Arcuate Uterus Research Articles

To See or Not to See? A Visually Directed Approach to the Hysteroscopic Removal of RPOC from an Angular Pregnancy in an Arcuate Uterus

To See or Not to See? A Visually Directed Approach to the Hysteroscopic Removal of RPOC from an Angular Pregnancy in an Arcuate Uterus

12200 Variations in Hysteroscopic Appearances of the Partial Septate Uterus and Arcuate Uterus

12200 Variations in Hysteroscopic Appearances of the Partial Septate Uterus and Arcuate Uterus

Diagnosis of arcuate uterus using three-dimensional transvaginal ultrasound and investigation of its association withperinatal complications.

Arcuate uterus does not impact the success of infertility treatments, but there is no consensus on whether it influences perinatal outcomes. The objective of the present study was to investigate whether minor congenital uterine anomalies such as an arcuate uterus contribute to perinatal complications. This was a retrospective cohort study at a single institution. The study included 1097 deliveries after 22 weeks of gestation. Transvaginal ultrasound, with three-dimensional functionality, assessed uterine morphology based on American Society for Reproductive Medicine criteria. We compared maternal backgrounds and perinatal complications between arcuate uterus and normal uterus groups. Statistical analyses, including multivariate analysis, aimed to identify independent risk factors. A total of 69 patients (7.5%) with diagnosed arcuate uterus were included. Maternal background factors showed no significant differences between groups. In perinatal complications, an arcuate uterus was associated with a significantly higher incidence of preterm delivery (13% versus 4.7%, P = 0.01), preterm premature rupture of membranes (7.2% versus 1.6%, P = 0.01), fetal growth restriction (FGR; 16% versus 6.7%, P = 0.01), and abnormal placental cord insertion (33% versus 7.6%, P < 0.01). After multivariate analysis, arcuate uterus emerged as an independent risk factor for preterm delivery (adjusted odds ratio [aOR], 4.0 [95% confidence interval (CI), 1.6-9.9], P < 0.01), FGR (aOR, 2.6 [95% CI, 1.2-5.6], P = 0.02), and abnormal placental cord insertion (aOR, 6.0 [95% CI, 3.4-10.6], P < 0.01). Arcuate uterus stands as an independent risk factor for preterm delivery, FGR, and abnormal placental cord insertion. The findings emphasize the importance of recognizing even minor uterine morphological abnormalities in assessing and managing perinatal complications.

MRI Imaging Appearance in Mullerian Duct Anomalies

Abstract Background Müllerian duct anomalies include a complex spectrum of anatomical anomalies that arise from deviations during the normal development of the Müllerian ducts. In paediatrics, such defects cannot present with any clinical symptoms before puberty, yet, they can also have obstructive symptoms or a mass effect due to presence of a non communicating rudimentary horn or transverse vaginal septum. At the beginning of puberty, girls with these anomalies might have primary amenorrhea, pelvic pain or endometriosis. Müllerian duct anomalies have also associated with a variety of other congenital abnormalities. Aim of the Work To review MRI features of Mullerian Duct Anomalies and classify them according to ASRM and ESHRE-ESGE classifications. Patients and Methods The study was a case series study that included 37 patients who underwent pelvic MRI at Radiology Department “Ain Shams University hospitals” in Cairo, Egypt. Results In our study, Hypoplastic, Agenesis and Didelphysis found to have the same ratio of (21.6%), while Bicornuate uterus was (13.5%), septate (8.1%), unicornuate and transverse vaginal septum all were of (5.4%) incidence and the least common was arcuate uterus with (2.7%) incidence. Conclusion MRI is a highly helpful technique for evaluating female genital abnormalities and is able to consistently provide the essential imaging characteristics for the accurate identification of Mullerian malformations. Additionally, incidental pelvic disease and any related renal abnormalities may be thoroughly evaluated by MRI in a single scan, removing the need for additional diagnostic procedures.

