Malformations Of Female Genital Tract Research Articles

New concepts in the diagnosis, treatment and fertility of female genital tract malformations

New concepts in the diagnosis, treatment and fertility of female genital tract malformations

Clinical features of 102 patients with different types of Herlyn-Werner-Wunderlich syndrome.

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare female genital tract malformation, and there are few large sample studies reported at home and abroad. The clinical manifestations of this syndrome are diverse, and insufficient understanding may delay the diagnosis and treatment of the patients. This study aims to analyze the clinical characteristics of different types of HWWS patients, and to improve the diagnosis and treatment of HWWS. The clinical data of patients with HWWS who were hospitalized in the Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University from October 1, 2009 to April 5, 2022 were retrospectively analyzed. The age, medical history, physical examination, imaging examination and treatment of the patients were collected for statistical analysis. The patients were divided into an imperforate oblique vaginal septum type, a perforate oblique vaginal septum type, and an imperforate oblique vaginal septum and cervical fistula type. The clinical characteristics of different types of HWWS patients were compared. A total of 102 HWWS patients were enrolled, with age of 10-46 years old, including 37 (36.27%) patients with type I, 50 (49.02%) type II, and 15 (14.71%) type III. All patients were diagnosed after menarche, with an average age of (20.5±7.4) years. There were significant differences in the age of diagnosis and course of disease among the 3 types of HWWS patients (both P<0.05). Patients with type I had the youngest age of diagnosis [(18.0±6.0) years] and the shortest course of disease (median course of 6 months), while patients with type III had the oldest age of diagnosis [(22.9±9.8) years] and the longest course of disease (median course of 48 months). The main clinical manifestation of type I was dysmenorrhea, and the main clinical manifestation of type II and type III was abnormal vaginal bleeding. Of the 102 patients, 67 (65.69%) patients had double uterus, 33 (32.35%) had septate uterus, and 2 (1.96%) had bicornuate uterus. The vast majority of patients had renal agenesis on the oblique septum, and only 1 patient had renal dysplasia on the oblique septum. The oblique septum located on the left side in 45 (44.12%) patients and on the right side in 57 (55.88%) patients. There were no significant differences in uterine morphology, urinary system malformation, pelvic mass, and oblique septum among the 3 types of HWWS patients (all P>0.05). Six (5.88%) patients had ovarian chocolate cyst, 4 (3.92%) patients had pelvic abscess, and 5 (4.90%) patients had hydrosalpinx. All patients underwent vaginal oblique septum resection. Among them, 42 patients underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen because they had no sexual life history, and the remaining 60 patients underwent traditional oblique vaginal septum resection. Among the 102 patients, 89 patients were followed up for 1 month to 12 years. The symptoms of vaginal oblique septum in 89 patients such as dysmenorrhea, abnormal vaginal bleeding and vaginal discharge were improved after operation. Among the 42 patients who underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen, 25 patients underwent hysteroscopies again 3 months after operation, and there was no obvious scar formation at the oblique septum incision site. Different types of HWWS have different clinical manifestations, but all can be manifested as dysmenorrhea. The patient's uterine morphology can be manifested as double uterus, septate uterus, or bicornuate uterus. The possibility of HWWS should be considered if uterine malformation is combined with renal agenesis. Vaginal oblique septum resection is an effective treatment.

Hysteroscopicmetroplasty as a treatment option for women with congenital dysmorphic uterus suffering from impaired reproductive performance

Congenital uterine anomalies have been proven to be associated with impaired reproductive performance. The 2013 ESHRE-ESGE classification of female genital tract malformations defines T shaped and infantalis uterus as dysmorphic uterus. Our aim was to examine whether the reproductive performance of patients with primary congenital dysmorphic uterus can be improved using hysteroscopic metroplasty. A retrospective cohort study of 35 patients suffering from 1 year of failed attempts to conceive, recurrent early pregnancy losses, or repeated implantation failures of in vitro fertilization cycles who were diagnosed with a dysmorphic uterus in both a diagnostic hysteroscopy procedure and three-dimensional transvaginal ultrasound (3D-TVS). All patients had undergone an operative hysteroscopic procedure for uterine anomaly repair and their reproductive performance is described before and after the procedure, so that the women acted as their own control. Within 3 years of the procedure, a total of 25 patients (71.4%) reported that they had achieved a pregnancy. A total of 15% of patients only conceived for the first time after the procedure, 15 patients (42.9%) conceived within 6 months and 18 (51.4%) within 1 year. A total of 12 of the 25 pregnant patients (48%) gave birth to a live newborn. We conclude that in non-DES exposed patients with impaired reproductive performance and congenital dysmorphic uterus, hysteroscopic metroplasty for uterine repair could serve as a treatment option for recurrent implantation failure, and may lead to improved reproductive performance and obstetric outcome.

