Anatomical Malformations Research Articles

EP.TH.665Where’s the gallbladder? A rare case of gallbladder agenesis with cystic duct stone

Abstract Aims Gallbladder agenesis is a rare congenital anatomical malformation with an incidence of 0.007-0.0027%. Although usually asymptomatic, clinically it may present similarly to biliary colic. There may be increased risk of de novo biliary duct stone formation due to biliary dyskinesia, subsequent duct dilatation and biliary stasis. We present a case of incidental gallbladder agenesis identified during intended laparoscopic cholecystectomy. Methods A 68 year-old female with no significant comorbidities presented with a 16 hour history of colicky right upper quadrant pain and vomiting. She had been awaiting cholecystectomy for increasingly symptomatic gallstones, most recently visualised within a contracted gallbladder on ultrasound two months prior. Recurrently obstructive LFT’s warranted urgent magnetic resonance cholangiopancreatography (MRCP), which identified a poorly-visualised contracted gallbladder and a 10mm common bile duct without filling defect. At index laparoscopic cholecystectomy, a very small thick-walled structure resembling the gallbladder was identified and safely excised in retrograde; a stone was seen within. Results Macroscopic examination revealed a 27 x 9 x 11mm piece of dark brown tissue containing soft orange material. Microscopic histological examination confirmed this to be cystic duct focally lined by mucinous epithelium with chronic inflammation. Findings were consistent with gallbladder agenesis. Conclusions Although rare, it is important for surgeons to maintain an index of suspicion for gallbladder agenesis, particularly if repeated imaging demonstrates a poorly-visualised or ‘contracted’ gallbladder despite adequate fasting. Furthermore, as in this case, the presence of ‘gallbladder’ stones radiologically does not preclude gallbladder agenesis. Anticipation of this malformation may aid interpretation of biliary anatomy, if incidentally found intra-operatively.

Meniere's disease-like symptoms in 22q11.2 deletion syndrome

22q11.2 deletion syndrome (22q11.2DS) caused by a microdeletion on the long arm of chromosome 22, is characterized by congenital heart disease, hypoparathyroidism, immunodeficiency, developmental delay, and velopharyngeal insufficiency. Anatomic malformations of the middle and inner ears are frequently present, leading to high prevalence of hearing impairment. We present a first case of 22q11.2DS showing fluctuating hearing loss with recurrent vertigo attacks, resembling Ménière's disease.

Експериментальна оцінка ембріотоксичних ризиків кадмію хлориду при ізольованому введенні та у поєднанні з солями цитрату і нанокомпозитом на його основі

Cadmium compounds that enter living organisms pose the potential for serious health effects as they exhibit mutagenic, carcinogenic, gonadotoxic, teratogenic, allergenic and embryotoxic effects. It is important to study the mechanisms of their toxic effect on embryonic development and structural and functional formation of organs of living organisms and to search for their bioantogonists. The purpose of the study was to highlight the results of intragastric administration of cadmium chloride (1.0 mg/kg) with isolated administration and in combination with metal citrates (cerium, germanium, zinc, and nanocomposite (iodine + sulfur + selenium citrates)) on the overall course of rat embryogenesis. Materials and methods. For the study, young female Wistar rats weighing 170-200 g were used. They were divided into 6 groups, depending on the test substances, which they received from the 1st to the 19th day of gestation. Results and discussion. The analysis of the results of the experimental study showed the negative effect of cadmium chloride on the analyzed indicators of embryogenesis (preimplantation mortality, postimplantation mortality, total embryonic mortality), indicators of intrauterine survival, morphological (anatomical) malformations, as well as general delay in fetal development), both on the 13th and 20th days of pregnancy relative to the control group. In particular, the indicators of total embryonic mortality significantly increased by 4.2 times (13th day) and 3.7 times (20th day), with significant increase preimplantation mortality by 6.5 times, postimplantation mortality by 3.0 times on the 13th day of embryonic development, and on the 20th day, the preimplantation mortality indicator was by 14.0 times higher (p <0.01), and the postimplantation mortality indicator was insignificantly by 2.5 times higher than the control group. In the groups of the combined effect of cadmium chloride with metal citrates, there was a proven decrease in the indicators of total embryonic mortality (18.18% - 38.10%), preimplantation mortality (21.43% - 53.85%), postimplantation mortality (20.0% - 66.7%), an increase in the number of fetuses per female (12.66% -36.0%). Conclusion. In groups of the combined effect of cadmium chloride with metal citrates, the obtained data indicate a decrease in the accumulation of cadmium under the influence of the studied citrates, which allows them to be considered as potential bioantagonists of cadmium chloride