Assessment of the Incidence of Müllerian Anomalies in Central Illinois

Introduction: Müllerian anomalies include a spectrum of malformations resulting from the underdevelopment of the Müllerian duct during embryological development. This results in a malformed vagina, uterus or both. Complete agenesis of one or both of these structures in a subset of these cases is known as Mayer‐Rokitansky‐Küster‐Hauser (MRKH) syndrome. There are two types of Müllerian agenesis: Type I MRKH only affects the upper vagina, cervix and uterus, whereas Type II MRKH has associated malformations affecting the renal, auditory and skeletal systems. The reported prevalence is approximately 1 in 5,000 for MRKH syndrome and ~5.5 in 100 for all Müllerian anomalies; however, there is a broad range in the described incidence rates. Purpose: We hypothesized the patient population served by the Department of Ob/Gyn, Division of Reproduction, Endocrinology and Infertility (REI) at Southern Illinois University (SIU) School of Medicine has a higher incidence of Müllerian anomalies and MRKH. Our objective was to assess the incidence of these Müllerian anomalies and describe the types of anomalies that affect women in Central Illinois. Methods: All patients receiving care at SIU Ob/Gyn, Division of REI from 01/1/2010-07/31/2021 were queried using specific ICD-9 and 10 codes and further screened to verify eligibility. A retrospective review (IRB# 21-893) was then conducted on all eligible subjects and relevant health information was extracted from the electronic health record. Continuous variables were measured by central tendency (mean or median) and dispersion (standard deviation or range). Categorical variables were described using frequencies and percentages. Results: The initial query identified 282 individuals of which 81 were deemed eligible (i.e., confirmed Müllerian anomaly). The total number of unique patients who underwent an ultrasound at REI during that time of study approval was 697. Based on these data, the calculated incidence of Müllerian anomalies in the REI patient population is ~11.6% and the incidence of MRKH is 57 in 5000. Demographics included: 74 subjects were White (91.4%), two Black or African American (2.5%), one Asian (1.2%) and 4 declined to report their race or identified as more than one race (4.9%); two subjects were of Hispanic ethnicity (2.5%). Mean ages at menarche and diagnosis were 12.7 ± 1.7 and 27.8 ± 6.4 years, respectively. Eight subjects diagnosed with MRKH had Type I MRKH. The specific type of anomalies identified included: uterine septum (29.1%), arcuate uterus (25.3%), unicornuate uterus (19.0%), agenesis (10.1%), bicornuate uterus (6.3%), uterus didelphys (6.3%) and 3.8% had another type of anomaly. The majority of patients underwent surgery within approximately one year of diagnosis (74%). Postoperative complications were rare (~7%) and included mild constipation, urinary retention and bleeding from the incision site. Pregnancy outcomes were as follows: prior to diagnosis, 3 (30%) infants were preterm vs. 7 (70%) term and those were spontaneous conceptions; after diagnosis 4 (30%) infants were preterm vs 9 (70%) term deliveries and the most common methods of conception were spontaneous and ovulation induction; post-surgery 11 (31%) infants were born preterm vs 24 (69%) term deliveries, and the most common methods of conception were ovulation induction and in-vitro fertilization. Conclusions: From this initial investigation, we found the incidence of Müllerian anomalies in the SIU Ob/Gyn, REI population is higher than the wide range of reported values. As expected, the vast majority of these patients underwent surgical management with little or no complications. We aim to further study what factors/exposures may be impacting the development of female fetuses resulting in Müllerian anomalies.

Diagnostic Concordance and Discrepancies in 3D TVUS and MRI of Congenital Uterine Malformations across the ASRM 2016, ASRM 2021, ESHRE/ESGE 2016, and CUME 2018

Background:: The classification of Congenital Uterine Malformations (CONUTA) relies on coronal imaging of the uterus using 3D TVUS and MRI. In everyday practice, radiologists and gynaecologists often struggle to confidently categorize CONUTA due to varying classification systems and the lack of worldwide consensus. Objectives:: The aim of this study was to evaluate the diagnostic concordance and discrepancies between two imaging techniques within the context of the ASRM, ESHRE/ESGE, and CUME systems. Methods:: Ninety-four patients suspected of having CONUTA underwent evaluation: 67 underwent 3D TVUS, 53 had MRI scans, and 34 were examined using both imaging techniques. An initial cross-listing table of ASRM, ESHRE/ESGE, and CUME was created, and a flowchart schema was used to define the type of congenital uterine anomaly for each system The prevalence of anomalies in each system was calculated, and Fleiss’ Kappa was used to assess and determine the level of agreement. Results:: Class VI arcuate uterus was the most common form in ASRM 2016 and 2021, while the partially septate uterus predominated in the CUME 2018 and ESHRE/ESGE 2016 classification systems. Conclusion:: There is no discordance between classification systems for all fusion defects and complete septate type of absorption defects. In the ESHRE/ESGE system, nearly half of the abnormal uteruses were categorized as partially septate. However, the CUME system proved less effective in distinguishing between normal and arcuate uteruses.

