Ultrasound screening for congenital uterine anomalies

The aim of this study was to investigate the prevalence of congenital uterine anomalies in 1046 women attending gynaecological ultrasound clinics for a variety of indications. Using three-dimensional ultrasound, anomalies were found in 55 women (5.4%), including 32 (3.1%) with an arcuate uterus and 23 (2.3%) with major anomalies. The prevalence of uterine anomalies was similar to the findings in women undergoing elective sterilisation, but lower than in studies of women with recurrent miscarriage.     

Management of missed abortion in a patient with congenital uterine anomalies

Uterine anomalies are rare entities, vary from 0.1 to 4%, and are related to an increase risk of obstetrical complications. We report a case of a uterine anomaly, diagnosed during the management of a patient who presented with a missed abortion.     

Assessing congenital uterine anomalies: the role of three-dimensional ultrasonography

Congenital uterine anomalies are associated with a range of adverse reproductive outcomes but may also be found incidentally. Their significance in women with normal reproductive histories, who do not have a history of recurrent miscarriage or infertility, has been uncertain. The absence of these data has made it difficult to understand the true significance of congenital uterine anomalies found in women with adverse pregnancy outcomes. The advent of transvaginal three-dimensional ultrasonography has enabled the accurate, non-invasive, outpatient diagnosis of congenital uterine anomalies. It has enabled large-scale screening and morphological analysis of congenital uterine anomalies.     

实时三维超声成像诊断子宫畸形

目的 :探讨三维超声在诊断子宫畸形中的作用及子宫畸形对妊娠的影响。方法 :对 30例子宫畸形患者及 2 0例子宫形态正常者行三维超声检查 ,并记录孕产史。结果 :30例子宫畸形中 ,纵隔子宫 14例 ,双角子宫 10例 ,双子宫 5例 ,残角子宫 1例。对子宫畸形患者三维超声成像能清晰显示子宫内部结构 ,特别是子宫腔及内膜的形态和结构。结论 :三维超声能从不同角度观察各种位置的子宫内部构造 ,显示内膜形态 ,诊断子宫畸形的准确性明显优于二维超声。     

Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening.

OBJECTIVE: To determine reproductive outcomes in women with congenital uterine anomalies detected incidentally by three-dimensional ultrasound. METHODS: We studied 1089 women with no history of infertility or recurrent miscarriage who were seen for a transvaginal ultrasound scan. They were screened for uterine abnormalities using three-dimensional ultrasound. We determined prevalence of miscarriage and preterm labor in women with normal and abnormal uterine morphology. RESULTS: We found that 983 women had a normally shaped uterine cavity, 72 an arcuate, 29 a subseptate, and five a bicornuate uterus. Women with a subseptate uterus had a significantly higher proportion of first-trimester loss (Zeta = 4.68, P <.01) compared with women with a normal uterus. Women with an arcuate uterus had a significantly greater proportion of second-trimester loss (Zeta = 5.76, P <.01) and preterm labor (Zeta = 4.1, P <.01). There were no other significant differences in pregnancy outcomes between women with normal and abnormal uterine morphology. CONCLUSION: This study shows the potential value of three-dimensional ultrasound and confirmed that women with congenital uterine anomalies were more likely to have adverse pregnancy outcomes than women with a normal uterus.     

Incidence of congenital uterine anomalies in repeated reproductive wastage and prognosis for pregnancy after metroplasty.

To discover the exact incidence of congenital uterine anomalies among infertile patients, hysterosalpingography was performed on 1,200 married women with a history of repeated reproductive wastage. Out of 1,200 hysterosalpingographies, 188 revealed congenital uterine anomaly (15.7%). The degree of uterine cavity deformity in the anomalies was evaluated during hysterosalpingography using the X/M ratio. This indicated that the incidence of repeated spontaneous abortion in cases with low-grade anomalies is as high as the incidence among cases with more severe anomalies. A significant improvement in maintaining pregnancy was observed after metroplasty; more than 84% of postoperative pregnancies were successfully maintained, whereas none of the 233 presurgical pregnancies had lasted full term. As a control group, 47 other women with anomalies were randomly chosen, and their subsequent pregnancies were monitored, without metroplasty. Of their pregnancies, 94.4% terminated spontaneously before 12 weeks of gestation.     

Surgical correction of female infertility. An analysis of results and failures in 101 cases

During the 1970s, surgery undertaken to remedy infertility at Sabbatsberg Hospital in Stockholm involved macrosurgical techniques. The patients described here had the same pathology on either side. Sixty-three underwent different procedures for the correction of tubal pathology at laparotomy, while 20 patients had lysis of adhesions performed at laparoscopy. A further 18 patients were operated on for ovarian endometriosis. The results in terms of conceptions (ranging from 43 to 60%, depending upon the type of operation) were similar to those reported from microsurgery, but the incidence of ectopic pregnancy was higher. Second-look laparoscopy revealed the presence of adhesions and tubal block in a significant number of patients, though less often in those who ultimatively conceived. There was no difference in semen findings between patients who conceived and those who did not. Postoperative adhesions are responsible for many surgical failures, but refined methods of surgery may reduce the risk of future ectopic gestation. Only a limited number of cases remain where persistence of infertility may be due to minor anatomical or functional defects not amenable to present-day clinical evaluation.     