Renal Parenchymal Hypoxia in Young Children in the Period of Complete Remission of Acute Uncomplicated Pyelonephritis without Renal Impairment

Introduction. After establishing the diagnosis of pyelonephritis, there is a need to determine, whether renal parenchymal hypoxia remains in the period of remission. The least studied methods up to now are functional ones, which allow to verify the presence and degree of tissue hypoxia in secondary pyelonephritis and to evaluate the results of the medical measures to restore kidney function. Objective: to clarify the presence of renal parenchymal hypoxia and membrane destruction of the renal epithelium in young children with pyelonephritis without anatomic congenital malformations of the urinary system during its remission.Materials and methods of the study. The study involved 65 children with acute uncomplicated pyelonephritis, who after nephro-urological examination did not reveal anatomical malformations of the urinary system. General clinical examination was carried out, markers of tissue hypoxia and morphofunctional state of cell membranes of renal epithelium were determined.Discussion of the study results. The ability of urine to prevent crystal formation was significantly reduced to oxalates and phosphates in 40.0 and 47.7 % of the surveyed children. In one-third of children with pyelonephritis, oxalate excretion was significantly higher than in healthy children, hypophosphaturia was detected in 52.3 % of cases and the tendency to reduce the excretion of urates in 10.8 % of pediatric patients with pyelonephritis. The content of lipid peroxidation products in urine was increased in 41.5 % of the surveyed children with pyelonephritis, and appearance of polar lipids was observed in 46.2 % of patients.Conclusions. To predict the formation and for the purpose of early diagnosis of renal parenchymal hypoxia and the processes of nephrothelial membrane destruction in young children with pyelonephritis, it is recommended to use such markers, as indicators of urine ability to prevent crystal formation, daily excretion of salts, excretion of lipid peroxidation products and polar lipids in the urine. It is recommended to apply the methods to correct these changes.

Diagnosis and Management of Central Congenital Hypothyroidism.

Central congenital hypothyroidism (CH) is defined as thyroid hormone (TH) deficiency at birth due to insufficient stimulation by the pituitary of the thyroid gland. The incidence of central CH is currently estimated at around 1:13,000. Central CH may occur in isolation, but in the majority of cases (60%) it is part of combined pituitary hormone deficiencies (CPHD). In recent years several novel genetic causes of isolated central CH have been discovered (IGSF1, TBL1X, IRS4), and up to 90% of isolated central CH cases can be genetically explained. For CPHD the etiology usually remains unknown, although pituitary stalk interruption syndrome does seem to be the most common anatomic pituitary malformation associated with CPHD. Recent studies have shown that central CH is a more severe condition than previously thought, and that early detection and treatment leads to good neurodevelopmental outcome. However, in the neonatal period the clinical diagnosis is often missed despite hospital admission because of feeding problems, hypoglycemia and prolonged jaundice. This review provides an update on the etiology and prognosis of central CH, and a practical approach to diagnosis and management of this intriguing condition.

P–425 Recurrent pregnancy loss: what can we learn from different international guidelines?