Angular Pregnancy in an Arcuate Uterus: Hysteroscopic Management of Retained Products of Conception

Angular Pregnancy in an Arcuate Uterus: Hysteroscopic Management of Retained Products of Conception

Cystic and Atrophic Kidneys, Atrophic Pancreas, Arcuate Uterus, and Diabetes Mellitus Associated With Deletion of HNF1β Gene

Cystic and Atrophic Kidneys, Atrophic Pancreas, Arcuate Uterus, and Diabetes Mellitus Associated With Deletion of HNF1β Gene

Exploring hysterosalpingography findings and pregnancy results among women applying to a tertiary referral hospital

Aims: To find out the correlation between hysterosalpingography (HSG) pathologies and pregnancy results of infertility patients. Infertility is a complicated complaint prevalent among women of reproductive age with severe financial and social consequences. HSG, adopted for evaluating infertility, can be considered a secondary imaging technique in practice following ultrasound examination. The present study attempted to explore the HSG results of patients applying to our hospital with the complaint of infertility in the last two years and to compare these results with their pregnancy. Methods: We retrospectively evaluated the HSG results of the patients applying to or referred to our hospital from an external center between 10.01.2018 and 30.08.2020 with the complaint of infertility.260 patients were included in the study. The patients were grouped by their primary and secondary infertility. We analyzed anomalies detected by HSG in two groups: uterine and tubal anomalies. Moreover, those becoming pregnant following HSG until June 2022 were grouped by reproductive techniques (spontaneous or assisted). Patients not having optimal imaging, with HSG reports obtained at an external center, and with insignificant results were excluded from the study. Results: The patients’ mean age was calculated to be 36 years (21-52 years). While 144 patients (55%) were diagnosed with primary infertility, 116 (45%) had a diagnosis with secondary infertility. There was no uterine or tubal anomaly in 157 patients undergoing HSG, but we discovered only a uterine defect in 28 of 103 patients and a tubal defect including at least one uterine and comorbid tuba in 44 patients. In 45 patients with a uterine anomaly, the most prevalent HSG findings were uterine filling defect (28 patients, 62.2%) and arcuate uterus (10 patients, 22.2%). We also discovered that 81 patients became pregnant at least once after HSG. While 50 of them got pregnant spontaneously, the remaining benefitted from assisted reproductive techniques. Our findings showed spontaneous pregnancy not to be associated with primary or secondary infertility (p=0.394; OR=0.765; 95% CI: 0.412-1.42). There was also no relationship between primary and secondary infertility and abnormal HSG findings (p=0.437; OR=0.820; 95% CI: 0.498-1.35). Finally, we concluded that abnormal HSG findings did not significantly contribute to the rate of spontaneous pregnancy (p=0.701; OR=1.13; 95% CI: 0.604-2.11). Conclusion: We concluded that abnormal HSG findings did not contribute to the rates of spontaneous pregnancy.

Prevalence of Congenital Uterine Anomalies and Tubal Blockage in Infertile Omani Women: A Retrospective Study.

Congenital uterine anomalies (CUAs) occur because of malformation of the female genital tract at any stage of the Müllerian duct development process. This retrospective study investigated the prevalence of CUAs and tubal blockage in infertile Omani women who underwent a hysterosalpingogram procedure as part of the evaluation of infertility. The radiographic reports of patients aged 19-48 years who underwent hysterosalpingogram as part of infertility evaluation during the 2013-2018 period, were collected and analyzed for the presence and the type of CUAs. The records of N = 912 patients were evaluated, 44.3% of whom had been investigated for primary infertility and 55.7% for secondary infertility. Patients with primary infertility were significantly younger than those with secondary infertility. Of the 27 (3.0%) patients who were found to have CUAs, 19 had arcuate uterus. No correlation was found between the type of infertility and the CUAs. CUAs were prevalent in 3.0% of the cohort, most of whom were diagnosed with arcuate uterus.

Reproductive Outcome in Women with different Types of Congenital Uterine Anomalies

