Rol de la laparoscopia en el manejo del síndrome OHVIRA: reporte de un caso y su relación con la endometriosis / Role of laparoscopy in the management of OHVIRA syndrome: a case report and its relation to endometriosis

El síndrome de hemivagina obstruida y anomalía renal ipsilateral (OHVIRA) es producido por una alteración en el desarrollo de los conductos de Müller y Wolff en la vida fetal. El síndrome es poco frecuente, se reporta una prevalencia de 1/2.000 a 1/28.000 casos. La endometriosis se presenta en un 19% de los casos complicando esta patología. El tratamiento del síndrome OHVIRA consiste en resecar el tabique vaginal drenando el hematocolpos. Hasta el momento no existe un consenso en recomendar la realización de una laparoscopia diagnóstica. El objetivo de este estudio es reportar la eventual importancia de la laparoscopia diagnóstica/terapéutica como parte del manejo del síndrome OHVIRA.

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is caused by a defect in the development of Müllerian and Wolffian ducts at fetal life. The syndrome is uncommon, with a reported prevalence of 1/2,000 to 1/28,000 cases. Endometriosis is present in 19% of cases complicating this pathology. Treatment of OHVIRA syndrome consists in resecting the vaginal septum and draining the hematocolpos. Until now there isnt an agreement on recommending diagnostic laparoscopy as part of the treatment. The aim of this study is to report the importance of diagnostic/therapeutic laparoscopy in the management of OHVIRA syndrome.

Clinical features of 102 patients with different types of Herlyn -Werner -Wunderlich syndrome / 中南大学学报(医学版)

OBJECTIVES@#Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare female genital tract malformation, and there are few large sample studies reported at home and abroad. The clinical manifestations of this syndrome are diverse, and insufficient understanding may delay the diagnosis and treatment of the patients. This study aims to analyze the clinical characteristics of different types of HWWS patients, and to improve the diagnosis and treatment of HWWS.@*METHODS@#The clinical data of patients with HWWS who were hospitalized in the Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University from October 1, 2009 to April 5, 2022 were retrospectively analyzed. The age, medical history, physical examination, imaging examination and treatment of the patients were collected for statistical analysis. The patients were divided into an imperforate oblique vaginal septum type, a perforate oblique vaginal septum type, and an imperforate oblique vaginal septum and cervical fistula type. The clinical characteristics of different types of HWWS patients were compared.@*RESULTS@#A total of 102 HWWS patients were enrolled, with age of 10-46 years old, including 37 (36.27%) patients with type I, 50 (49.02%) type II, and 15 (14.71%) type III. All patients were diagnosed after menarche, with an average age of (20.5±7.4) years. There were significant differences in the age of diagnosis and course of disease among the 3 types of HWWS patients (both P<0.05). Patients with type I had the youngest age of diagnosis [(18.0±6.0) years] and the shortest course of disease (median course of 6 months), while patients with type III had the oldest age of diagnosis [(22.9±9.8) years] and the longest course of disease (median course of 48 months). The main clinical manifestation of type I was dysmenorrhea, and the main clinical manifestation of type II and type III was abnormal vaginal bleeding. Of the 102 patients, 67 (65.69%) patients had double uterus, 33 (32.35%) had septate uterus, and 2 (1.96%) had bicornuate uterus. The vast majority of patients had renal agenesis on the oblique septum, and only 1 patient had renal dysplasia on the oblique septum. The oblique septum located on the left side in 45 (44.12%) patients and on the right side in 57 (55.88%) patients. There were no significant differences in uterine morphology, urinary system malformation, pelvic mass, and oblique septum among the 3 types of HWWS patients (all P>0.05). Six (5.88%) patients had ovarian chocolate cyst, 4 (3.92%) patients had pelvic abscess, and 5 (4.90%) patients had hydrosalpinx. All patients underwent vaginal oblique septum resection. Among them, 42 patients underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen because they had no sexual life history, and the remaining 60 patients underwent traditional oblique vaginal septum resection. Among the 102 patients, 89 patients were followed up for 1 month to 12 years. The symptoms of vaginal oblique septum in 89 patients such as dysmenorrhea, abnormal vaginal bleeding and vaginal discharge were improved after operation. Among the 42 patients who underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen, 25 patients underwent hysteroscopies again 3 months after operation, and there was no obvious scar formation at the oblique septum incision site.@*CONCLUSIONS@#Different types of HWWS have different clinical manifestations, but all can be manifested as dysmenorrhea. The patient's uterine morphology can be manifested as double uterus, septate uterus, or bicornuate uterus. The possibility of HWWS should be considered if uterine malformation is combined with renal agenesis. Vaginal oblique septum resection is an effective treatment.

