Abnormalities Of Uterus Research Articles

Place de l’hystérectomie lors de la cure de prolapsus par promontofixation

In the past, hysterectomy was routinely performed at the time of pelvic organ prolapse repair. Nowadays, in patients with abnormal uterus (fibroma, dysplasia...), hysterectomy should be performed at the time of surgery. In contrast, in young women especially with desire of childbearing, uterus preservation is the best choice. But there is still a debate in postmenopausal patients with normal uterus and POP. There is currently no argument for choosing hysterectomy or uterus preservation at the time of POP repair in regard of the anatomical results for the middle as well as the anterior and posterior compartments. But it has been proven that hysterectomy increased the perioperative morbidity. Subtotal hysterectomy decreases this morbidity and result in a decreased rate of mesh erosion. To date, literature is not conclusive about the impact of hysterectomy on lower urinary tract symptoms. Patient's counselling is important before hysterectomy with adequate information about potential psychosexual consequences of such procedure. At least, if uterus preservation, patients must be aware of the risk of malignant diseases (cervix or endometrial carcinoma) even if the risk is low in case of a good screening preoperatively.

Unilateral Renal Agenesis and Associated Müllerian Anomalies: A Case Report and Recommendations for Pre-adolescent Screening

The combination of unilateral renal agenesis and abnormalities of the internal genitalia in women has regularly been reported in literature. Since 1922 1 Purslow C.E. A case of unilateral haematocolpos, haematometra and haematosalpinx. J Obstet Gyaecol Br Emp. 1922; 29: 643 Crossref Scopus (80) Google Scholar almost three hundred cases have been described in which a single kidney was found in women with abnormalities of uterus and vagina, notably the combination of uterus didelphys and unilateral imperforate vagina with haematocolpos and haematometra. In a recently published series of 27 cases this association has been named OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly). 2 Smith N.A. Laufer M.R. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA syndrome): management and follow-up. Fertil Steril. 2007; 87: 918 Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar

Utérus malformé et Assistance médicale à la procréation : prévention du défaut d'implantation ?

The infertility in women with an abnormal uterus seems a subject of controversy. The prognosis of in vitro fertilization among these patients with such an anomaly is even less founded. The results of in vitro fertilization have been only studied with few patients and recently. Through the literature, we will focus step by step, on the impact of uterine anomalies on natural reproduction, then the impact of metroplasty on natural reproduction, the role of anomalies on the endometrium quality and lastly, the results of Assisted Rerpoductive Techniques with women with such an anomaly. It seems that the main risk is obstetric complications such as spontaneous abortion or premature delivery, not implantation failure. However, when infertility exists, surgical treatment tends to improve the pregnancy rate for some.

Transvaginal sonohysterographic evaluation of uterine malformations

Objective The aim of this study was to assess the diagnostic value and the usefulness of sonohysterography (SHG) in the detection of uterine anomalies, compared with other diagnostic methods. Study design From January 2002 to December 2003, we collected 54 patients with a history of primary or secondary infertility or repeated spontaneous abortion and with a clinically or sonographically suspected abnormal uterus. All patients had previously undergone hysterosalpingography (ISG). All patients were examined by standard transvaginal ultrasound. Sonohysterography was then carried out by the intrauterine injection of an isotonic saline solution. Suspected uterine anomalies were also confirmed by hysteroscopy (HS) and/or laparoscopy. Results Sonohysterography was able to detect all the anomalies. The sensitivity and specificity of sonohysterography were the same as for hysteroscopy. However, there was no significant difference between the diagnostic capabilities of the methods analyzed. Conclusions Transvaginal sonohysterography with saline solution is a low-cost, easy, and helpful examination method for uterine malformations. We propose that sonohysterography should be performed for the primary investigation of infertility and repeated miscarriages.

Struma ovarii: a rare form of presentation and clinical review

Struma ovarii: a rare form of presentation and clinical review

Reproductive outcomes in women with uterine anomalies.