Introduction: Mullerian ducts are the primordial analogue of female genital tract. They differentiate to form the fallopian tubes, uterine body, cervix and upper part of the vagina. A wide variety of malformation occur when this system is disrupted. The range from uterine agenesis, duplication of uterus to minor cavity abnormalities. All these congenital anomalies have been implicated as a potential cause for impaired reproductive outcome. Our aim was to evaluate the association between different types of congenital anomaly and various reproductive outcome. Material &amp; Methods: This cross sectional descriptive study was conducted at the Department of gynae and obstetrics in Dhaka Medical College and Hospital (DMCH), Ad-din Women’s Medical College and Hospital and Gonoshasthaya Samaj Vittik Medical College and Hospital during the period of March 2012 to September 2022.The study subjects were women with uterine anomalies who were diagnosed during evaluation of causes for bad obstetric history, during infertility work up or incidental findings during antenatal investigations or during Carsarian section . Reproductive outcomes were observed in the form of infertility, miscarriage, preterm delivery, ectopic pregnancy, intra uterine growth retardation (IUGR) and post-partum haemorrhage (PPH). These were recorded in a standard research questionnaire. Data were analyzed regarding types of uterine anomalies and their reproductive performance. Results: During the study period total 84 patients were recruited with uterine anomalies. Regarding distributions of uterine anomalies in study subjects the most common uterine anomaly was bicornuate uterus (n-32,38%), followed by arcuate uterus (n-18,21%), septate uterus (n-16,19%), unicornuate uterus (n-12,14%), and uterine didelphys (n-6,7. 1%).Women with bicornuate uterus was associated with miscarriage (37.25%), term delivery (31.25%) and preterm delivery (25%). Therefore, bicornuate uterus was found more evident with miscarriage. Only two cases of ectopic pregnancy were observed in the study which was found with bicornuate uterus. And in arcuate uterus percentage of preterm delivery was 44.4%, term delivery 33.3%, miscarriage only 22.2%. Therefore, arcuate uterus was more associated with preterm delivery. In septate uterus miscarriage was maximum (37.5%) followed byl term and pre term delivery, 12.5% each We found 12 cases of unicornuateuterus, where pregnancy continued to term in 6(50%) cases,2 aborted and 4(33.3)were delivered before term. Infertility was more associated with canalization defect, 6 cases with septate and 2 with didelphys uterus. Among live births (preterm and term deliveries,) malpresentation (breech, transverse) was more common in bicornuate uterus (44%).PPh was found in 2 cases of didelphys and two of bicornuate uterus. One case of septate and one from bicornuate uterus were associated with IUGR. Conclusion: The study makes clear that congenital uterine anomaly is associated with poor reproductive outcome. The exact effect is dependent on the type of anomaly.

REPRODUCTIVE OUTCOME IN WOMEN HAVING CONGENITAL UTERINE ANOMALIES: A RETROSPECTIVE STUDY

Background: Congenital uterine anomalies result from failure of or incomplete development, fusion or canalisation of one or both Mullerian ducts during foetal life. [1] These anomalies are often asymptomatic and unrecognized, until menarche or starting of reproductive life. The spectrum of uterine anomalies ranges from an arcuate uterus, uterine didelphys , unicornuate , bicornuate, t-shaped and septate uterus.[3] Pregnancy occurs in many women despite these anomalies. The complication rates with pregnancy are considerably increased; complications include intrauterine fetal growth restriction, fetal malposition, preterm labor, preterm premature rupture of membrane and malpresentation (breech) [21]. Not surprisingly, the rate of caesarean delivery is markedly higher. [4] Thus we want to conduct a systematic review to evaluate the association between the different subtypes of uterine anomaly and various clinical presentations and reproductive outcomes. This study was carried out retrospectively in 52 patients Method: that were in the age group of 12-38 years and having congenital uterine anomalies and presenting with either primary or secondary infertility / amenorrhoea, bad obstetrical history, recurrent abortions, preterm deliveries and ectopic pregnancies using consecutive sampling. All patients were evaluated and investigated further including reproductive &amp; perinatal outcome. Data were analyzed regarding type of uterine anomalies and their reproductive performance. Results &amp; Conclusion: Results of study shows that patients with uterine anomalies have higher rates of reproductive loss, preterm deliveries, that increase obstetric intervention and perinatal mortality.

What type of uterine anomalies had an additional effect on pregnancy outcomes, compared to other uterine anomalies? An evaluation of a large population database

Objective To compare pregnancy risks between different congenital uterine anomalies utilizing other congenital anomalies as a control group in a large population database. Design, setting, and sample A retrospective population-based cohort study from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) included 3,846,342 births (2010–2014). Of them, 6195 deliveries were to women with bicornuate uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with unicornuate uteri and 1404 with septate uteri. Main outcome measures and results After adjustment for confounders, women with bicornuate uteri were more likely to deliver vaginally (aOR 1.4, 95%CI: 1.1–1.9), p = .01), less likely to deliver by cesarean (CD) and had lower risk of small for gestational age (SGA) (aOR 0.8, 95%CI: 0.7–0.9, p = .03) when compared to the other anomalies (aOR 0.6, 95%CI: 0.5–0.6, p = .0001). Pregnant women with arcuate uterus had lower risks of preterm delivery (PTD) (aOR 0.6, 95%CI: 0.5–0.8, p = .0001), less chance of operative vaginal delivery (aOR 0.5, 95%CI: 0.2–0.9, p = .04), and higher risk for CD (aOR 1.6, 95%CI: 1.4–2, p = .0001). Pregnant women with didelphys uteri had higher risk of preterm premature rupture of membranes (PPROM) (aOR 1.6, 95%CI: 1.3–1.9, p = .0001), PTD (aOR 1.5, 95%CI: 1.3–1.6, p = .0001), CD (aOR 1.4, 95%CI: 1.2–1.5, p = .0001) and wound complications (aOR 1.6, 95%CI: 1.1–2.4, p = .02). Pregnant unicornuate uteri had increased risks of PTD (aOR 1.4, 95%CI: 1.1–1.6, p = .0001), CD (aOR 2, 95%CI: 1.6–2.5, p = .0001) and of SGA (aOR 1.8, 95%CI: 1.4–2.3, p = .0001). Pregnant septate uteri had higher risk of chorioamnionitis (aOR 1.5, 95%CI: 1.1–2.1, p = .048) and CD (aOR 1.4, 95%CI: 1.2–1.6, p = .0001). Conclusions We demonstrated that there are different risks for certain adverse pregnancy and neonatal outcomes in diverse uterine anomalies as compared to the other anomalies.

