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Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies
Reproductive BioMedicine Online, 2014
He subsequently, obtained an MSc in medical research methodology, a PhD, and completed his training in obstetrics and gynaecology at the same institution. He also recently completed his subspecialty training in reproductive medicine. Dr. Venetis is an author of more than 40 publications in international and national scientific journals and several chapters in books. He is a strong advocate of evidence-based medicine, and his research interests include ovarian stimulation, reproductive endocrinology and research methodology.
Reproductive outcomes in women with congenital uterine anomalies: a systematic review
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2011
Objective Congenital uterine anomalies are common but their effect on reproductive outcome is unclear. We conducted a systematic review to evaluate the association between different types of congenital uterine anomaly and various reproductive outcomes.
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...
Reproductive Implications and Management of Congenital Uterine Anomalies
BJOG: An International Journal of Obstetrics & Gynaecology, 2019
Plain language summaryCongenital uterine anomalies (CUAs) are malformations of the womb that develop during fetal life. When a baby girl is in her mother’s womb, her womb develops as two separate halves from two tubular structures called ‘müllerian ducts’, which fuse together before she is born. Abnormalities that occur during the baby’s development can be variable from complete absence of a womb through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good in screening for CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex womb abnormality is suspected, MRI scanning may also be used, with a combination of laparoscopy in which a camera is inserted into the cavity of the abdomen, and hysteroscopy, when the camera is placed in the womb cavity. As there can be a link between CUAs and abnormalities of the kidney and bladder, scans of these organs are also usually requested.Although CUAs are present at birth, adult wo...
Diagnosis and Management of Congenital Uterine Anomalies in Pregnancy
Importance: Congenital uterine anomalies (CUAs) are strongly associated with adverse fertility and pregnancy outcomes. Health care providers must be able to diagnose these anomalies, understand their impact, and counsel women on interventions that might improve rates of pregnancy and live birth. Objectives: The aims of this study were to characterize CUAs and their effects on adverse fertility and pregnancy outcomes, to describe the best imaging modalities to diagnose specific uterine anomalies, and to learn about interventions that may improve the reproductive outcomes of infertile and pregnant women. Evidence Acquisition: A search of the PubMed database revealed 56 relevant studies, 49 of which were ref-erenced in this comprehensive summary of the literature. Results: Congenital uterine anomalies are strongly associated with recurrent pregnancy loss, low birth weight, preterm birth, hypertensive disorders of pregnancy, malpresentation, and cesarean delivery. Transvaginal 3-dimensional ultrasonography appears to be the best initial test for uterine anomaly evaluation. Prior to conception , women who undergo hysteroscopic metroplasty may have better fertility and pregnancy outcomes. Conclusions and Relevance: Congenital uterine anomalies, although rare in the general population, pose significant challenges to women and their clinicians with regard to fertility and pregnancy management. Accurate diagnosis, preconception counseling and metroplasty, and antenatal monitoring may improve reproductive outcomes for women with CUAs. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After completing this activity, the learner should be better able to (1) characterize congenital uterine anomalies and their potential effects on adverse fertility and pregnancy outcomes, (2) determine the best imaging modalities to diagnose specific uterine anomalies, and (3) counsel both infertile and pregnant patients about interventions that may improve their reproductive outcomes.
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.
National Journal of Clinical Anatomy, 2022
Uterine anomalies arise from abnormal fusion of paramesonephric ducts or failure of apoptosis of septum between two ducts leading to abnormal division of the uterine cavity. Initial dearth of universal standard diagnosis was the reason for the improper reporting of the data associated with prevalence of uterine developmental anomalies. But now various authors have reported the prevalence of uterine anomalies using standard diagnostic techniques. The objective of the study was to assess the prevalence of various uterine congenital anomalies among women of reproductive age (15–45 years) with no previous uterine pathology. Methodology: An ultrasound was utilized to take a transabdominal sonographs of both longitudinal and transverse planes from the supine position of participants who were made to consume 500–1000 mL of water to promote diuresis for the duration of the scan. Scans were then interpreted. Results: From a study of 200 participants whose mean age group fell around 30 ± 8 years, 140 of the women were parous and 60 were nulliparous. Twelve of the participants displayed anomalies that included bicornuate, arcuate, and septate. Five cases of the bicornuate uterus (2.5%), four arcuate uterus (2.0%), and three septate uterus (1.5%) were noted. Conclusion: From a sample size of 200, the occurrence of uterine anomalies is 6%, with no cases of uterine agenesis or a hypoplastic uterus. Keywords: Arcuate uterus, bicornuate uterus, septate uterus, uterine anomalies
Congenital Uterine Malformation by Experts (CUME): T-shaped uterus
2019
Objectives: To assess whether is there any uterine measurement that is reliable and accurate to distinguish between T-shaped and normal/arcuate uterus considering the most voted option by 15 experts as the reference standard. Methods: This was a prospectively designed multi-rater reliability/agreement study with elements of diagnostic accuracy study performed between Nov-2017 and Dec-2018 in a sample of 100 3D datasets of different uteri acquired in consecutive women with the presence of lateral uterine cavity indentations between 2014-2016. Fifteen blinded representative experts (5 clinicians, 5 surgeons, and 5 imaging specialists) provided their independent opinion whether that the uterus was T-shaped or not regarding anonymized images of the coronal plane of each uterus. Two other blinded experienced observers performed 15 measurements using the originally acquired 3D datasets. The agreement between experts was assessed by kappa and percent agreement. The interobserver reliabilit...