Abstract Study question To which extent do the current international guidelines and recommendations concerning recurrent pregnancy loss (RPL) differ? Summary answer All guidelines apply definitions for RPL, however few diagnostic and therapeutic options are described. Diagnostics should be based on best evidence and current scientific knowledge. What is known already Established risk factors for RPL include anatomical, genetic, endocrine, hemostatic and immune alterations. The European Society of Reproduction and Embryology (ESHRE), American Society of Reproductive Medicine (ASRM), German/Austrian/Swiss Society of Obstetrics and Gynecology (DGGG/OEGGG/SGGG) and the Royal College of Obstetricians and Gynecologists (RCOG) published guidelines concerning diagnostic and therapeutic options in RPL. Due to the different guideline processes and date of publication actuality as well as complexity differ widely. Study design, size, duration We compared the guidelines of the ESHRE, ASRM, DGGG/OEGGG/SGGG and RCOG with regard to definition, diagnostic and therapeutic aspects. The guidelines were published between 2011 and 2018. Structured guideline processes with regular (complete) updates are only provided by the DGGG/OEGGG/SGGG. Participants/materials, setting, methods After thorough literature research (Pubmed, Embase) all existing guidelines and recommendations were analysed and compared considering the current state of knowledge. The RCOG recommendations from 2011 were updated in 2014 and 2017, the ARSM expert letter was last updated in 2012. The ESHRE guideline was published in 2017. The first version of the DGGG/OEGGG/SGGG guideline was published 2006, updated in 2013 and upgraded to a higher evidence-level in 2018 and is currently under review. Main results and the role of chance All guidelines agree that a diagnostic work-up is indicated after at least two clinical pregnancies and should exclude anatomical malformations, an antiphospholipid syndrome and thyroid dysfunction. Furthermore, lifestyle modifications are recommended by all. The general evaluation of an inherited thrombophilia is not recommended by any guideline. Exclusion of other risk factors like parental chromosomal disorders, a polycystic ovary syndrome or insulin resistance are only included in some guidelines, partly due to a lack of diagnostic criteria (luteal phase insufficiency) or due to the different year of publication of the recommendations (e.g. chronic endometritis). All guidelines recommend treating APLS by administering low-dose aspirin (75–100mg daily) in combination with unfractionated/low-molecular-weight heparin. With regard to uterine malformations whether or not a septum should be dissected is still a matter of debate: ESHRE and RCOG consider evidence insufficient, while DGGG/OEGGG/SGGG and ASRM recommend a surgical intervention. In case of chronic endometritis, the DGGG/OEGGG/SGGG recommends antibiotic therapy e.g. with doxycycline (200 mg daily for 14 days). Limitations, reasons for caution Different health economic as well as consensus aspects in the process of guideline development have a significant influence on the individual guidelines and recommendations. Wider implications of the findings: Since personalized diagnostic and therapeutic strategies in RPL patients are required, physicians have to decide when to follow the guideline and when to expand diagnostics and therapy. Therefore, the knowledge of the weaknesses of each guideline and its developmental process is helpful for treating RPL couples. Trial registration number -

Size matters: Large copy number losses in Hirschsprung disease patients reveal genes involved in enteric nervous system development.

Hirschsprung disease (HSCR) is a complex genetic disease characterized by absence of ganglia in the intestine. HSCR etiology can be explained by a unique combination of genetic alterations: rare coding variants, predisposing haplotypes and Copy Number Variation (CNV). Approximately 18% of patients have additional anatomical malformations or neurological symptoms (HSCR-AAM). Pinpointing the responsible culprits within a CNV is challenging as often many genes are affected. Therefore, we selected candidate genes based on gene enrichment strategies using mouse enteric nervous system transcriptomes and constraint metrics. Next, we used a zebrafish model to investigate whether loss of these genes affects enteric neuron development in vivo. This study included three groups of patients, two groups without coding variants in disease associated genes: HSCR-AAM and HSCR patients without associated anomalies (HSCR-isolated). The third group consisted of all HSCR patients in which a confirmed pathogenic rare coding variant was identified. We compared these patient groups to unaffected controls. Predisposing haplotypes were determined, confirming that every HSCR subgroup had increased contributions of predisposing haplotypes, but their contribution was highest in isolated HSCR patients without RET coding variants. CNV profiling proved that specifically HSCR-AAM patients had larger Copy Number (CN) losses. Gene enrichment strategies using mouse enteric nervous system transcriptomes and constraint metrics were used to determine plausible candidate genes located within CN losses. Validation in zebrafish using CRISPR/Cas9 targeting confirmed the contribution of UFD1L, TBX2, SLC8A1, and MAPK8 to ENS development. In addition, we revealed epistasis between reduced Ret and Gnl1 expression and between reduced Ret and Tubb5 expression in vivo. Rare large CN losses-often de novo-contribute to HSCR in HSCR-AAM patients. We proved the involvement of six genes in enteric nervous system development and Hirschsprung disease.

Recurrent Spontaneous Miscarriage: a Comparison of International Guidelines.