Successful outcome of pregnancy in bicornuate uterus: a case report

Bicornuate uterus is a major cause of spontaneous abortion. The recurrent pregnancy loss has been reported to the range of 15% to 27%. There is different type of congenital uterine abnormalities like Bicornuate uterus, septate uterus, arcuate uterus, unicornuate uterus, didelphys uterus. It is important to consider this diagnosis in recurrent miscarriages, malpresentation, intra uterine growth restrictionand preterm deliveries. This report is about self at the age of 25-year-old pregnancy with a history of missed abortion. I was not diagnosing with a bicornuate uterus in my first pregnancy. However, I was diagnosed with a bicornuate uterus based on transvaginal ultrasound and hysterosalpingogram. A successful caesarean section was donein the 38th week of gestation. According to the results, successful outcome could be achieved with bicornuate uterus. The outcome of bicornuate uterus was successful.

Resección histeroscópica de septo uterino conformado por mioma submucoso / Hysteroscopy Resection of the Uterine Septum Due To Submucosal Myoma

Las malformaciones uterinas congénitas presentan una baja prevalencia en la población general (0,5-6,7 por ciento), el útero septo es la más frecuente. Estas enfermedades pueden afectar a los resultados reproductivos de las pacientes, así como aumentar la incidencia de abortos de repetición, presentaciones fetales anómalas o partos pretérminos. De la misma forma, los miomas uterinos submucosos también pueden producir alteraciones de la fertilidad, aunque la sintomatología más relacionada con los mismos es el sangrado. Constituyen el tumor benigno más frecuente del aparato genital femenino. El diagnóstico de estas patologías puede realizarse mediante pruebas de imagen como la ecografía transvaginal y la resonancia magnética, aunque la visualización directa vía histeroscópica sigue siendo de elección. Esta técnica constituye, además, la primera opción terapéutica, ya que se puede realizar tanto la resección del septo uterino como la miomectomía, sin apenas complicaciones y mediante una técnica quirúrgica segura y poco invasiva. El tratamiento histeroscópico está especialmente indicado en pacientes sintomáticas, con esterilidad o abortos de repetición, incluso antes de iniciar terapias de reproducción asistida. En el siguiente trabajo exponemos el caso de una paciente que presentaba un septo uterino constituido en su mayor parte por un leiomioma submucoso tratado vía histeroscópica; siendo un caso muy raro, dada la infrecuente asociación entre ambas patologías(AU)

Congenital uterine malformations present low prevalence in the general population (0.5-6.7 percent), and uterus septum is the most frequent. These pathologies can affect the reproductive outcomes of patients, as well as increase the incidence of repeating abortions, abnormal fetal presentations or preterm deliveries. In the same way, submucosal uterine fibroids can also produce alterations in fertility, although the most related symptomatology is bleeding. They are the most frequent benign tumor of the female genital tract. Diagnosis can be carried out through imaging tests such as transvaginal ultrasound and magnetic resonance imaging, although direct visualization, via hysteroscopy, is still the preferred option. This technique is also the first therapeutic option, since both, resection of the uterine septum and myomectomy can be performed with few complications and a safe and minimally invasive surgical technique. Hysteroscopy is especially indicated in symptomatic patients, with sterility or repeated abortions, even before initiating assisted reproduction therapies. In the following paper, we present the case of a patient who presented a uterine septum formed mostly by a submucosal leiomyoma. She was treated by hysteroscopy. This case is very rare given the infrequent association between both pathologies(AU)

Malformación arteriovenosa uterina: a propósito de un caso / Arteriovenous uterine malformation: a case report

Paciente de 37 años que acudió a urgencias por metrorragia, G3P1A2, el último de ellos un aborto tardío en gestación gemelar monocorial biamniótica de 20 semanas hacía dos meses. En la ecografía destaca en zona miometrial un área de marcada vascularización de 67 x 45 mm. Tras descartar proceso residual gestacional y ante la sospecha de malformación arteriovenosa uterina se solicitó resonancia magnética nuclear y angiotac, tras confirmar la malformación vascular se programó para embolización de ambas arterias uterinas con el fin de preservar la fertilidad.

A 37-year-old patient came to the emergency due to metrorrhagia, G3P1A2, the last of them a late abortion in a 20 weeks monochorionic diamniotic twin pregnancy two months ago. Ultrasound revealed an intramiometrial area of 67 x 45 mm with increased vascularization area. A diagnosis of an arteriovenous malformation was considered. In order to confirm the diagnosis pelvic magnetic resonance and angiogram was performed. Once the vascular malformation was confirmed the patient was scheduled for transcatheter arterial embolization in order to preserve fertility.