CASE REPORT ON MATURE CYSTIC TERATOMA OF OVARY WITH RUDIMENTARY UTERUS

Mature ovarian cystic teratoma of ovary with rudimentary uterus is a rare clinical condition. It is congenital malformation of female genital tract during embryonic development. Ovarian tumors are commonly seen in reproductive age group. This condition might be present with wide variety of presentation and symptoms along with associated conditions. Here we describe a young patient with acute presentation. Mature cystic teratoma is benign tumor that can lead to malignant transformation in 1 to 3 % of cases. Introduction- It is rare anomaly and due to wide variation of the presentation this clinical condition remains an interesting point of study regarding diagnosis and management. Evolution of rudimentary uterine horn in young patient is very less reported among the published literature. Mature cystic teratoma is benign tumor commonly called as dermoid cyst. It Is most common ovarian germ cell tumor. 80% of cases present in reproductive periods especially in women under 40 years of age, Malignant transformation occurs in 1- 3 % of cases. 80% of histopathological type of malignant transformation is squamous cell carcinoma.

Pattern of Morphological Anomalies of Uterus as Observed by Modern Investigation Techniques

Abstract Background: Due to the high prevalence and possible impact on the reproductive health of the of woman, congenital uterine malformation of female genital tract is a challenge for the therapeutic decision-making process. The current study aimed to evaluate the morphological anomalies of the uterus as observed by modern investigation techniques. Methods: This cross-sectional observational study was done in Prathima Institute of Medical Sciences, Nagnoor, Karimnagar, Telangana state. Women who were infertile and anxious to conceive and women were subjected to 2D ultrasound Screening followed by Hysterosalpingography. Those women who were fertile and found to have uterine anomalies and needed reconfirmation of the provisional diagnosis were subjected to Hysterosalpingography. Results: Out of n=300 cases studied n=288 (96%) were with normal uterine anatomy and n=12 (4%) cases were detected with uterine malformations as seen by USG. N=5 (40.5%) had a Bicornuate Uterus. While uterus didelphys and unicornuate uterus were seen in n=2 (16.67%) each. Arcuate uterus, uterine septum, uterine Aplasia/Hypoplasia were seen in n=1(8.33%) women each respectively. Conclusion: Due to the psychological consequences associated with infertility, the effects of uterine anomalies on the life of women are very important. It is critical to know the exact nature of the anomaly, to plan for the most appropriate treatment modality. As most of these anomalies cannot be rectified by medical management, they need surgical correction. For optimal results, it is important to know the exact type of anomaly for surgical correction. The 2D USG can be recommended as the basic modality to evaluate uterine anomalies. HSG/MRI may be used to delineate detail of anomalies if initially detected by the 2D scan.

HERLYN-WERNER-WUNDERLICH SYNDROME - DIAGNOSTIC-TREATMENT APPROACHES

Introduction. Herlyn-Werner-Wunderlich syndrome is a complex abnormality in the development of the female genitourinary system, which includes the uterus didelphys, the longitudinal septum of the vagina with obstruction of one half and ipsilateral agenesis of the kidney. The exact prevalence of this syndrome is unknown, but some publications indicate that the frequency of this pathology ranges from 0.16 to 10% among all female genital tract malformations. Clinical case. The article presents a clinical case of a 14-year-old patient with Herlyn-Werner-Wunderlich syndrome, who was diagnosed and treated in time. Diagnostic approaches and treatment were also discussed. The patient complained about progressive dysmenorrhea from the age of menarche within 6 months, which became intolerable and did not pass after receiving symptomatic therapy. Ultrasound examination of the pelvis and kidneys revealed a combined anomaly of the genitourinary system: the uterus didelphys, right-sided hematocolpos and hemato cervix, agenesis of the right kidney. Magnetic resonance imaging of the pelvic organs and abdominal cavity confirmed that the patient had Herlyn-Werner-Wunderlich syndrome. Excision of the longitudinal septum of the vagina with the formation of a single vagina was carried out. About 200 ml of thick, dark blood was released during the excision of the septum from the blind right vagina.. There were neither intraoperative nor postoperative complications. The patient was discharged home in a stable condition on the 5th day. Twelve days after discharge from the hospital, the patient had their period that lasted for 6 days and was painless. The patient had no more complaints. Conclusions. Early diagnosis of Herlyn-WernerWunderlich syndrome and its surgical correction will prevent serious gynecological complications. The combined use of expert ultrasound and magnetic resonance imaging plays a decisive role in the diagnosis of this syndrome. The key to success in the management of patients with HerlynWerner-Wunderlich syndrome is the coordinated work of a multidisciplinary team with the involvement of a pediatric gynecologist, urologist, radiologist, ultrasound specialist and anesthesiologist. In cases of intrauterine diagnosis of agenesis of one kidney or other pathology of renal development in female fetuses, a differential diagnosis with Herlyn-Werner-Wunderlich syndrome should be made later before the onset of menarche.