While roughly 30% of all women experience a spontaneous miscarriage in their lifetime, the incidence of recurrent (habitual) spontaneous miscarriage is 1 – 3% depending on the employed definition. The established risk factors include endocrine, anatomical, infection-related, genetic, haemostasis-related and immunological factors. Diagnosis is made more difficult by the sometimes diverging recommendations of the respective international specialist societies. The present study is therefore intended to provide a comparison of existing international guidelines and recommendations. The guidelines of the ESHRE, ASRM, the DGGG/OEGGG/SGGG and the recommendations of the RCOG were analysed. It was shown that investigation is indicated after 2 clinical pregnancies and the diagnosis should be made using a standardised timetable that includes the most frequent causes of spontaneous miscarriage. The guidelines concur that anatomical malformations, antiphospholipid syndrome and thyroid dysfunction should be excluded. Moreover, the guidelines recommend carrying out pre-conception chromosomal analysis of both partners (or of the aborted material). Other risk factors have not been included in the recommendations by all specialist societies, on the one hand because of a lack of diagnostic criteria (luteal phase insufficiency) and on the other hand because of the different age of the guidelines (chronic endometritis). In addition, various economic and consensus aspects in producing the guidelines influence the individual recommendations. An understanding of the underlying decision-making process should lead in practice to the best individual diagnosis and resulting treatment being offered to each couple.

Anatomic Variations and Malformations as Rare Causes of Median Nerve Compression in Adults: A Narrative Review.

The median nerve can become compressed at multiple points in the arm, causing carpal tunnel-, pronator-, anterior interosseous-, or lacertus syndrome. Anatomical variations are potential reasons of persisting or recurrent symptoms of median nerve compression and are often recognized late. The objective of this study is to provide a comprehensive list of rare anatomical variations and malformations causing median nerve compression. A total of 62 studies describing median nerve compression due to an anatomical structure in adults published from 2000 in English were included. The findings were: 35 tenomuscular, 16 vascular causes, and 4 cases with nerve involvement. Only 1 osseous and 18 combined anomalies caused compression. In 18 cases, the anomaly was found in the proximal forearm. In 44 cases, the median nerve was surgical released and 35 anomalies were completely resected. Persistent or recurrent symptoms were present in 13 cases. During follow-up, 1 case of recurrence was reported.Standard operative option for median nerve compression consists of an open median nerve release. In case of persistent or recurrent carpal tunnel syndrome, unilateral symptoms, the presence of a palpable mass, manifestation of symptoms at young age and pain in the forearm or upper arm, the surgeon has to rule out the presence of an anatomical anomaly. Complete resection of the anomaly is not always necessary. The surgeon should be aware of potential anomalies to avoid inadvertent damage at surgery.

P0413 / #1177: CONGENITAL BRONCHOBILIARY FISTULA IN A PEDIATRIC HOSPITAL, MANIZALES, COLOMBIA: CASE REPORT

Aims & Objectives: Bronchobiliary fistula is a rare developmental abnormality. Until 2019 only 44 cases had been reported worldwide. Clinicians should have a high index of suspicion to make an early diagnosis and start prompt treatment to reduce mortality. All cases should undergo surgery in order to avoid pulmonary complications. Methods: We report a case of a 45-day-old female patient admitted to the Pediatric Intensive Care Unit after a Brief Resolved Unexplained Event. Severe gastroesophageal reflux was suspected but failed to conventional treatment and developed respiratory distress requiring mechanical ventilation Results: Bile was obtained through the orotracheal tube and a 3D computed tomography and bronchoscopy were performed to demonstrate anatomic malformation between the biliary tract and the bronchial tree. A bronchobiliary fistula was observed between the main right bronchus and the biliary tract. Surgery was performed on day 95 after birth requiring mechanical ventilation for 75 days. Pulmonary chronic disease was diagnosed at time of discharge and inhaled steroid was started immediately. Conclusions: Congenital bronchobiliary fistula is a rare disease; survival rates and prognosis depends on a high index of suspicion to make an early diagnosis and rule out other biliary tract malformations. Prognosis rates are improved managing pulmonary complications due to biliary fluid in the pulmonary tree until a surgical treatment can be carried out.

Pediatric pulmonology 2019 year in review: rare and diffuse lung disease.

Pediatric Pulmonology publishes original research, review articles, and case reports on topics related to a wide range of children's respiratory disorders. Here we review manuscripts published in 2019 in this journal and others on (1) anatomic lung, airway, and vascular malformations, (2) children's interstitial lung disease, and (3) primary ciliary dyskinesia and non-cystic fibrosis bronchiectasis.