Pregnancy outcomes in women with uterine anomalies / 安徽医科大学学报

Objective To investigate pregnancy complications,cesarean delivery and abnormal fetal presentation in women with uterine anomalies.Methods Fifty women diagnosed with uterine malformation and sixty women with normal uterus were retrospectively analyzed .Results The group comprised women with uterine malformation had significantly higher stillbirth or fetal death (P <0.05) and lower rates of the full-term delivery(P <0.05) than that of the control group.The subgroup comprised women with uterine anomalies had significantly higher rates of cesare -an section(P <0.05) and abnormal fetal position(P <0.05) than the control group.The birth weight and length of infant in observation group were significantly lower than those in control group (P <0.05).The rate of placenta abnormalities in uterine anomalies was significantly higher than that in control group (P <0.05).The incidences of premature rupture of membrane,cord entanglement,oligohydramnios,postpartum hemorrhage and neonatal asphyxia in observation group were no significant difference than those in control group .The rate of premature rupture of membrane(PROM) in uterus unicornis was significantly higher than that in other types (P <0.05).Conclusion Compared with women with normal uterus ,the incidences of abnormal fetal position ,the placenta abnormalities,pre-mature delivery,and stillbirth or fetal death in women with congenital uterine anomalies are high .Uterine anomalies are associated with a decrease in the birth weight and length .We should pay more attention to finding the uterine malformation and treatment before pregnancy .Antenatal care should be reinforced in pregnancy women with uterine anomalies.

Gestación eutópica en útero malformado / Eutopic pregnancy in malformation uterus

Se presenta el caso de una paciente con útero bicorne, en la cual se realizó el diagnóstico de la malformación uterina por videolaparoscopía, al informarse por ultrasonido la posibilidad de un embarazo ectópico no complicado. La infrecuencia de esta malformación, el momento de la vida de la paciente en el que se hizo, la importancia del ultrasonido como medio diagnóstico, y el mostrar, como un embarazo ectópico puede precisar el diagnóstico diferencial con uno eutópico en un útero malformado, decidió reportáramos el caso e hiciéramos una breve revisión del tema

This is the case of a patient presenting with bicornate uterus diagnosed with a uterine malformation using video-laparoscopy and reporting by ultrasound the possibility of a non-complicated ectopic pregnancy. The infrequency of this malformation, the time in life of patient when it was carried out, the significance of ultrasound as a diagnostic means, and to demonstrate as an ectopic pregnancy may to specify exactly the differential diagnosis and an eutopic on in a malformation uterus, lead to the report of case and to carried out a brief review of this subject

Clinical Management of Pregnant Patients with Uterine Malformation in Perinatal Period / 实用妇产科杂志

Objective:The clinical features,maternal and fetal outcomes and management of pregnant women with uterine malformation during the pednatal period were investigated.Methods:99 pregnant patients with uterine malformation as research group and 100 pregnant patients without uterine malformation as control group were recruited in Peking Union Medical College hospital from January 1 st in 2000 to September 30th in 2008.A retrospective study was done to compare the clinical features,matemal and fetal outcomes in these two groups.Clinical management of pregnancy with uterine malformation.Results:In the research group,the incidence of caesarean section,threatened abortion,preterm rupture of membrane,abnormal presentation,and placenta accrete were higher than those in the control group.The average fetal weight was smaller than that of control group.There were no significant differences in postpartum hemorrhage and perinatal child death in these two groups.Conclusions:Patients with uterine malformations more likely undergo C-section.Postpartum hemorrhage and other pregnant complications should be paid more attention.

The exploration of clinical application of hysteroscopy combined with laparoscopy in the diagnosis and treatment of congenital uterine malformation / 中国医师进修杂志

Objective To explore the clinical value of hysteroscopy combined with laparoscopy in the diagnosis and treatment of congenital uterine malformation. Method The clinical data of 53 cases with congenital uterine malformation being diagnosed and treated by hysteroscopy combined with laparoscopy were analyzed retrospectively. Results The 53 diagnosed cases included 25 with incomplete uterus septum, 14 with complete uterus septum, 4 with rudimentary horn of uterus, 3 with unicomuate uterus, 2 with bicornuate uterus, 3 with double-uterus, 2 with bicorbate uterus. Hysteroscopy combined with laparoscopy could diagnose the lesions in the uterine and the abdominal cavity, also could rectify the uterine malformation simultaneously. Ultrasound, hysterosalpingography, hysteroscopy all could not diagnose the uterine malformation completely correct, but hysteroscopy combined with laparoscopy could do. Conclusion Hysteroscopy combined with iaparoscopy is safe and effective, which can be the first-line selection for the diagnosis and treatment of congenital uterine malformation.

Combined use of hysteroscopy and ultrasonography in the diagnose of 24 cases of uterine malformation / 中国微创外科杂志

Objective To investigate the diagnosis under hysteroscopy for uterine malformation,especially in maiden. Methods Hysteroscopy combined with ultrasonography was used to determine the types of uterine malformation in 24 cases. Results Definitive diagnosis indicated 8 cases of uterus bicornis,10 cases of uterus septus with single uterine neck,2 cases of uterus septus with double uterine neck and single uterine body,and 4 cases of puberal rudimentary horn of uterus. Conclusions Combined use of hysteroscopy and ultrasonography in the diagnosis of uterine malformation is accurate and applicable to maiden.