Uterine anomaly

D ie thyls tilbestrol Vaginal adenosis, uterine anomalies, vaginal carcinogenesis... 

Whatever steps in embryogenesis are defective different types of MDA can occur. The AFS introduced a classification system in 1988 [12] that stratifies MDA into seven different classes of uterine anomalies (Fig. 4.1). It is based on a previous classification system introduced by Buttram et al. [13]. Other classification systems followed and included broader collections of anomalies in order to avoid conflicting observations and over simplicity [15]. With all classification systems, one must emphasize that with the overlap of associated cervical and vaginal anomalies, the classifications describe primarily the uterine defects whereas the cervicovaginal defects as well as the associated malformations must be added separately... 

DES-exposed uterus. DES (synthetic estrogen, di-ethyl-stilbestrol, 1948-1971) may induce abnormal myometrial hypertrophy in the fetal uterus forming small T-shaped endometrial cavities [33], as well as increase the risk of developing a dear cell carcinoma of the vagina [34]. The characteristic uterine abnormalities must be categorized in the group of complex uterine anomalies and may occur with or without the exposure of DES. 

Ashton D,Amin HR, Richart RM,Neuwirth RS (1988) The inddence of asymiptomatic uterine anomalies in women undergoing transcervical tubal sterilization. Obstet Gynecol 72 28-30... 

Nahum GG (1998) Uterine anomalies. How common are they, and what is their distribution among subtypes J Reprod Med 43 877-887... 

Developmental anomalies of the ovaries are very rare. Although ovaries have a different developmental origin from uterus and fallopian tubes, ovarian anomalies are significantly more often associated with congenital uterine anomalies (22%), particularly with unicornuate uterus [16]. Uterus and fallopian tubes develop from the paramesonephric ducts. Defects of the paramesonephric tubes result not only in abnormalities of the uterus but also of tbe fallopian tubes, kidneys, and ureters. 

Dabirash H, Mohammad K, Moghadami-Tabrizi N (1994) Ovarian malposition in women with uterine anomalies. Obstet Gynecol 83 293-294... 

If other causes of infertility are excluded, uterine anomalies may be suggested as a cause of infertility On the other hand, unknown numbers of uterine anomalies may escape detection since reproductive ability is often unaffected or not noticeably affected [27]. 

Spontaneous abortion and premature labor may occur in pregnancies with unicornuate uterus, and the poorest fetal survival among all uterine anomalies has been reported [27]. A potentially lethal com-... 

Most patients evaluated for repeated abortions and found to have a uterine anomaly will have a septate uterus [27]. Avascular fibrous septa can be safely resected hysteroscopically, whereas vascularized myometrial tissue within the septum requires metroplasty as a surgical procedure for treatment of this anomaly and may enhance fetal survival, with one report indicating that 95% of patients became pregnant, 73% carried to term, and 77% delivered a liveborn baby [36]. 

Uterine configuration. These uterine anomalies are associated with an increased incidence of spontaneous abortion, preterm labor, and ectopic pregnancy [34]. 

HSG is an excellent imaging modality for diagnosing DBS-related uterine anomalies. Typical cavity contour changes seen include scalloping and constriction bands, while uterine shape abnormalities are hypoplasia, T-configuration, and a bulbous lower uterine segment (Fig. 16.22). 

Heinonen PK, Saarikoski S, Pystynen P (1982) Reproductive performance of women with uterine anomalies an evaluation of 182 cases. Acta Obstet Gynecol Scand 61 157-162... 

Pellerito JS, McCarthy SM, Doyle MB et al (1992) Diagnosis of uterine anomalies relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology 183 795-800... 

Kupesic S, Kiurjak A (2000) Ultrasound and Doppler assessment of uterine anomalies. In Kupesic S, de Ziegler D (eds) Ultrasound and infertility. Parthenon, Pearl River, NY,pp 147-153... 

Goldberg JM, Falcone T, Attaran M (1997) Sonohystero-graphic evaluation of uterine anomalies noted on hysterosalpingography. Hum Reprod 12 1251-1253... 

An uterus didelphys or bicornuate uterus can, therefore, readily be demonstrated. The prepubertal uterus is smaller, has a tube shape, and a non-appar-ent endometrium, making it almost impossible to evaluate uterine anomalies (Fig. 7.10). 

Van der Putte SCJ (1986) Normal and abnormal development of the anorectum. J Pediatr Surg 24 434-440 Wagner BJ, Woodward P (1994) Magnetic resonance evaluation of congenital uterine anomalies. Sem Ultrasound CT MR 15 4-17... 

---