Порушення репродуктивного здоров’я у пацієнток з аномаліями розвитку статевих органів

Female genital tract malformations are often a challenge not only for obstetricians and gynecologists, but also for doctors of other specialties. This pathology often leads to negative obstetric and perinatal consequences, the emergence of gynecological complications that significantly impair the quality of life of patients at different ages. The incidence of female genital abnormalities in the general female population ranges from 5.5 to 6.7% and is on average three times higher among patients with reproductive health disorders. The objective: to assess the frequency of reproductive disorders and determine the sequence of use of clinical and instrumental methods of examination in patients with female genital tract malformations. Materials and methods. We conducted a retrospective assessment of the relationship between menstrual disorders and the presence of female genital tract malformations. We observed 124 patients with a confirmed diagnosis of female genital tract malformations. The age of women ranged from 22 to 42 years. The diagnosis was based on complaints, medical history and life, as well as data from clinical, laboratory and instrumental examinations. Results. The mean age of patients was 29.2±3.8 years. From the moment of the patient’s first visit to the gynecologist until the final verification of the diagnosis took from 6 months to 7 years. Dysmenorrhea occurred in 70.2% of patients with abnormalities in the development of the female genital organs, late menarche – in 12.1%, primary / secondary amenorrhea – in 11.3%, irregular menstrual cycle – in 9.7%, violation of the menstrual cycle – at 28.2%. The combination of female genital tract malformations with various defects of the urinary system occurred in 24 (19.4%) women. Conclusion. In 81.2% of patients from adolescence there were clinical manifestations associated with female genital tract malformations. Screening ultrasound examination of the pelvic organs and gynecological examination is shown to all girls aged 15 years. It is advisable to determine the karyotype in patients with primary / secondary amenorrhea. Renal ultrasound should be performed in all patients with suspected female genital tract malformations. In case of suspicion of ultrasound examination for abnormal development of the female genitals, patients before sexual intercourse are recommended to perform MRI examination; in the presence of sexual life with a preserved menstrual cycle, it is advisable in the second phase of the cycle to conduct transvaginal 3D ultrasound, which can be supplemented by MRI. Keywords: genital abnormalities, dysmenorrhea, menstrual function.

Prevention of reproductive disorders in women with female genital tract malformations

Summary. Reproductive health is a priority in today’s global health care system. Among the factors of reproductive health disorders are female genital tract malformations. This pathology is mostly diagnosed with the onset of reproductive disorders at different ages of women, negatively affecting not only the reproductive but also the sexual functions of women, absorbing the quality of her life. The objective: to develop measures for the prevention of reproductive disorders in patients with female genital tract malformations based on the assessment of clinical manifestations and the frequency of reproductive disorders. Materials and methods. A retrospective assessment of reproductive disorders in 84 patients with a verified diagnosis of abnormalities in the development of the female genital organs was performed. The diagnosis was based on complaints, anamnestic data, the results of objective examination, clinical, laboratory and instrumental methods. The control group consisted of 25 women without abnormalities in the development of the female genitalia. Results. The mean age of the surveyed women was 27.6 ± 3.8 years. The duration of verification of the diagnosis of female genital tract malformations from the moment of the first visit to the gynecologist took an average of 3.1 ± 1.3 years. Of all the abnormalities in the development of the female reproductive system, 14.3 % were so-called «obstructive» abnormalities associated with impaired menstrual blood flow. Therefore, their clinical manifestation was earlier and more pronounced than in other patients and was manifested primarily by severe dysmenorrhea. Deviations in the age of onset of menarche occurred in 25 % of patients (OR =8; 95 % CI 1,019 – 62,798). In 73.8 % of women, the first reproductive disorders began during puberty. Dys menorrhea of varying severity occurred in 69.1 % of patients (OR = 7,064; 95 % СІ 2,527 – 19,744), of whom 70.6 % used medical treatment. The share of infertility among the women with anomalies in the development of the reproductive system was 19.1 %, pregnancy loss – 40.5 %. It was found that the risk of miscarriage in patients with congenital pathology of the female genitalia increases significantly (OR = 3,570; 95 % CI 1,125 – 11,325). 34.5 % of patients were diagnosed with genital endometriosis (OR = 6,064; 95 % СI 1,335 – 27,540). In 21.4 % of cases, abnormalities in the development of the female genitals were combined with congenital kidney disease. Conclusions. Prevention and predictability of reproductive disorders in patients with female genital tract malformations should begin with the pubertal period of the girl. A separate risk group consists of girls with pathology of the kidneys diagnosed prenatally. The basis for the prevention of reproductive health disorders in women with female genital tract malformations is the timely verification of congenital pathology and the development of a personalized system of management. The results of our research and the literature suggest that verification of the diagnosis of female genital tract malformations in women usually begins when patients have lost pregnancy or are experiencing infertility, while dysmenorrhea, menstrual irregularities that may occur in adolescence, often do not alert and do not become the basis for exclusion of congenital anomalies. That is why we believe that screening ultrasound examination of the pelvic organs in the presence of these disorders, it is advisable to conduct girls during puberty, if necessary – using 3D ultrasound and/or MRI.