Diagnostic Value of Hysterosalpingography

Objective: Hysterosalpingography (HSG) is a contrast-enhanced, radiographic examination method of the internal female reproductive organs, which is used in the context of infertility diagnostics for the clarification of uterine malformations. The aim of this study was to investigate the significance of HSG as a diagnostic method in reproductive medicine. Methods: The results of HSG examinations from the Clinic for Reproductive Medicine and Andrology of the University Hospital Halle (Saale) between 2006 and 2020 were retrospectively examined. Results: Normal uterine findings were diagnosed by HSG in 151(51.01%) patients. The most common uterine malformation was uterus arcuatus, which was found in 46 patients (15.54%); 30(10.14%) patients had uterus bicornis unicollis. Uterus bicornis, unicornis, and subseptus were present in 5(1.69%) patients each. A duplex uterus was detected in 3(1.01%) patients, and malformations of a uterus arcuatum unicollis, uterus septus, bicornis subseptus, and uterus corpora in case of sectio bicornis were detected in 1(0.34%) patient each. A comparison of HSG findings with those from initial baseline diagnostics (gynecologic manual examination, sonography, etc.) revealed a correlation of findings in 105 cases (35.84%) and divergence of findings in 79 cases (26.96%). With the assistance of the HSG findings, further specification of the previously collected findings was achieved in 27 cases (9.22%). The diagnostic significance of HSG in reproductive medicine was demonstrated by the fact that findings were obtained and could not be detected in the preliminary examinations. In addition, basic diagnostic findings were confirmed by HSG, and conversely, previously collected findings could be further specified. HSG is a less invasive diagnostic imaging procedure with a short examination time. The fluoroscopy time is usually only a few seconds. Therefore, the radiation exposure is negligible. Conclusion: HSG is a method of radiologic examination that can be used to diagnose and specify uterine malformations. The diagnosis by HSG often opens up new therapeutic options to correct uterine malformations.

An Ultrasonographic Assessment to Document the Prevalence of Various Congenital Uterine Anomalies and their Probable Clinical Outcome in the Eastern Uttar Pradesh Region

Background: Uterine anomalies arise from abnormal fusion of paramesonephric ducts or failure of apoptosis of septum between two ducts leading to abnormal division of the uterine cavity. Initial dearth of universal standard diagnosis was the reason for the improper reporting of the data associated with prevalence of uterine developmental anomalies. But now various authors have reported the prevalence of uterine anomalies using standard diagnostic techniques. The objective of the study was to assess the prevalence of various uterine congenital anomalies among women of reproductive age (15–45 years) with no previous uterine pathology. Methodology: An ultrasound was utilized to take a transabdominal sonographs of both longitudinal and transverse planes from the supine position of participants who were made to consume 500–1000 mL of water to promote diuresis for the duration of the scan. Scans were then interpreted. Results: From a study of 200 participants whose mean age group fell around 30 ± 8 years, 140 of the women were parous and 60 were nulliparous. Twelve of the participants displayed anomalies that included bicornuate, arcuate, and septate. Five cases of the bicornuate uterus (2.5%), four arcuate uterus (2.0%), and three septate uterus (1.5%) were noted. Conclusion: From a sample size of 200, the occurrence of uterine anomalies is 6%, with no cases of uterine agenesis or a hypoplastic uterus.