Integration of nuchal translucency screening into the first-trimester fetal anatomy scan: the time has come.

Integration of nuchal translucency screening into the first-trimester fetal anatomy scan: the time has come.

Definition, diagnostic and therapeutic options in recurrent implantation failure: an international survey of clinicians and embryologists.

What is the global variability in recurrent implantation failure (RIF) definition, investigation and therapy, currently offered to patients undergoing IVF? Definitions, diagnostic investigations and treatments offered to RIF patients differ widely amongst assisted reproduction healthcare professionals and clinical guidelines on RIF are urgently needed. RIF affects around 10% of patients undergoing IVF worldwide. There is no consensus on the definition of RIF, its diagnostic investigations or the therapeutic options, which leads to inconsistencies in clinical practice. A cross-sectional study of clinicians and embryologists was conducted between May and June 2020. The survey included 43 questions aimed at understanding participants' background and their current practice with regards to defining, investigating and managing RIF. The questions were designed by the European Society of Human Reproduction and Embryology (ESHRE) Special Interest Group (SIG) on implantation and early pregnancy following three consensus meetings. A total of 8579 ESHRE members from 6916 IVF centers were invited to participate using two global email calls based on their pre-specified interest in implantation and early pregnancy. SurveyMonkey and SPSS were used for data collection and analysis, respectively. Furthermore, differences were reported in the answers of European and non-European professionals, as well as between public and private settings and among clinicians clustered according to the average number of RIF patients treated per year. The final data set included 735 clinicians and 300 embryologist or IVF-biologists. The majority defines RIF based on the number of failed embryo transfers (ETs) with the most common threshold adopted being three ETs both fresh and frozen. More than two-thirds take lifestyle factors into account, mainly drugs, smoking and BMI. The highest consensus on which diagnostic investigations should be performed was reached for anatomical malformations and gynecological aspects focusing on hydrosalpinx, Asherman's syndrome, endometrial thickness and endometriosis. Concerning treatment of RIF patients, the highest consensus was reached for preconceptional therapies, including BMI adjustment, smoking and endometritis followed by therapies during IVF procedures. The response rate was relatively low, but comparable to other surveys. A consensus on definition, diagnosis and treatment of RIF would help to reduce costly, time-consuming and poorly validated approaches. No external funding was used. B.T. received support from Bayer for Clinical trials concerning endometriosis and Ferring for clinical trials concerning ovarian stimulation. She received reimbursement for travel expenses from Astropharm, Ferring. Dr Kade and is a shareholder of Reprognostics. She is a board member of the Austrian Society for Obstetrics and Gynecology (OEGGG), the associate head of the 'Reproduktionsmedizinische Zentren Baden-Württemberg' (RZBW), a member of guideline group of the German Society for Obstetrics and Gynecology (DGGG) and an editorial board member of the following journals: American Journal of Reproductive Immunology (AJRI), Archives of Gynecology and Obstetrics. All the other authors declare no conflict of interest. N/A.

Study of clinical profile and associated risk factors for congenital malformations in neonates: a hospital based prospective study

Background: Congenital malformations are major cause of neonatal morbidity and mortality and account for 8-10% of all peri-natal deaths especially in developing countries. Incidence of congenital malformation is increasing owing to reduction in other causes of neonatal deaths due to improvement in perinatal care worldwide. This study was aimed to evaluate the incidence, perinatal variables and contributing risk factors associated with birth defects that will help to plan future strategies for prevention, early diagnosis and timely management. Methods: This is a hospital-based prospective observational study conducted in department of pediatrics of a tertiary care centre of western India over period of two year. All new-borns with anatomical congenital malformations detected antenatal or postnatal (prior to discharge) period were included in this study. Detailed and careful clinical examination was carried out for all new-born.Results: The incidence of congenital malformation in the present study is 1.27%. Prematurity (76.1%), low birth weight (68%) and male neonates (67%) were associated with increased risk of congenital malformation. Most common system involved in this study was cranio-spinal system (47.3%). Overall, most common congenital anomaly was Hydrocephalus with meningomyelocele (8%). Among maternal variables, malnutrition (90%), consanguinity (40%) and abortions (40%) are strongly associated with malformations. Conclusions: Congenital malformations are important cause of neonatal death. Strategies to diagnose, prevent, treat and rehabilitate the neonate are utmost necessary. Early screening to identify high risk pregnancies and timely management is strongly recommended.