Because of diagnostic improvements in the evaluation of uterine anomalies, more patients desirous of pregnancy come to clinicians with identified uterine anomalies. It is desirable for the family physician, internist, and obstetrician/gynecologist to provide accurate information during preconceptional counseling of these patients. This review attempts to provide a concise summary of the current English-speaking literature concerning the reproductive outcome in women with uterine anomalies following both natural conceptions and those pregnancies occurring with assisted reproductive techniques (ART). A literature review of reproductive anomalies and pregnancy outcomes was performed using PubMed databases. Obstetrical outcomes were compiled from the medical literature and compared with the known rates of pregnancy outcomes in subjects presumed to have normal uterine anatomy. In general, obstetrical complications, such as preterm delivery and first trimester miscarriage, are higher in women with abnormal uteri. Women with an arcuate uterus have a similar reproductive outcome to women with a normal uterus. The unicornuate uterus has the poorest overall reproductive outcome, and the septate uterus has an increased miscarriage rate. The didelphic uterus, historically thought to have no adverse reproductive outcomes, also has poor obstetrical outcomes. Didelphic, bicornuate, unicornuate, and septate uteri have lower pregnancy rates in ART. Women with uterine anomalies have poorer reproductive outcomes and lower pregnancy rates with all conceptions whether spontaneous or induced with ART compared with women with normal uteri.

The added value of transvaginal sonohysterography over transvaginal sonography alone in women with known or suspected leiomyoma.

To assess whether sonohysterography provides added diagnostic value over transvaginal sonography in patients with suspected or known myomas by comparing diagnostic confidence, interobserver agreement, accuracy, and change in diagnoses when 2 independent observers interpreted transvaginal sonography alone and later interpreted transvaginal sonography and sonohysterography together. Hard copy images from 72 women were interpreted independently by 2 sonologists on separate occasions, rating parameters (abnormal uterus, myoma in any location, submucous myoma, classification of location of a submucous myoma with respect to the uterine cavity, myoma remote from the cavity, adenomyosis, and focal and diffuse endometrial lesions) on a scale of 1 to 5 (1 indicated definitely no; 2, probably no; 3, uncertain; 4, probably yes; and 5, definitely yes). Correlation was made with clinical and imaging follow-up, surgery, and pathologic examination. The added information provided by sonohysterography resulted in improved diagnostic confidence for most parameters. Interobserver agreement was markedly improved for the diagnosis and location of submucous myomas and focal endometrial lesions. Sensitivity values for submucous myomas and focal endometrial lesions were 100% and 90% for transvaginal sonography and sonohysterography together and 100% and 70% for transvaginal sonography alone. We found that sonohysterography does provide additional information over transvaginal sonography alone and is an important adjunct to transvaginal sonography in symptomatic women with known or suspected myomas, particularly before surgical or medical therapy.

Measurement of endometrial tissue blood flow: a novel way to assess uterine receptivity for implantation

Objective: To assess endometrial receptivity in terms of endometrial tissue blood flow (ETBF) measured hysterofiberscopically by laser blood-flowmetry, and to examine the technique’s effectiveness in an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) program. Design: A prospective clinical study. Setting(s): IVF program in a university hospital. Patient(s): A total of 75 infertile women with normal menstrual cycles undergoing IVF/ICSI. Intervention(s): ETBF, conventional ultrasonographic, endocrinologic, and histologic parameters for receptivity and immunoreactivity for vascular endothelial growth factor (VEGF) in endometrium were assessed between days 4 and 6 of the luteal phase in a spontaneous menstrual cycle. Then all patients underwent IVF/ICSI. Main Outcome Measure(s): Achievement of clinical pregnancy by IVF/ICSI. Result(s): ETBF, VEGF expression, and the number of embryos were significantly higher in the women who became pregnant than in those who did not. By stepwise multiple logistic regression, significant predictors of pregnancy were the number of embryos and ETBF but not conventional receptivity markers. The rate of pregnancy was significantly higher in women with ETBF values of at least 29 mL/min per 100 grams of tissue than in women with lower values (42 vs. 15% in 36 and 39 women, respectively). ETBF was significantly greater in morphologically normal than abnormal uteri. In normal uteri, ETBF was greatest in the fundus. Correspondingly, in normal uteri 85% of gestational sacs were implanted in the fundus. Conclusion(s): ETBF is superior to conventional parameters for determining endometrial receptivity for implantation.

Abnormal Uterus with Polycysts, Accumulation of Uterine Prostaglandins, and Reduced Fertility in Mice Heterozygous for Acyl-CoA Synthetase 4 Deficiency

Arachidonate released by various stimuli is rapidly reesterified into membrane phospholipids initiated by acyl-CoA synthetase (ACS) and subsequent acyl-transfer reactions. ACS4 is an arachidonate-preferring enzyme abundant in steroidogenic tissues and postulated to modulate eicosanoid production. Female mice heterozygous for ACS4 deficiency become pregnant less frequently and produce small litters with extremely low transmission of the disrupted alleles. Striking morphological changes, including extremely enlarged uteri and lumina filled with numerous proliferative cysts of various sizes, were detected in ACS4+/− females. Furthermore, marked accumulation of prostaglandins was seen in the uterus of the heterozygous females. These results indicate that ACS4 modulates female fertility and uterine prostaglandin production.