Prospective study of Feto maternal outcome in pregnancies with reproductive tract anomalies

Introduction: Congenital uterine anomalies are common but their effect on reproductive outcome is unclear. Congenital uterine anomalies result from abnormal formation, fusion or resorption of mullerian ducts during fetal life. The overall frequency of uterine or mullerian anomalies is 4%. In general fertile population the frequency of mullerian anomalies is 5%, in infertile population 3%. Recurrent miscarriages occur in 5-10% of cases. Materials and methods:A hospital based cross-sectional analytical study was conducted among the pregnant women with uncorrected reproductive tract anomalies in the Shaheed NirmalMahto Medical College, Dhanbad, Jharkhand. All the pregnant women with uncorrected uterine anomalies, diagnosed by transvaginal ultrasound and/or hysterosalpingography admitted through emergency or OPD basis. The study was conducted for a period of two years from September 2018 to August 2020. Results: A total of 31 pregnant women with uterine anomalies were included in the study. Bicornuate uterus was the most common uterine anomaly (45.2%) followed by arcuate uterus (19.3%). Cesarean section was conducted in 72.6% of the pregnant women and its major indication was fetal malpresentation (breech). Maternal complications were present in 55% of the pregnancies and fetal complications in 52% of the newborns.

O-059 Pregnancy, delivery and neonatal outcomes among women with an arcuate uterus, a large American population based study

Abstract Study question In this study, we evaluated the pregnancy, delivery and neonatal outcomes among women with an arcuate uterus. Summary answer The arcuate uterus is associated with multiple adverse pregnancy outcomes, particularly, increased risk for; cesarean delivery (CS), venous thromboembolism (VTE) and pulmonary embolism (PE). What is known already Congenital uterine anomalies (CUAs) have been associated with poor reproductive outcomes. The arcuate uterus is one of the most common CUAs, however, it is believed to be a variation of normal and should as such have minimal adverse effects on pregnancies. However, the published studies evaluating the effects of arcuate uteri on pregnancy outcomes, involved only small numbers of participants, and were not powered to detect differences, while reporting conflicting results. Study design, size, duration A retrospective population-based study was conducted using data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). Unique in-hospital births occurring between 2010 and 2014 were included. Cases of arcuate uterus were identified using the ICD code 752.36. A total of 3,840,147 control births and 754 in women with an arcuate uterus occurred during the study period. Pregnancies in women with an arcuate uterus were compared to those without CUAs. Participants/materials, setting, methods We assessed hypertensive disorders, gestational diabetes and placenta previa, preterm premature rupture of membranes (PPROM), preterm delivery, placental abruption, chorioamnionitis, delivery mode, bleeding, clotting and wound complications, maternal infections or death. Selected neonatal outcomes included small for gestational age(SGA), intrauterine fetal demise and congenital anomalies. A multivariate logistic regression was used to adjust for confounding effects. IRB approval was not required since the study included only publicly available anonymized data. Main results and the role of chance Women with an arcuate uteri were more likely to be older, Caucasian, with a higher income, and private insurance (P-value &amp;lt; 0.0001 all). They were also more likely to have had a Cesarean in the past, to have pre-gestational diabetes, thyroid disorders, an in-vitro pregnancy and multiple gestations (P-value &amp;lt;0.01 all). Pregnancies associated with the arcuate uterus had higher rates of pregnancy-induced hypertension (PIH) (aOR 1.32, 95% CI 1.03-1.70), preeclampsia (aOR 1.63, 95% CI 1.18-2.24), premature preterm rupture of membranes (PPROM) (aOR 2.86, 95% CI 1.86-4.40), preterm delivery (aOR 1.86, 95% CI 1.45-2.37) and placental abruption (aOR 3.08, 95% CI 1.99-4.77). They also had 10.88 times the odds of delivering via Cesarean (95% CI 8.90-13.30), 4.81 times the odds of suffering from a VTE (95% CI 1.20-19.30) and 15.14 times the odds of having a PE (95% CI 3.76-60.91). Small for gestational age (SGA) neonates were also more common (aOR 2.21, 95% CI 1.58-3.10). Limitations, reasons for caution The database may be affected by recall bias and coding issues. Information on the method of diagnosing arcuate uteri was lacking. However, to our knowledge, this is the largest study looking at the reproductive outcomes with the arcuate uterus. We were powered to adjust results to identified confounding factors. Wider implications of the findings Our study demonstrates that women with an arcuate uterus are at increased risk for certain undesirable pregnancy outcomes. Physicians following these women should be prepared to manage these complications. Since our results differ from those of some smaller cohorts, additional large studies should be undertaken to confirm the results. Trial registration number Not applicable

P-749 How do different uterine anomalies compare for pregnancy complications? An evaluation of a large American population database

