Road, Suite 2300, Rochester Hills, Michigan 48307, USA.
| | - O. Abuzeid
- IVF Michigan PC, 3950 Rochester Road, Suite 2300, Rochester Hills, Michigan 48307, USA.
| | - M. Mitwally
- Odessa Reproductive Medicine Center, 520 E. 6th Street, Odessa, TX 79761, USA.
| | - M. Ashraf
- Division of Reproductive Endocrinology and Infertility, Department of OB/GYN, Hurley. Medical Center, Two Hurley Plaza, Suite 209, Flint, Michigan 48503, USA. Michigan State University College of Human Medicine, Flint Campus, USA.
,IVF Michigan PC, 3950 Rochester Road, Suite 2300, Rochester Hills, Michigan 48307, USA.
| | - M. Diamond
- Georgia Regents University, Chairman of the Department of OB/GYN, 1120 15th Street BA 7300, Augusta, Georgia 30909, USA.
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Jain N, Gupta A, Kumar R, Minj A. Complete imperforate tranverse vaginal septum with septate uterus: A rare anomaly. J Hum Reprod Sci 2013; 6:74-6. [PMID: 23869157 PMCID: PMC3713583 DOI: 10.4103/0974-1208.112387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 08/13/2012] [Revised: 11/04/2012] [Accepted: 02/07/2013] [Indexed: 11/04/2022] Open
Abstract
The isolated, complete, transverse vaginal septum is one of the most infrequent anomalies of the female genital tract, and when it coexists with a septate uterus, it is even rarer. This report describes a case of transverse vaginal septum with septate uterus. A 12-year-old girl sought medical assessment because of severe cyclic lower abdominal cramping and pelvic pain. Local examination revealed a blind vaginal pouch of 2 cm and on rectal examination a tender pelvic mass was noted. Radiological examination showed transverse vaginal septum in the lower vagina with bicornuate uterus. Surgical resection of the vaginal septum was done under laparoscopic guidance. Hysteroscopy revealed presence of uterine septum which was resected by a resectoscope. Post-operative dilatation of vagina was done to prevent restenosis. Laparoscopic guided abdominoperineal approach is better in such a case as multiple mullerian anomalies may coexist with each other.
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Affiliation(s)
- Nutan Jain
- Vardhman Trauma and Laparoscopy Centre Pvt. Ltd. A-36, South Civil Lines, Mahavir Chowk, Muzaffarnagar - 251 001, Uttar Pradesh, India
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Pace S, Cerekja A, Dillon KC, Pace G, Piazze J. Improvement in uterine artery doppler indices via hysteroscopic metroplasty. J Prenat Med 2013; 7:25-28. [PMID: 23991276 PMCID: PMC3755794] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE the objective of our research was to study uterine artery doppler indices and their evolution over time after metroplasty and subsequent pregnancy in patients whose septate uterus was the only explanation for infertility. MATERIALS AND METHODS a retrospective study. The uterine arteries of 78 patients with septate uteri were evaluated using endovaginal color doppler ultrasound before and after metroplasty. Fifty-one patients became pregnant after metroplasty and were selected as study group, pregnancy occurred within 17 months. By comparing uterine artery doppler indices before and after metroplasty, we observed that the resistive index (RI) and pulsatility index (PI) post surgery were significantly lower compared to premetroplasty levels. RESULTS all pregnant women in the study group showed uterine resistive indexes within normal ranges, they all underwent scheduled cesarean in-tervention. Gestational evolution was normal in all patients (mean score of Apgar and birth weight); no neonatal complications were observed. CONCLUSION metroplastic intervention in women with septate uterus as the sole cause of infertility may be a plausible alternative for patients wishing to carry a pregnancy.
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Affiliation(s)
| | | | | | | | - Juan Piazze
- Poliambulatorio di Ceprano, “SS Trinità”, Hospital Sora, Service of Ultrasound in Obstetrics and Gynecolgy, ASL Frosinone, Italy
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Selvaraj P, Selvaraj K. Reproductive outcome of septate uterus following hysteroscopic septum resection. J Hum Reprod Sci 2011; 3:143-5. [PMID: 21234176 PMCID: PMC3017331 DOI: 10.4103/0974-1208.74157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [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: 05/01/2010] [Revised: 06/04/2010] [Accepted: 09/02/2010] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the reproductive outcome following hysteroscopic septum resection in patients with primary and secondary (recurrent pregnancy loss [RPL] and bad obstetric history [BOH]) infertility. STUDY DESIGN Retrospective study. MATERIALS AND METHODS Hysteroscopic septum resection was performed on 26 patients with a history of either recurrent pregnancy loss, BOH or infertility. The septum resection was performed using a bipolar versapoint system. Reproductive performance of these patients after septum resection was analyzed. The main outcome measures were clinical pregnancy and live birth rates. RESULTS Hysteroscopic septum resection was performed on seven patients with the history of secondary infertility. Post operatively, the pregnancy rate was 86% (n=6), and the live birth rate was 67% (n=4). After septum resection in 19 primary infertile patients, 6 (32%) patients conceived which resulted in live birth rates of 67% (n=4). CONCLUSION Hysteroscopic septum resection using bipolar versapoint system is an effective and safe approach for the removal of septum. Hysteroscopic septum resection in women with septate uterus significantly improves the live birth rates and future fertility is not impaired.
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Affiliation(s)
- Priya Selvaraj
- Fertility Research Centre, G G Hospital, 6E - Nungambakkam High Road, Chennai - 600 034, India
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Nigam A, Puri M, Trivedi SS, Chattopadhyay B. Septate uterus with hypoplastic left adnexa with cervical duplication and longitudinal vaginal septum: Rare Mullerian anomaly. J Hum Reprod Sci 2011; 3:105-7. [PMID: 21209756 PMCID: PMC2970785 DOI: 10.4103/0974-1208.69331] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 02/23/2010] [Accepted: 05/14/2010] [Indexed: 11/09/2022] Open
Abstract
A large analysis of all the studies in the period from 1950 to 2007 suggests that the prevalence of congenital uterine anomalies in the general population is 6.7%; and in the infertile population, 7.3%. We report a rare case of unilateral hypoplastic fallopian tube and ovary with septate uterus, cervical duplication, longitudinal vaginal septum. To the best of our knowledge, this is the first report of such a congregation of anomalies.
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Affiliation(s)
- Aruna Nigam
- Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
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