Prenatal magnetic resonance imaging of fetal anomalies

LINICAL MAGNETIC resonance imaging (MRI) has been available for the last 15 years; however, its use in the evaluation of the fetus has been minimal. Reports of the use of prenatal MRI in the mid-1980s were primarily for evaluation of the abnormal uterus or ovaries. 1,2 As more imaging was performed, reports appeared documenting abnormalities of the fetus. TM Because of the long acquisition times of standard spin-echo images, fetal motion significantly degraded many scans. Good examinations were obtained using paralyzing agents in the fetus, either direct intramuscular or umbilical cord injection of pancuronium to obtain motion-free spin-echo images. 5 Development of ultrafast MRI sequences and fast scanners, such as echo planar, began in the early 1990s. 6,7 More recently, ultrafast MRI sequences using single-shot turbo spin-echo techniques were developed. 8 These sequences were used in the abdomen and found to be breathing independently. This type of sequence has T2weighting and a single anatomic image can be obtained in less than 500 msec. These sequences are now being applied to imaging the human fetus. 9-~2 The ultrafast scanning technique decreases or eliminates the amount of artifacts caused by fetal motion. Fetal sedation is no longer necessary to obtain good images. Overall, fetal anatomy has been well documented in fetuses over 18 weeks' gestational age. 9,n Prenatal MRI is now at a time of great growth and has the potential to become a valuable adjunct to high-resolution ultrasonography in further defining abnormalities in the fetus, which may help prenatal counseling and therapy. Safety is always an issue in evaluating the developing fetus. The biological effects of MR on the human are very complex. To date, no known harmful effects to the developing fetus have been documented using clinical scanners at field strengths of 1.5 Tesla or less. One 3-year follow-up study of fetuses scanned using echo planar technique has shown no untoward biological effect. 13 The safety committee of the Society of Magnetic Resonance Imaging issued guidelines for patient safety in 1991. ~4 It stated that MRI may be used in pregnant woman if other nonionizing forms of diagnostic imaging were inadequate. It recommended that

Use of plasma concentrations of 13,14-dihydro,15-keto-PGF2 alpha (PGFM) in the diagnosis of sub-clinical endometritis and its relationship to fertility in the postpartum dairy cow

The objective of this study was to determine the value of using plasma concentrations of PGFM to diagnose subclinical endometritis in the dairy cow, and its relationship to subsequent fertility. A total of 274 cows between 24 to 29 d post partum was divided into 4 groups on the basis of clinical features of the uterus and ovary. Cows in Group 1 (n=74) had a normal, involuting uterus and a CL on the ovary; cows in Group 2 (n=51) had a normal, involuting uterus but no CL on the ovary; cows in Group 3 (n=83) did not have a normal, involuting uterus but had a CL on the ovary; and cows in Group 4 (n=66) did not have a normal, involuting uterus or a CL on the ovary. A blood sample was obtained from each cow on the day they were placed on the study, and plasma concentrations of PGFM and P4 were determined using RIA. Cows were artificially inseminated (AI) at the first observed estrus after Day 60 post partum, and pregnancy was determined by palpation of the uterus per rectum between 45 and 50 d postAI. Reproductive responses evaluated were conception rate to first service, days open, and percentage of cows pregnant by 90, 120, 150 and 180 d post partum. Data were analyzed using GLM procedures of SAS and a 2x2 factorial with contrast procedures. Polynomial regression analysis was used to determine the shape of the PGFM, P4 and fertility curves. There was no difference among mean PGFM concentrations of cows in each group. The rate of decline of plasma PGFM concentrations was lower in cows with an abnormal uterus and a CL on the ovary compared with those- without a CL. A lower percentage of cows with abnormal uteri was pregnant by 90 d post partum compared with cows with normal uteri. From the results of this study, it was concluded that plasma PGFM concentrations between Days 24 to 29 post partum were not effective in identifying cows with subclinical endometritis.