Abstract Study question What type of uterine anomalies cause alterations in pregnancy complications, compared to other anomalies, based on analysis of the Healthcare-Cost and Utilization-Project-Nationwide Inpatient Sample(HCUP-NIS) database? Summary answer After controlling for confounders, bicornuate uteri had lower risks and arcuate uteri had increased risks of cesareans and mostly similar risks of other outcomes. What is known already Women with mullerian anomalies are known to have increased risks of adverse obstetrical outcomes. Comparison of different adverse obstetrics outcomes between women with different type of uterine anomalies has minimally been studied. Study design, size, duration This retrospective population-based cohort study utilized data from the HCUP-NIS from 2010-2014, inclusively. A cohort of all deliveries during the study period was created. Within this group, Six thousand and one hundred ninety-five deliveries were to women with bicornuate uteri, 798 were to women with arcuate uteri, 2255 were in women with didelphys uteri, 802 were from women with unicornuate uteri and 1404 were deliveries to women with septate uteri. Participants/materials, setting, methods HCUP-NIS is the largest inpatient sample database in the USA and is comprised of hospital stays throughout the country. It provides information relating to seven million inpatient stays yearly, includes 20% of admissions, and represents over 96% of the American population. Multivariate logistic regression was conducted to explore associations between uterine anomalies and delivery outcomes. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance After adjustment for confounders, women with bicornuate uteri had less risk for chorioamnionitis(aOR:0.6, 95%CI:0.5-0.8-P=0.003), were more likely to deliver vaginally or by operative vaginal delivery(aOR:1.4, 95%CI:1.1-1.9-P=0.01), and less likely to deliver by CD when compared to the other anomalies(aOR:0.6, 95%CI:0.5-0.6-P=0.0001). They had lower risk of SGA (small for gestational age)(aOR:0.8, 95%CI:0.7-0.9-P=0.03). Pregnant women with arcuate uterus had lower risk of preterm delivery compared to the other anomalies(aOR:0.6, 95%CI:0.5-0.8-P=0.0001), less chance of having delivered by an operative vaginal delivery(aOR:0.5, 95%CI:0.2-0.9-P=0.04), and were at higher risk of having a CD(aOR:1.6, 95%CI:1.4-2-P=0.0001). Pregnant women with didelphys uteri had higher risk of PPROM(aOR:1.6, 95%CI:1.3-1.9-P=0.0001), preterm delivery(aOR:1.5, 95%CI:1.3-1.6-P=0.0001), CD(aOR:1.4, 95%CI:1.2-1.5-P=0.0001) and wound complications(aOR:1.6, 95%CI:1.1-2.4-P=0.02) compared to the other anomalies. However, they had less risk for placenta abruptia(aOR:0.6, 95%CI:0.5-0.9-P=0.02). Pregnant women with unicornuate uteri had increased risks of preterm delivery(aOR:1.4, 95%CI:1.1-1.6-P=0.0001), CD(aOR:3.0, 95%%CI:1.6-2.5-P=0.0001) and SGA(aOR:1.8, 95%CI:1.4-2.3-P=0.0001) with lower risk of placenta abruptia(aOR:0.5, 95%CI:0.3-0.9-P=0.03). Pregnant women with septate uteri had higher risk of chorioamnionitis(aOR:1.5, 95%CI:1.1-2.1-P=0.048) and CD(aOR:1.4, 95%CI: 1.2-1.6-P=0.0001). Other pregnancy complications studied which included PPH, the need for hysterectomy, and IUFD had similar rates between the groups(p &amp;gt; 0.05 all). Limitations, reasons for caution This is a retrospective analysis utilizing an administrative database that relies on data coding accuracy and consistency Wider implications of the findings There are different risks for certain adverse pregnancy and neonatal outcomes in different uterine anomalies as compared to the other anomalies. Although, regarding many pregnancy complications, risks were similar with different anomalies. Arcuate uterus mostly responds in a similar manner in terms of pregnancy complications as other anomalies. Trial registration number NA