Tilapia Fish Skin: a new biological graft in gynecology

Vaginal agenesis is a rare mal-formation of the lower female genital tract, with a prevalence of 1 in 5000 female newborns. Mayer‑Rokitansky‑Kuster‑Hauser (MRKH) syndrome represents 90% of all causes and is caused by partial or complete aplasia of the Mullerian ducts. The majority of these women have complete uterine agenesis. Primary amenorrhea is the first clinical sign, in patients with 46 XX karyotype, functioning ovaries and normal external genitalia.Creating a satisfactory neovagine when sexual activity is desired is primarily the goal of treatment. This ideal vaginal reconstruction should provide a long-lasting, functional passage for sexual intercourse that does not need maintenance with dilators or lubrication for sexual activity. At present, however, no standard treatment exists. Progressive dilatation is recommended by the American College of Obstetricians and Gynecologists as the first choice for creation of a neovagina, but this requires highly motivated patients and has a considerable failure rate. Surgical treatment usually shares a common step of tissue dissection between the urinary tract and the rectum.

Preoperative Evaluation for Complex Female Genital Tract Malformation Using Three-dimensional Printing Technology.

Preoperative Evaluation for Complex Female Genital Tract Malformation Using Three-dimensional Printing Technology.

Distribution of female genital tract anomalies in two classifications

ObjectiveThis study assessed the distribution of Müllerian duct anomalies in two verified classifications of female genital tract malformations, and the presence of associated renal defects. Study design621 women with confirmed female genital tract anomalies were retrospectively grouped under the European (ESHRE/ESGE) and the American (AFS) classification. The diagnosis of uterine malformation was based on findings in hysterosalpingography, two-dimensional ultrasonography, endoscopies, laparotomy, cesarean section and magnetic resonance imaging in 97.3% of cases. Renal status was determined in 378 patients, including 5 with normal uterus and vagina. ResultsThe European classification covered all 621 women studied. Uterine anomalies without cervical or vaginal anomaly were found in 302 (48.6%) patients. Uterine anomaly was associated with vaginal anomaly in 45.2%, and vaginal anomaly alone was found in 26 (4.2%) cases. Septate uterus was the most common (49.1%) of all genital tract anomalies, followed by bicorporeal uteri (18.2%). The American classification covered 590 (95%) out of the 621 women with genital tract anomalies. The American system did not take into account vaginal anomalies in 170 (34.7%) and cervical anomalies in 174 (35.5%) out of 490 cases with uterine malformations. Renal abnormalities were found in 71 (18.8%) out of 378 women, unilateral renal agenesis being the most common defect (12.2%), also found in 4 women without Müllerian duct anomaly. ConclusionsThe European classification sufficiently covered uterine and vaginal abnormalities. The distribution of the main uterine anomalies was equal in both classifications. The American system missed cervical and vaginal anomalies associated with uterine anomalies. Evaluation of renal system is recommended for all patients with genital tract anomalies.

The presentation and management of complex female genital malformations.