Septate uterus: New idea on the histologic features of the septum in this abnormal uterus

OBJECTIVE: Our purpose was to examine some of the classic concepts about the histologic features of the uterine septum. STUDY DESIGN: Four biopsy specimens were taken from 16 patients with septate uteri during Tompkins metroplasty: biopsy A from the septum near the serosal layer, biopsy B from the midpoint of the septum, biopsy C from the tip of the septum, and biopsy D from the left posterior aspect of the uterus away from the septum. Thirteencharacteristics were examined in these specimens by means of mean ridit analysis and Bonferroni criteria for multiple comparisons in relation to connective tissues (four characteristics), muscles (four characteristics), and vessels (five characteristics). RESULTS: In the septum the mean ridit score was less for the amount of connective tissues ( p < 0.001) and higher for the amount of muscle tissue ( p < 0.025), amount of muscle interlacing ( p < 0.05), and vessels with a muscle wall ( p < 0.005). However, the Bonferroni criterion for multiple comparisons was only significant for the amount of connective tissue ( p < 0.001). CONCLUSION: Our findings of less connective tissue in the septum, which was confirmed by the Bonferroni criterion for multiple comparisons and the mean ridit results for the three other significant findings, were contrary to the classic view about the histologic features of the septum.

Uterine Torsion in Pregnancy

Torsion of the pregnant uterus is defined as rotation more than 45 degrees around the long axis of the uterus. Uterine torsion is observed in all age groups of the reproductive period, in all parity groups, and at all stages of pregnancy. Torsion from 60 degrees to 720 degrees has been described. It is not possible to clarify why uterine torsion occurs, but numerous abnormalities have appeared with uterine torsion; most often, abnormal fetal presentation, myoma uteri and uterine malformations. The most usual symptoms of uterine torsion are birth obstruction, abdominal pain, vaginal bleeding, shock, and urinary and intestinal symptoms. Eleven percent are asymptomatic. The treatment in the earlier months of pregnancy is immediate laparotomy and detorsion of the uterus and, if practicable, adjunct surgery to eliminate the possible etiologic factors. Near term or during labor cesarean section is carried out, and elimination of the possible etiologic factors. The fetal and maternal mortality rates since 1976 are 12% and 0% respectively.

Application of two‐dimensional electrophoresis in comparing the effects of progestins and tamoxifen on proteins of the abnormal uterus

AbstractIn the androgenized rat, uterine histological abnormalities associated with unopposed oestrogenic stimulation can be partially reversed following progestin therapy. The effects of progestins and tamoxifen on the uterine protein composition of androgenized animals have therefore been investigated in an attempt to identify hormonally sensitive proteins that reflect changes in tissue morphology. Subcellular fractions prepared from uteri of androgenized animals were analysed by one‐ and two‐dimensional gel electrophoresis. In all fractions, protein changes were observed and the identity of some of these proteins has been tentatively assigned following peptide mapping. Evidence is presented of an apparent correlation between potency to antagonize the effects of unopposed oestrogenic stimulation and an increase in the proportion of cytosolic glucose‐6‐phosphate dehydrogenase and the B form of creatine kinase.

Application of two dimensional electrophoresis to characterise hormonally sensitive proteins in the normal and abnormal uterus

AbstractProgesterone therapy of androgenized rats results in the elimination of histological abnormalities of the uterus associated with constant unopposed oestrogenic stimulation. Subcellular fractions prepared from uteri of normal, androgenized and progesterone treated animals have been analysed by two‐dimensional gel electrophoresis. In all fractions, protein changes were observed as a result of androgenization and subsequent progesterone therapy. The identity of some of these proteins has been assigned following peptide mapping. Following progesterone therapy, the relative proportion of cytosolic tubulins, tropomyosins and D‐glucose‐6‐phosphate dehydrogenase were increased. In the abnormal uterus, a protein with similarity to the B subunit of creatine kinase was present in the mitochondrial fraction but could not be detected in the cytosol. Subsequent to progesterone therapy, this protein was no longer detectable in the mitochondrial fraction whilst two molecular forms of the B subunit of creatine kinase appeared in the cytosol. These hormonally‐sensitive changes in both structural and enzymatic proteins, which are ubiquitous to most cell types, are discussed in relation to morphological differentiation of the uterus and the molecular mechanisms underlying cell growth.