V04-09 UNDOUBLED BLADDER IN THE SAGITTAL PLANE WITH ONE EXSTROPHIC BLADDER: A CASE REPORT ON RECONSTRUCTIVE TECHNIQUE

You have accessJournal of UrologyCME1 May 2022V04-09 UNDOUBLED BLADDER IN THE SAGITTAL PLANE WITH ONE EXSTROPHIC BLADDER: A CASE REPORT ON RECONSTRUCTIVE TECHNIQUE Wietse Claeys, Caroline Jamaer, Camille Berquin, Irina Verbakel, Achilles Ploumidis, Erik Van Laecke, Piet Hoebeke, and Anne-Françoise Spinoit Wietse ClaeysWietse Claeys More articles by this author , Caroline JamaerCaroline Jamaer More articles by this author , Camille BerquinCamille Berquin More articles by this author , Irina VerbakelIrina Verbakel More articles by this author , Achilles PloumidisAchilles Ploumidis More articles by this author , Erik Van LaeckeErik Van Laecke More articles by this author , Piet HoebekePiet Hoebeke More articles by this author , and Anne-Françoise SpinoitAnne-Françoise Spinoit More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Exstrophy-Epispadias complex is a spectrum of rare congenital malformations that can involve multiple organ systems. It can range from a simple glandular defect to a complete multisystem malformation with cloacal exstrophy and musculoskeletal diastasis. We report on the case of an adult woman who was born with an exstrophy variant with bladder and urethral duplication in the sagittal plane. The aim of our study was to report our reconstructive approach in this rare case of bladder exstrophy with maximum use of available tissues. METHODS: A 27-year old female patient was referred to our center for the complaint complete incontinence since birth. Upon first clinical examination, we discovered an exstrophic bladder with blind ending ureteral orifices. Further evaluation revealed a urethral meatus caudal to the exstrophic bladder plate. Cystoscopy revealed a second non-exstrophic bladder in the sagittal plane with complete incontinence due to a broad open bladder neck. This bladder contained 2 orthotopic ureters with normal retrograde urethrography. Vaginoscopy revealed a short and small vaginal channel and an arcuate uterus. Plain radiography of the pelvis showed a diastasis of 5 centimeters. CT scanning could not reveal any aberrant anatomy in the upper urinary tract. Genetic testing showed a normal 46XX karyotype. A laparotomy incision is performed and the exstrophic bladder plate is dissected caudally up to the point where a ventral inlay in the non-exstrophic bladder can be performed as augmentation tissue. A Mitchell-type bladder neck reconstruction with fascia sling interposition is performed. Since we do not know if this non-exstrophic bladder will be capable of emptying or if the bladder neck reconstruction will remain patent, we chose for the interposition a continent Mitrofanoff-type vesicostomy. Genital reconstruction with re-anastomosis of the urethral meatus between the inner labia is performed. The patient was thought self-catheterization through the appendiceal channel. At this point the patient can hold around 250 ml in the bladder. She catheterizes 5 times a day and once at night. She is completely dry. RESULTS: We present our reconstructive technique in a step-by-step-video guide. Our main focus was to achieve continence by maximal use of available tissues with the best possible quality of life for the patient. CONCLUSIONS: No surgical technique will be suitable for all these varying anomalies. Therefore, reconstructive surgeons need to tailor their approach based on available tissues and functional goals. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e369 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wietse Claeys More articles by this author Caroline Jamaer More articles by this author Camille Berquin More articles by this author Irina Verbakel More articles by this author Achilles Ploumidis More articles by this author Erik Van Laecke More articles by this author Piet Hoebeke More articles by this author Anne-Françoise Spinoit More articles by this author Expand All Advertisement PDF DownloadLoading ...

Frequency and Types of Uterine Anomalies during Caesarean Section Done for Abnormal Presentation

Background: Congenital uterine abnormalities are caused by abnormal fusion or canalisation of the mullerian duct during embryonic development. Congenital uterine abnormalities affect about 2% to 4% of women in reproductive years, and 5 to 25% of women who have had a difficult pregnancy. Ultrasonography, magnetic resonance imaging, hysterosalpingogram, and hysterolaparoscopy are some of the diagnostic modalities used to diagnose uterine anomalies. This observational study is conducted to determine the frequency and types of congenital uterine anomalies discovered during Caesarean section done for abnormal presentations. Aims and Objectives: 1) To determine the frequency and types of congenital uterine anomalies during caesarean section done for abnormal presentations. 2) To find out relationship between abnormal presentation and uterine anomaly. Material and Methods: This is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology, FAAMCH Barpeta. A total number of 176 cases were included in the study over a period of 1 year. Patients who underwent Caesarean section due to abnormal presentation were included in the study. After delivery of the foetus and the placenta, uterus was examined for the presence or absence of congenital malformations by digital palpation of the uterine cavity and inspection of fundus of uterus after exteriorisation. Demographic characteristics and obstetric outcomes were noted. Results: Out of 176 patients, 24 (13.63%) were diagnosed with uterine anomalies and 152 (86.36%) patients had normal uterus. Majority of the patients with uterine anomalies who underwent Caesarean section were primigravida (79.16%) and majority of them belonged to the age group of 25 - 30 years (70.83%). The most commonly observed uterine anomaly during the study period was arcuate uterus. Our study included cases only with abnormal presentation, 17 out of 24 (70.83%) had breech presentation and 6 (25%) had transverse lie.