Magnetic resonance imaging of fetal pelvic cysts (original) (raw)

Fetomaternal outcome in pregnancies with reproductive tract anomalies

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021

Background: Congenital reproductive tract anomalies result from abnormal formation, fusion or resorption of the mullerian ducts during fetal life. Pregnancies with reproductive tract anomalies are known to have higher incidence of spontaneous abortions, fetal malpresentations, preterm labour, preterm premature rupture of membranes and increased cesarean section rate. The present study was conducted to describe the fetal and maternal outcomes among pregnant women with uncorrected reproductive tract anomalies in a tertiary care centre, Manipur, India.Methods: A hospital based cross sectional study was conducted among pregnant women with uncorrected reproductive tract anomalies in regional institute of medical sciences, Imphal, Manipur, India between September 2018 to August 2020.Results: A total of 62 pregnant women with uterine anomalies were included in the study. Bicornuate uterus was the most common uterine anomaly (45.2%) followed by arcuate uterus (19.3%). Cesarean section was c...

Imaging of the uterovaginal anomalies

The Egyptian Journal of Radiology and Nuclear Medicine, 2010

Objective: To assess the role of different imaging modalities including ultrasonography, hysterosalpingogram, and magnetic resonance imaging in detection of variable Mu¨llerian anomalies. Preoperative proper diagnosis data about Mu¨llerian anomalies necessary for clear indications of how and when to operate. Patients and methods: A retrospective MRI study of 34 patients was done in the period from February 2008 to February 2010, their age ranging from 3 months to 38 years (mean 24 years), with uterovaginal anomalies. Ultrasonography was performed for all cases; HSG was performed in 16 cases before MRI imaging. Results: MRI is the most reliable method for evaluating uterovaginal anomalies, particularly in pediatrics and virgins. MRI is an accurate examination for identification and categorization of MDAs and should be carried out prior to any surgery, in this study MRI allowed correct diagnosis of 34 uterine anomalies (accuracy 100%) whereas US was correct in 30 out of 34 cases (accuracy 88%). HSG had a limited role as cannot be preformed for virgins, and cannot identify non-communicating horns in unicornuate cases. Conclusion: MRI is the examination of choice in uterovaginal anomalies. Endovaginal ultrasound cannot be preformed for children or females who have never had sexual intercourse. TAUS have not proved completely reliable in Mu¨llerian duct anomalies.

Anatomical development of the fetal uterus

Early Human Development, 2007

Objective: The objective of this study was to gather data on the morphology of the uterus during its development, to provide detailed information regarding the neighboring structures and its variations using anatomical dissections. Study design: Eighty uteri acquired from female fetuses aged 10-40 weeks of gestation were used in this study. Firstly, the relationship between the fetal uterus and the linea terminalis and the position of the uterus within the pelvic cavity was noted. Then the distance between the fundus of the uterus to the promontory and pubic symphysis were measured. Fetal uteri were classified according to their physical appearances. Finally the lengths of the corpus and cervix in three planes and the anteflexion angle were measured. Results: During the fetal period, the fundus of the uterus was above the linea terminalis in 94% and below it in 6% of the cases. The distance between the fundus of the uterus and the promontory significantly correlated with the distance between the fundus of the uterus and the pubic symphysis (p b 0.001). This was true for the correlation between the gestational age and the orthogonal lengths of the uterine corpus and cervix (p b 0.001). As the gestational age advanced, the anteflexion angle was noted to reduce from 177°to 120°. The shape of the uterus was either cylindrical, pear-shaped, heart-shaped or hourglass-shaped during the fetal period. Condensation: We believe that the data obtained through dissections of the human fetuses in this study will help identifying uterine developmental variations, anomalies and pathologies and will contribute to the studies carried out in obstetrics, perinatology, forensic medicine and fetal pathology departments.

Clinical approach for the classification of congenital uterine malformations

Gynecological Surgery, 2012

A more objective, accurate and non-invasive estimation of uterine morphology is nowadays feasible based on the use of modern imaging techniques. The validity of the current classification systems in effective categorization of the female genital malformations has been already challenged. A new clinical approach for the classification of uterine anomalies is proposed. Deviation from normal uterine anatomy is the basic characteristic used in analogy to the American Fertility Society classification. The embryological origin of the anomalies is used as a secondary parameter. Uterine anomalies are classified into the following classes: 0, normal uterus; I, dysmorphic uterus; II, septate uterus (absorption defect); III, dysfused uterus (fusion defect); IV, unilateral formed uterus (formation defect); V, aplastic or dysplastic uterus (formation defect); VI, for still unclassified cases. A subdivision of these main classes to further anatomical varieties with clinical significance is also presented. The new proposal has been designed taking into account the experience gained from the use of the currently available classification systems and intending to be as simple as possible, clear enough and accurate as well as open for further development. This proposal could be used as a starting point for a working group of experts in the field.

