Pregnancy and delivery outcomes in genital malformations
Background. Despite significant advances in the diagnosis and treatment of gynecological diseases, uterine malformations remain one of the urgent problems. The diagnosis of congenital uterine and vaginal malformations presents significant challenges despite a wide range of modern imaging techniques (laparoscopy, hysteroscopy, hysterosalpingography, pelvic ultrasound and magnetic resonance imaging) and leads to errors in recognizing the nature of the defect. In 24–34% of patients with congenital abnormalities of the reproductive tract, the diagnosis is unclear or incorrectly formulated, which further affects the efficiency of treatment and preservation of reproductive function in patients.Andreeva M.V., Linchenko N.A., Shevtsova E.P.
Case report. The paper describes a clinical case of a 31-year-old patient with uterine malformation (uterus bicornis), which demonstrates a diagnostic algorithm, medical treatment efficiency, and favorable pregnancy and delivery outcomes.
Conclusion. A comprehensive examination of women with suspected uterine malformations involves simultaneous hysteroscopy and laparoscopy. However, these are invasive techniques and are associated with the risks of anesthetic management. This clinical example demonstrates the possibility of making this diagnosis using three-dimensional transvaginal ultrasonography (3D ultrasound) and metrosalpingography.
Keywords
female genital abnormalities
reproductive function
diagnosis
treatment
pregnancy and delivery outcomes
References
- Бобкова М.В., Пучко Т.К., Адамян Л.В. Репродуктивная функция у женщин с пороками развития матки и влагалища. Проблемы репродукции. 2018; 24(2): 42-53. [Bobkova M.V., Puchko T.K., Adamyan L.V. Reproductive function in women with uterine and vaginal malformations. Problemy Reproduktsii. (Problems of Reproduction). 2018; 24(2): 42-53. (in Russian)].
- Гилязутдинова З.Ш., Тухватуллина Л.М. Невынашивание беременности при анатомических и функциональных нарушениях репродуктивной системы. Казань: Медицинская литература; 2008. 239 с. [Gilyazutdinova Z.Sh., Tukhvatullina L.M. Miscarriage in anatomical and functional disorders of the reproductive tract. Kazan: Meditsinskaya Literatura; 2008. 239 p. (in Russian)].
- Taylor E., Gome L.V. The uterus and fertility. Fertil. Steril. 2008; 89(1): 1-16. https://dx.doi.org/10.1016/j.fertnstert.2007.09.069.
- Gordts S. New developments in reproductive surgery. Best Pract. Res. Clin. Obstet. Gynaecol. 2013; 27(3): 431-40. https://dx.doi.org/10.1016/j.bpobgyn.2012.11.004.
- Bailey A.P., Jaslow C.R., Kutteh W.H. Minimally invasive surgical options for congenital and acquired uterine factors associated with recurrent pregnancy loss. Womens Health (Lond.). 2015; 11(2): 161-7. https://dx.doi.org/10.2217/whe.14.81.
- Адамян Л.В., Богданова Е.А., Степанян А.А., Окулов А.Б., Глыбина Т.М., Макиян З.Н., Курило Л.Ф. Аномалии развития женских половых органов: вопросы идентификации и классификации (обзор литературы). Проблемы репродукции. 2010; 16(2): 7-15. [Adamyan L.V., Bogdanova E.A., Stepanyan A.A., Okulov A.B., Glybina T.M., Makiyan Z.N., Kurilo L.F. Female genital malformations: Issues of identification and classification (a literature review) / Problemy Reproduktsii. (Problems of Reproduction). 2010; 16(2): 7-15. (in Russian)].
- Адамян Л.В., Кулаков В.И. Современные технологии в диагностике и лечении гинекологических заболеваний. М.; 2006. 216 с. [Adamyan L.V., Kulakov V.I. Modern technologies in the diagnosis and treatment of gynecological diseases. Moscow; 2006. 216 p. (in Russian)].