Histological, immunohistochemical and transcriptomic characterization of human tracheoesophageal fistulas.

Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are relatively frequently occurring foregut malformations. EA/TEF is thought to have a strong genetic component. Not much is known regarding the biological processes disturbed or which cell type is affected in patients. This hampers the detection of the responsible culprits (genetic or environmental) for the origin of these congenital anatomical malformations. Therefore, we examined gene expression patterns in the TEF and compared them to the patterns in esophageal, tracheal and lung control samples. We studied tissue organization and key proteins using immunohistochemistry. There were clear differences between TEF and control samples. Based on the number of differentially expressed genes as well as histological characteristics, TEFs were most similar to normal esophagus. The BMP-signaling pathway, actin cytoskeleton and extracellular matrix pathways are downregulated in TEF. Genes involved in smooth muscle contraction are overexpressed in TEF compared to esophagus as well as trachea. These enriched pathways indicate myofibroblast activated fibrosis. TEF represents a specific tissue type with large contributions of intestinal smooth muscle cells and neurons. All major cell types present in esophagus are present-albeit often structurally disorganized-in TEF, indicating that its etiology should not be sought in cell fate specification.

Esophageal atresia with tracheoesophageal fistula: A novel rare variant

Esophageal atresia (EA) is one of the most common congenital anatomical malformations that affect the alimentary tract and might be associated with the presence of tracheoesophageal fistula (TEF), and both occurs in about 1/2500 to 1/4000 live births. Depending on the anatomical description it is classifies into subtypes and there are many reported variants other than those subtypes like esophageal webs and congenital esophageal stenosis (CES). Here we report a rare variant of EA with proximal TEF which although presented clinically and radiologically as type C (EA) with (TEF) but at thoracotomy it is proved to be a different rare anatomical variant were the esophagus is found to be continuous down to the stomach with no gap resembling a type E (TEF) but there is an atretic segment just 1 cm above a (TEF). This is the first Case described in the literature. The knowledge and the anticipation of such types of variations remains the cornerstone for proper management and a high index of suspicion is needed to aid not to miss such rare anomalies.

Cáncer de mama asociado a síndrome de Poland

IntroductionPoland syndrome is a rare congenital malformation. Its incidence ranges from 1 case per 100,000 live births. The aetiology is unclear, and several factors related to its etiopathogenesis have been identified. Previous reports have shown an association with malignant tumours such as lung cancer, Wilms tumour, leiomyosarcoma, leukaemia, lymphoma, and breast cancer. Case reportA 56-year-old mixed-race woman presented with a 1-year history of a progressively growing tumour in the left breast. Physical examination revealed an anatomical malformation of the left hemithorax and upper limb. Ultrasound showed a solid, nodular, hypoechoic and irregular lesion (BIRADS IV), as well as uterine and right renal agenesis. We decided to perform total left mastectomy and sentinel lymph node biopsy, which showed uptake in the contralateral axillary tail. The histopathology report revealed infiltrating ductal carcinoma, right sentinel lymph node positive for carcinoma, and left axillary lymph nodes without metastasis. ConclusionThe clinical findings correspond to those reported for this syndrome; a notable finding was the malignant tumour in the contralateral axilla, which raised a diagnostic and therapeutic dilemma. All patients with Poland syndrome should be carefully screened for early cancer detection.

In Vitro Fertilization in Women with Asherman's Syndrome - Comparison of Maternal and Neonatal Morbidity

