Case series on obstetrical outcomes in patient with uterine malformations

Congenital uterine anomalies occur due to abnormal fusion of mullerian duct during embryonic life. It is associated with high incidences of reproductive failures and adverse obstetrical outcomes. It may be associated with malpresentation, preterm labour, or recurrent pregnancy losses. Authors report a case series of 7 patients which were admitted in obstetrics and gynaecology department of SP medical college and associated group of hospitals between time period of March 2019 to July 2019. Among 7 cases 6 cases were associated with malpresentation, 1 with abortion, and 1 with preterm labour. This series shows that uterine anomalies are associated with different obstetrical outcomes varying from totally uneventful antenatal and postnatal period to abortion or preterm labour. Prenatal diagnosis of uterine anomaly may help in improving the obstetrical outcome in these patients.

Recurrent hematometra with endometriosis in an adolescent girl: a case report

Hematometra is a collection or retention of blood in the uterine cavity. This condition is most commonly associated with congenital uterine anomalies that result from abnormal formation, fusion or resorption of Mullerian ducts during fetal life or may be due to prior surgical procedures, causing an obstruction of the genitourinary outflow tract. We report an unusual case of hematometra with endometriosis secondary to cervical stenosis. This is a rare and important case report due to the complexity of diagnosis as cervical stenosis was not presented as primary amenorrhoea as its usual presentation. This case was successfully managed by Hysteroscopic cervical dilatation under USG guidance followed by transcervical insertion of a catheter to prevent recurrent stenosis.

A case report: Metroplasty of a noncommunicated uterine body and cervix due to unknown etiology / 대한산부인과학회지

Congenital anomalies of the female reproductive tract may involve the uterus, cervix, fallopian tubes, or vagian. Depending on the specific defect, a women's obstetric and gynecologic health may be adversely affected. We have experienced a case of rudimentary uterine horn with noncommunicated uterus complicated by pelvic endometriosis in a 25 years old woman with primary amenorrhea and monthly periodic pelvic pain. We observed noncommunicating uterus with blind pouch, cervix disconnected to uterus with normal appearance, and left ovarian endometrial cyst. For treatment, the metroplastic surgery with end-to end anastomosis connecting cervix and noncommunicated uterus and removal of endometrial cyst were done. Many cases of uterine anomalies have been documented but, there have been few reported cases of noncommunicated uterus with disconnected cervix and successful performance of the metroplasty. Thus hereby we report this case with a review of literatures.

The pregnancy outcome of women with congenital uterine anomaly exceeding 20 weeks of gestation / 대한산부인과학회지

OBJECTIVE: To evaluate the pregnancy outcomes of women with congenital uterine anomaly exceeding 20 weeks of gestation. METHODS: We reviewed retrospectively the birth records of the Seoul National University Hospital between January 1, 1990, and December 31, 2005. We grouped congenital uterine anomalies into five classes, namely bicornuate, didelphys, septate, arcuate, and unicornuate uterus. We compared the pregnancy outcomes with each anomaly. RESULTS: We found 106 cases of congenital uterine anomaly within a given period of time. There were 63 cases of bicornuate uterus, 19 cases of didelphys, 16 cases of septate uterus, 5 cases of arcuate uterus, and 3 cases of unicornuate uterus. The overall preterm delivery rate was 22.6% (24/106) and cesarean section rate was 74.5% (79/106). A high cesarean section rate was due to metroplasty, abnormal fetal presentation, and uterine anomaly itself. The preterm delivery rate and cesarean section rate of each uterine anomaly did not differ statistically from one another. Five fetuses were stillborn, and one fetus died after birth because of a placenta abruption. The overall take-home baby rate was 94.3% (100/106). There was no maternal mortality and only one case was suffered from postpartum bleeding. CONCLUSION: Our results suggest that the most of women with uterine anomaly exceeding 20 weeks of gestation may take their baby home.

Reproductive Outcomes after Metroplasty in Patients with Congenital Uterine Anomalies / 대한산부인과학회잡지

OBJECTIVE: Metroplasty has been shown to improve the reproductive outcomes in patients with congenital uterine anomalies, especially for those suffering from multiple fetal losses. This study was performed to evaluate the impact of abdominal metroplasty on the reproductive outcomes in patients with infertility or recurrent abortions. METHODS: Among fifty cases diagnosed as Mullerian anornalies at SNUH from Oct. 1988 to Dec. 1996, only 26 cases were included in this retrospective study. Inclusion criteria was the patients with primary infertility(n=7) or recurrent spontaneous abortions(n 19) who underwent abdominal metroplasty for the correction of uterine anomalies. Statistical analysis was carried out by chi-square test using SPSS ver 7.0. RESULTS: Bicornuate uterus was the most common uterine anomaly as 53.9%(14/26). After metroplaty, the overall live birth rate was increased from 0% to 57.7%(15/26), and the live birth rate in patients with recurrent abortions, 68.4%(13/19), was significantly higher than that in patients with primary infertility, 28.6%(2/7). The rate of fetal wastage was dropped from 96.0%(48/50) to 41.7%(10/24) after metroplasty in 19 patients with recurrent abortions. Pelvic pathologic lesions associated with uterine anomalies were diagnosed in 11(42.3%) patients, and 45.5%(5/11) of them succeeded in live births postoperatively. CONCLUSION: These data showed that metroplasty may improve the reproductive outcomes definitely in patients with recurrent abortions. Although the impact of metroplasty on the fertility in infertile patients was not definite, it seems better to perform metroplasty in infertile patients with uterine anomaly, which offers the opportunity to correct the combined pelvic lesions such as myoma, ovarian cyst or endometriosis, and to avoid the chance of abortion after ART(assisted reproductive technology) such as 1VF-ET.

The Study of Obstetric Consequences of Women with Uterine Anomaly / 대한산부인과학회잡지

OBJECTIVE: To evaluate the frequency and obstetric consequences of women with uterine anomalies and correlation between obstetric consequence and congenital uterine anomalies. Materials and METHODS: A retrospective study was made on 65 patients with uterine anomalies in order to evaluate the obstetric consequence at department of obstetrics and gynecology, Soonchunhyang University Hospital from January 1994 to June 1997. The diagnosis of uterine anomalies was made with hysterosalpingogram or ultrasonogram, or at the time of cesarean section. The uterine anomalies were classified according to the classification of Buttram and Gibbons and compared the pregnancy outcome for each classification. The obstetric consequences were divided into preterm delivery, premature rupture of membranes, intrauterine growth restriction, and abnormal presentation of fetus. Statistical analysis was carried out using chi-square test, the significance was defined as P< 0.05. RESULTS: 1. The incidence of uterine anomalies accounted for 1.04% (65/6,250 deliveries). 2. The most common uterine anomalies were class III (Uterine didelphys, 47.7%). 3. We noted preterm birth rate (16.9%), premature rupture of membranes rate (20%), intrauterine growth restriction rate (9.2%) in 65 patients. 4. The rate of breech presentation was 41.5% and the mean birth weight was 2,747 gram. 5. When uterine anormalies were present, the incidence of obstetric consequences was significantly increased. CONCLUSION: We concluded that congenital uterine anomalies were closely related to obstetric consequences, such as preterm, breech presentation, intrauterine growth retardation.