“CONGENITAL ANOMALIES OF THE UTERUS” EMBRYOLOGICAL BASIS AND ITS CLINICAL IMPORTANCE

Introduction The uterus also known as the womb is a major female hormone-responsive reproductive sex organ of mammals. The uterus is a muscular organ that is responsible for nourishment and care of the fetus until birth. The development of the fetus during gestation usually happens within the uterus. The uterus has a body and cervix. It is made up of three layers which are the endometrium, myometrium, and perimetrium. The uterus receives ovum (either fertilized which implants in the endometrium or unfertilized which sheds out as menstruation). The fertilized ovum receives nourishment from blood vessels. The fertilized ovum develops into an embryo and attaches to the wall of the uterus and later and the placenta develops (now responsible for the nourishment, waste elimination, immunity and gaseous exchange of the fetus until childbirth). Normally at week six, in the intrauterine life, there is two genital ducts named paramesonephric (Mullerian) duct and mesonephric (Wolffian) duct for the female and male embryos respectively. The paramesonephric duct arises from the invagination of epithelium. This duct can be divided into three parts as they move laterally to the mesonephric duct, anterior and medial where both Mullerian ducts get close to each other and finally run downward where they meet and join at the definitive urogenital sinus (DUGS) to form the Mullerian tubercle also called the paramesonephric tubercle. The two ducts are separated by uterovaginal (UV) septum but later fuse (due to the resorption of the UV septum) to form the uterine (uterovaginal) canal. The caudal tip of the joined ducts projects into the posterior wall of the urogenital sinus where there is a small swelling called the paramesonephric (Mullerian) tubercle. Failure of the UV septum to be reabsorbed, failure of one or more of the paramesonephric ducts to develop, failure of normal fusion of the ducts and

Differences in Origin and Outcome of Intra-Abdominal Cysts in Male and Female Fetuses

Fetal Diagnosis and Therapy

Objective: To investigate the origin and outcome in a cohort of male and female fetuses with intra-abdominal cysts, in order to provide recommendations on management and to improve prenatal counselling. Methods: From 2002 to 2016, intra-abdominal cysts were detected by ultrasound in 158 fetuses. Cases with an umbilical vein varix were excluded. Fetal, neonatal, and maternal characteristics were retrieved from electronic patient files. Results: In female fetuses (n = 114), intra-abdominal cysts were diagnosed at a later gestational age compared with male fetuses (n = 44) (median 32.0 vs. 21.5 weeks, p < 0.001). The maximum prenatal cyst diameter was larger in female fetuses (median 35 vs. 17 mm, p < 0.001). Associated anomalies were less frequent in females (n = 15, 13.2%) compared with males (n = 15, 34.1%). In females (n = 114), most cysts were of ovarian origin (n = 81, 71.1%). Surgery was performed in 30 (26.3%) female and 15 (34.1%) male neonates (p = 0.33). Anorectal malformations were present in 6 cases and often not recognized prenatally. Conclusions: The differences in the origin of intra-abdominal cysts between male and female fetuses, resulting in differences in prenatal presentation and postnatal outcome should be taken into account in prenatal counseling within a multidisciplinary team. Evaluation of the fetal perianal muscular complex is indicated.

Diagnostic imaging and cataloguing of female genital malformations

Insights into Imaging, 2016

To help physicians and radiologists in the diagnosis of female genito-urinary malformations, especially of complex cases, the embryology of the female genital tract, the basis for Müllerian development anomalies, the current classifications for such anomalies and the comparison for inclusion and cataloguing of female genital malformations are briefly reviewed. The use of the embryological system to catalogue female genito-urinary malformations may ultimately be more useful in correlations with clinical presentations and in helping with the appropriate diagnosis and treatment. Diagnostic imaging of the different genito-urinary anomalies are exposed, placing particular emphasis on the anomalies within group II of the embryological and clinical classification (distal mesonephric anomalies), all of them associated with unilateral renal agenesis or dysplasia. Similarly, emphasis is placed on cases of cervico-vaginal agenesis, cavitated noncommunicated uterine horns, and cloacal and urogenital sinus anomalies and malformative combinations, all of them complex malformations. Diagnostic imaging for all these anomalies is essential. The best imaging tools and when to evaluate for other anomalies are also analysed in this review. Teaching points • The appropriate cataloguing of female genital malformations is controversial. • An embryological classification system suggests the best diagnosis and appropriate management. • The anomalies most frequently diagnosed incorrectly are the distal mesonephric anomalies (DMAs). • DMAs are associated with unilateral renal agenesis or renal dysplasia with ectopic ureter. • We analyse other complex malformations. Diagnostic imaging for these anomalies is essential.

Diagnosis of Congenital Uterine Abnormalities: Practical Considerations

Journal of Clinical Medicine, 2022

As most congenital uterine abnormalities are asymptomatic, the majority of them are detected incidentally. While most women with uterine anomalies have a normal reproductive outcome, some may experience adverse reproductive outcomes. Accurate diagnosis and correct classification help in the appropriate counselling of women about their potential reproductive prognosis and risks and for planning any intervention. Evaluation of the internal and external contours of the uterus is the key in making a diagnosis and correctly classifying a uterine anomaly. Considering this, the gold standard test has been the combined laparoscopy and hysteroscopy historically, albeit invasive. However, 3D ultrasound has now become the diagnostic modality of choice for uterine anomalies due to its high degree of diagnostic accuracy, less invasive nature and it being comparatively less expensive. While 2D ultrasound and HSG are adequate for screening for uterine anomalies, MRI and combined laparoscopy and hy...