Study Objective We seek to examine effects of in vitro fertilization (IVF) on the maternal and neonatal morbidities of patients previously treated for Asherman's syndrome. Design A retrospective cohort study using fertility and obstetrical data from our institution's electronic medical records. Setting A community teaching hospital affiliated with a large academic medical center. Patients or Participants 43 singleton births identified from 40 women previously treated at our institution for Asherman's syndrome. Interventions Data analysis comparing the maternal and neonatal outcomes in singleton births from Asherman's syndrome patients who had been treated with hysteroscopic adhesiolysis, then either conceived spontaneously versus IVF. Measurements and Main Results Of the 43 singleton births, 27/43 (62.8%) were conceived spontaneously and 16/43 (37.2%) were conceived through IVF. No statistical differences were found in antepartum conditions within clinical pregnancies in patients who conceived spontaneously versus through IVF. There was no difference in the rate of preterm birth in Asherman's pregnancies (11.6%) regardless of conception method. We documented 4/43 (9.3%) cases of IUGR in our study, with no difference in between spontaneous versus IVF conception groups. The rate of morbidly adherent placenta (MAP) in Asherman's syndrome patients was 14.0%, with no differences in the rate of MAP found in the two conception groups. Postpartum hemorrhage in Asherman's patients was documented at 32.6% (14/43). Newborn anatomic malformations of any cause were documented in 18.6% (8/43) of all singleton births. Conclusion Our series indicates a higher prevalence of IUGR, MAP, post-partum hemorrhage, and newborn anatomical malformations in Asherman's syndrome pregnancies compared to incidences reported in pregnancies within the general population. However, we found no significant differences in the maternal and neonatal outcomes of Asherman's syndrome patients who conceived either spontaneously or through IVF after being treated with hysteroscopic adhesiolysis.

The Surgical Approach to Hysterectomy in a Patient with Mullerian Duct Anomaly

Study Objective To present the key surgical steps to complete hysterectomy safely in the presence of uterine anomalies. Design An educational video reviewing Mullerian duct anomalies, their associated anatomic malformations, and the steps to safely complete laparoscopic hysterectomy in a patient with these anomalies. Setting Minimally Invasive Gynecology division at a tertiary care hospital. Patients or Participants N/A Interventions A 45-year-old female undergoing robotic-assisted laparoscopic hysterectomy with presence of Mullerian duct anomaly including proximal vaginal septum with two cervices. Surgical intervention including the robotic localization and resection the proximal vaginal septum. Key points of surgical safety are reviewed including complete bilateral ureterolysis and ligation of the uterine arteries at their origin. Measurements and Main Results N/A Conclusion Minimally invasive approaches can be ideal for use in a patient with a noted Mullerian duct anomaly. Identification of dual collecting ducts or additional renal anomalies is vital to complete hysterectomy safely in these patients, specifically if a uterine anomaly is not recognized prior to surgical intervention.

Effects of Asherman Syndrome on Maternal and Neonatal Morbidity with Evaluation by Conception Method

Create a comprehensive summary of maternal and neonatal morbidities from patients previously treated for Asherman syndrome and evaluate for differences in perinatal outcomes based on conception method. Retrospective cohort. Community teaching hospital affiliated with a large academic medical center. Total of 43 singleton births identified from 40 patients previously treated at our institution for Asherman syndrome. Review of fertility and obstetric data to summarize the maternal and neonatal outcomes in singleton births from patients with Asherman syndrome who had been treated with hysteroscopic adhesiolysis. Primary outcomes of maternal morbidity (i.e., hypertensive disease, gestational diabetes, ruptured membranes, postpartum hemorrhage, morbidly adherent placenta [MAP]) and secondary outcomes of neonatal morbidity (i.e., gestational age at birth, method of delivery, weight, length, 1- and 5-minute Apgar score oxygen requirement, anatomic malformations, length of neonatal admission) were evaluated. We identified 40 patients who completed successful treatment of Asherman syndrome and went on to carry a singleton gestation within our institution: 20 (50%) with mild disease, 18 (45%) with moderate disease, and 2 (5%) with severe disease under the March classification system. In total, 43 singleton births were examined, with 27 of 43 (62.8%) conceived without in vitro fertilization (IVF) (group A: non-IVF conception) and 16 of 43 (37.2%) conceived through IVF (group B: IVF conception). The overall rate of preterm birth in Asherman pregnancies was 11.6%, with no difference between the 2 conception groups. We documented 9.3% cases with intrauterine growth restriction, with no difference based on conception groups. The rate of MAP in patients with Asherman syndrome was 14.0%, and the rate of postpartum hemorrhage was 32.6%, with no differences between the conception groups. Newborn anatomic malformations of any cause were documented in 18.6% of all singleton births, with no difference between the conception groups. Our series indicates a higher incidence of intrauterine growth restriction, MAP, postpartum hemorrhage, and newborn anatomic malformations in Asherman syndrome pregnancies than that reported in pregnancies within the general population. However, we found no significant differences in the maternal and neonatal outcomes of patients with Asherman syndrome who conceived with or without IVF after being treated with hysteroscopic adhesiolysis.