Polycystic ovarian syndrome and congenital uterine anomalies: the hidden common player

Objective

To study the association between polycystic ovary syndrome (PCOS) and congenital uterine (Müllerian) anomalies in infertile patients. The ultimate aim was to check for a common factor linking both reproductive health problems.

Design

A prospective observational study.

Setting

Tertiary referral infertility center.

Subjects and methodology

3,900 infertile patients were included. The diagnoses of PCOS and uterine anomalies were made. Patients with or without PCOS were correlated to the presence or absence of uterine anomalies and statistically assessed.

Main outcome measures

Study of the prevalence of PCOS/uterine anomalies in the studied population and the ratio of coexistence.

Results

The prevalence of PCOS in the studied cohort was 10.48 %. 409 (10.48 %) patients were confirmed to have PCOS, while 204 (5.23 %) were with confirmed uterine anomalies. Of the patients with confirmed PCOS, almost one-third (n = 149, 31.4 %) had uterine anomalies, while in patients with confirmed uterine anomalies, almost three-fourths (n = 149, 73 %) had PCOS.

Conclusions

There is evident association between PCOS and uterine anomalies in infertile patients. We suggest a genetic rather than a developmental defect to be a possible common player for the development of both PCOS and uterine anomalies.     

Surgical management of congenital uterine anomalies (including indications and surgical techniques)

The prevalence of congenital uterine anomalies (CUA) is reported to be 4.3–6.7% in the general population, 3.4%–8% in the infertile population, and 12.6–18.2% of those with recurrent miscarriages. They are the result of abnormal formation, differentiation, and fusion of the Müllerian or paramesonephric ducts during fetal life.To date, various classification systems have been proposed for the categorization of CUA, but the recently introduced ESHRE/ESGE classification seems to be a new, clear, and systematic categorization, which could be the basis for clinicians to rely on when they refer to CUA and their clinical impact either generally or concerning pregnancy outcomes. CUA are apparently related to an impaired reproductive outcome, while their exact clinical impact as well as the effectiveness of their treatment remain considered controversial. Surgery is indicated in women presenting with symptoms related to specific uterine anomalies, especially in those with fertility problems. In this review, indications, surgical techniques for the repair of CUA according to their classification, and fertility and pregnancy outcomes before and after surgery will be thoroughly reviewed.     

Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies

The clinical implications of congenital uterine anomalies (CUA), and the benefits of hysteroscopic resection of a uterine septum, were evaluated. Studies comparing reproductive and obstetric outcome of patients with and without CUA and of patients who had and had not undergone hysteroscopic resection of a uterine septum, were evaluated. Meta-analysis of studies indicated that the pregnancy rate was decreased in women with CUA (RR 0.85, 95% CI 0.73 to 1.00; marginally significant finding, P = 0.05). The spontaneous abortion rate was increased in women with CUA (RR 1.68, 95% CI 1.31 to 2.15). Preterm delivery rates (RR 2.21, 95% CI 1.59 to 3.08), malpresentation at delivery (RR 4.75, 95% CI 3.29 to 6.84), low birth weight (RR 1.93, 95% CI 1.50 to 2.49) and perinatal mortality rates (RR 2.43, 95% CI 1.34 to 4.42) were significantly higher in women with CUA. Hysteroscopic removal of a septum was associated with a reduced probability of spontaneous abortion (RR 0.37, 95% CI 0.25 to 0.55) compared with untreated women. Presence of CUA might be associated with a detrimental effect on the probability of pregnancy achievement, spontaneous abortion and obstetric outcome. Hysteroscopic removal of a septum may reduce the probability of a spontaneous abortion.     

Conservative surgery of ovarian endometriosis in infertility

53 patients attending the infertility clinic were operated for ovarian endometriosis. The overall pregnancy rate was 53%. The major benefit of the surgery was that 79% of the pregnancies occurred within the year following the operation.     

Cervical and uterine factors in infertility

The uterus plays a pivotal role in many aspects of human reproduction. The cervix and its secretion are actively involved in sperm transport. Postcoital tests and other in-vitro and in-vivo tests evaluate sperm-cervical mucus interaction and should be an integral part of infertility investigation. Various diagnostic tests should help clinicians evaluate developmental and organic disorders of the uterine body. Adequate management of cervical and uterine factors in infertility is commonly rewarded by restoration of fertility in a high proportion of cases, when impairment of fertility is due to these conditions.