- Nouri K., Ott J., Huber J., Fischer E., Stogbauer L., Tempfer C. Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus-a retrospective cohort study and systematic review of the literature. Reprod. Biol. Endocrinol. 2010; 8: 52. https://dx.doi.org/10.1186/1477-7827-8-52.
- Venetis C.A., Papadopoulos S.P., Campo R., Gordts S., Tarlatzis B.C., Grimbizis G.F. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod. Biomed. Online. 2014; 29(6): 665-83. https://dx.doi.org/10.1016/j.rbmo.2014.09.006.
- Ludwin A., Pitynski K., Ludwin I., Banas T., Knafel A. Two- and three-dimensional ultrasonography and sonohysterography versus hysteroscopy with laparoscopy in the differential diagnosis of septate, bicornuate, and arcuate uteri. J. Minim. Invasive Gynecol. 2013; 20(1): 90-9. https://dx.doi.org/10.1016/j.jmig.2012.09.011.
- Berger A., Batzler F., Lev-Toaff A., Berry-Roberts C. Diagnostic imaging modalities for Mullerian anomalies: the case for a new gold standard. J. Minim. Invasive Gynecol. 2014; 21(3): 335-45. https://dx.doi.org/10.1016/j.jmig.2013.10.014.
- Robbins J.B., Broadwell C., Chow L.C., Parry J.P., Sadowski E.A. Müllerian duct anomalies:embryological development, classification, and MRI assessment. J. Magn. Reson Imaging. 2015; 41(1): 1-12. https://dx.doi.org/10.1002/jmri.24771.
- Graupera B., Pascual M.A., Hereter L., Browne J.L., Úbeda B., Rodríguez I. et al. Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Mullerian duct anomalies using ESHRE-ESGE consensus on the classification of congenital anomalies of the female genital tract. Ultrasound Obstet. Gynecol. 2015; 46(5): 616-22. https://dx.doi.org/10.1002/uog.14825.
- Ludwin A., Martins W.P., Nastri C.O., Ludwin I., Coelho Neto M.A., Leitão V.M. et al. Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between normal, arcuate and septate uterus? Ultrasound Obstet. Gynecol. 2018; 51(1): 101-9. https://dx.doi.org/10.1002/uog.18923.
- Демидов В.Н., Краснова К.Г. Возможности эхографии в диагностике пороков развития матки, шейки матки и влагалища. Ультразвуковая и функциональная диагностика. 2015; 5: 44-9. [Demidov V.N., Krasnova K.G. Possibilities of echography in the diagnosis of uterine, cervical, and vaginal malformations. Ultrazvukovaya i Funktsionalnaya Diagnostika (Ultrasound and Functional Diagnosis). 2015; 5: 44-9. (in Russian)].
Received 03.02.2020
Accepted 29.06.2020
About the Authors
Margarita V. Andreeva, doctor of medical sciences, professor of the Department of Obstetrics and Gynecology, Volgograd State Medical University of the Ministryof Health of Russia. Tel.: +7(8442)33-45-56. E-mail: vaa1947@yandex.ru.
400131, Russia, Volgograd, Pl. Pavsikh Bortsov, 1.
Natalya A. Linchenko, candidate of medical sciences, Associate Professor of the Department of Obstetrics and Gynecology Volgograd State Medical University,
Ministry of Health of Russia. Tel.: +7(8442)33-45-56. E-mail: linchenko@inbox.ru.
400131, Russia, Volgograd, area of the Fallen Fighters, 1.
Elena P. Shevtsova, сandidate of medical sciences, Associate Professor of the Department of Obstetrics and Gynecology, Volgograd State Medical University,
Ministry of Health of Russia. Tel.: +7(8442)33-45-56. E-mail: e.p.shevtsova@mail.ru.
400131, Russia, Volgograd, Pl. Pavsikh Bortsov, 1.
For reference: Andreeva M.V. Linchenko N.A., Shevtsova E.P. Pregnancy and delivery outcomes in genital malformations.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 7: 166-169 (in Russian).
https://dx.doi.org/10.18565/aig.2020.7.166-169
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