Progesterone therapy results in partial reversibility of uterine abnormalities of the adult anovulatory rat

The effects of progesterone therapy (5 mg, administered subcutaneously daily for 6 days) on the abnormal uterus of adult anovulatory Wistar rats have been studied. These rats, rendered anovulatory by neonatal treatment with testosterone propionate or clomiphene citrate, displayed severe hyperplasia and metaplasia of the uterine luminal epithelium and a disproportionately high content of nuclear oestrogen receptor, as a result of constant oestrogen stimulation unrelieved by progesterone [White, Moore, Elder & Lim (1981) Biochem. J. 196, 557-565]. Progesterone therapy resulted in the virtual elimination of the hyperplasia and metaplasia and a corresponding decrease in the content of nuclear oestrogen receptor with the proportion of the unoccupied nuclear receptor being increased to values exhibited by normal cyclic females. There was also a decrease in the content of progestin receptors, a putative index of oestrogenic stimulation. Further, in the testosterone-treated group, progesterone therapy resulted in the restoration of oestrogen receptor translocational responses to oestradiol stimulation. Progesterone treatment of these anovulatory rats thus provides a model system for investigating the biochemical mechanisms underlying progestin antagonism and regulation of oestrogen-stimulated cell proliferation.

The relationship of the oestrogen and progestin receptors in the abnormal uterus of the adult anovulatory rat. Effects of neonatal treatment with testosterone propionate or clomiphene citrate.

The neonatal administration of testosterone propionate to Wistar rats resulted in anovulatory adults in persistent vaginal oestrus. Clomiphene citrate had a similar effect. In both groups of adults, hyperplasia of the uterine epithelium and occasional metaplasia was observed. The uterine nuclear and cytosol oestrogen and progestin receptors of these anovulatory rats were found to have affinities for their respective ligands similar to those of normal females. The nuclear oestrogen receptor comprised occupied and unoccupied components, as in normal females. The content of the nuclear oestrogen receptor was comparable with that of females in the late dioestrous or pro-oestrous phase. This content was higher in the clomiphene-treated group. Despite the relatively high nuclear oestrogen receptor content the content of progestin receptors, a putative index of the oestrogenic response, was lower in the treated rats than in normal adult females throughout the cycle. Administration of oestradiol to both treatment groups resulted in depletion of cytosol oestrogen receptor content 1 h later, which, however, was not reflected by an increase in the content of nuclear oestrogen receptors. There was no measurable increase in progesterone receptor content in treated rats after daily administration of oestrogen (5 microgram/rat) for 3 days. These changes in sex-hormone-receptor interactions involving an impairment of the normal oestrogenic response may be associated with the abnormal differentiation of the uterus in these sterile, anovulatory animals.

Pathogenesis of hydrometra-endometritis complex in rats.

Among 31 rats with a cervical ligation for 79 to 88 days, hydrometra developed in 17 uterine horns of 13 rats. Eleven of those 17 uterine horns of hydrometra contained the turbid or transparent exudate with a bacterial contamination at the level of 107 to 109/ml, and affected with endometritis. The remaining 5 hydrometra were filled with sterile exudate and free from endometritis. On the other hand, the uterine luminal fluid in some cases of the apparently normal rats at the proestrous stage was contaminated with Streptococcus sp. and/or P. pneumotropica at the level of 103 to 105/ml. Another 14 rats, in which 14 uterine horns (9 rats) were preliminarily confirmed for bacterial contamination, were treated by ovariectomy, uterine ligation and subcutaneous injection of estradiol 0.2/μg/day for 20 days. However, hydrometra was macroscopically negative in all rats. Endometritis was also negative in 11 of 14 uterine horns except for a slight endometritis in the remaining 3 uterine horns. These results indicate that the luminal fluid of hydro-metra plays an important role in the growth of pre-existing bacteria and development of endometritis, accordingly, the transition of hydrometra to endometritis may occur in the rat uteri with a contamination by the pre-existing bacteria. Therefore, it was thought to be reasonable to include those abnormal uteri in the words of Hydrometra-endometritis complex.

Uterine malformation and fetal deformation

Beyond the enhanced miscarriage and prematurity associated with the structurally abnormal uterus, we have found 14 examples of fetal deformation secondary to uterine malformation with its consequent uterine constraint. In several instances the constellation of deformations had been misinterpreted as a multiple malformation disorder. One patient died of pulmonary hypoplasia, but all the survivors showed restoration toward normal form postnatally. Recognition of the basic problem allows for surgical reconstruction of the uterus, which is generally accompanied by an improved outlook for subsequent pregnancies.

Pregnancy and uterine malformations: A report of two unusual cases

Two cases of pregnancy associated with congenital uterine abnormalities are presented. Complications are much greater in the abnormal uterus of dual Müllerian origin (bicornis, septate, etc.) compared to the uterus of single Müllerian origin (didelphys, unicornis, etc.). Abortion, prematurity, breech and transverse presentations, and retained placentas are more common in the malformed uterus. Fertility does not seem to be impaired.