Document Detail


The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum.
MedLine Citation:
PMID:  15284765     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study was undertaken to evaluate the diagnostic management and the reproductive outcome after surgical repair of a rare reproductive malformation. STUDY DESIGN: Sixteen women with a complete septate uterus, double cervix, and a longitudinal vaginal septum were referred for evaluation. Presenting complaints were chiefly pregnancy loss in parous women (n=9) and dyspareunia in nulligravid women (n=7). The combination of hysterosalpingography, ultrasonography, and/or magnetic resonance imaging was used to correctly identify the anomaly in 15 of the 16 cases. Both hysteroscopic (n=11) and transabdominal (n=5) surgical techniques were used to repair the uterine septum. RESULTS: In no case was the correct diagnosis made before referral; the uterus didelphys was the most common misdiagnosis. The preoperative pregnancy loss was 81%. Postoperatively, 12 women conceived for a total of 17 pregnancies; there were 14 term live births or ongoing pregnancies in the third trimester (82%), with a first trimester spontaneous abortion rate of 18%. In 9 women who conceived after hysteroscopic surgery, term live births occurred in 9 of 12 (75%) conceptions. A modified Tompkins metroplasty was performed in 5 women with subsequent term live births or ongoing third trimester pregnancies in 5 of 5 (100%) patients. CONCLUSION: The identification of a duplicated cervix and a vaginal septum is consistent with several uterine malformations, which leads to frequent misdiagnosis and errors in management. Significant pregnancy wastage, obstetric complications, and dyspareunia are common, and surgical treatment is therefore advisable. Making the best choice between hysteroscopic or transabdominal metroplasty depends on the anatomic features of the cervix and the uterine cavity, but optimal patient management requires familiarity with both techniques.
Authors:
Phillip E Patton; Miles J Novy; David M Lee; Lee R Hickok
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  190     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-07-30     Completed Date:  2004-08-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1669-75; discussion 1675-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, USA.
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / diagnosis,  surgery
Adolescent
Adult
Cervix Uteri / abnormalities*,  surgery
Cohort Studies
Congenital Abnormalities / diagnosis,  surgery*
Female
Follow-Up Studies
Gynecologic Surgical Procedures / methods
Humans
Hysterosalpingography / methods
Hysteroscopy / methods*
Infertility, Female / prevention & control
Magnetic Resonance Imaging
Pregnancy / statistics & numerical data*
Reproductive History
Risk Assessment
Uterus / abnormalities*,  surgery
Vagina / abnormalities*,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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