Common uterine anomalies are important owing to their impact on fertility, and complex mesonephric anomalies and certain Müllerian malformations are particularly important because they cause serious clinical symptoms and affect woman's quality of life, in addition to creating fertility problems. In these cases of complex female genital tract malformations, a correct diagnosis is essential to avoid inappropriate and/or unnecessary surgery. Therefore, acquiring and applying the appropriate embryological knowledge, management and therapy is a challenge for gynaecologists. Here, we considered complex malformations to be obstructive anomalies and/or those associated with cloacal and urogenital sinus anomalies, urinary and/or extragenital anomalies, or other clinical implications or symptoms creating a difficult differential diagnosis. A diligent and comprehensive search of PubMed and Scopus was performed for all studies published from 1 January 2011 to 15 April 2015 (then updated up to September 2015) using the following search terms: 'management' in combination with either 'female genital malformations' or 'female genital tract anomalies' or 'Müllerian anomalies'. The MeSH terms 'renal agenesis', 'hydrocolpos', 'obstructed hemivagina' 'cervicovaginal agenesis or atresia', 'vaginal agenesis or atresia', 'Herlyn-Werner-Wunderlich syndrome', 'uterine duplication' and 'cloacal anomalies' were also used to compile a list of all publications containing these terms since 2011. The basic embryological considerations for understanding female genitourinary malformations were also revealed. Based on our experience and the updated literature review, we studied the definition and classification of the complex malformations, and we analysed the clinical presentation and different therapeutic strategies for each anomaly, including the embryological and clinical classification of female genitourinary malformations. From 755 search retrieved references, 230 articles were analysed and 120 studied in detail. They were added to those included in a previous systematic review. Here, we report the clinical presentation and management of: agenesis or hypoplasia of one urogenital ridge; unilateral renal agenesis and ipsilateral blind or obstructed hemivagina or unilateral cervicovaginal agenesis; cavitated and non-communicating uterine horns and Müllerian atresias or agenesis, including Rokitansky syndrome; anomalies of the cloaca and urogenital sinus, including congenital vagino-vesical fistulas and cloacal anomalies; malformative combinations and other complex malformations. The clinical symptoms and therapeutic strategies for each complex genitourinary malformation are discussed. In general, surgical techniques to correct genital malformations depend on the type of anomaly, its complexity, the patient's symptoms and the correct embryological interpretation of the anomaly. Most anomalies can typically be resolved vaginally or by hysteroscopy, but laparoscopy or laparotomy is often required as well. We also include additional discussion of the catalogue and classification systems for female genital malformations, the systematic association between renal agenesis and ipsilateral genital malformation, and accessory and cavitated uterine masses. Knowledge of the correct genitourinary embryology is essential for the understanding, study, diagnosis and subsequent treatment of genital malformations, especially complex ones and those that lead to gynaecological and reproductive problems, particularly in young patients. Some anomalies may require complex surgery involving multiple specialties, and patients should therefore be referred to centres that have experience in treating complex genital malformations.

Classification of the Female Genital Tract Malformations and its Embryological Origin. Diagnostic and Therapeutical Considerations

Female genital tract malformations are known to be a frequent cause of reproductive problems. Besides, complex malformations also frequently generate serious gynaecological problems, often ones with inappropriate surgical solutions, as the gynecologist does not think of the malformation as either the cause of the symptoms or of its embryonic origin. Apart from analyzing the embryological bases in the development of the female genital and urinary tract, it is presented the update of the clinical and embryological classification for malformations. Knowing the embryological origin of the female genitourinary malformations, the schematic drawing of the malformations and their related symptoms, will allow the gynaecologist to choose the best therapeutical approach for the patient. Therefore, a discussion on ethiopathogenical deductions and therapeutical management of malformations is also done with clinical recommendations for the general gynaecologist. Keywords: Malformations of the female genital tract, complex malformations, embryology, embryology of the vagina, renal agenesis, blind vagina, mullerian anomalies, mesonephric anomalies.

Use of 3-Dimensional Sonography to Assess Uterine Anomalies

Female genital tract malformations are frequent but are not always detected because many are asymptomatic. Therefore, their true prevalence is unknown.1 They can range from up to 7% in the general population2 to 8% to 10% in women with recurrent pregnancy loss.3 Uterine anomalies are associated with an increased risk of infertility, miscarriage, premature birth, fetal loss, malpresentation, and cesarean delivery.4,5 Their accurate diagnosis is essential to minimize complications such as hydronephrosis, endometriosis, and infertility and to prevent unnecessary and, occasionally, inadequate surgery. Precise classification of a uterine anomaly is of clinical importance because the need for intervention and the type of intervention depends on this distinction. Furthermore, accurate classification of uterine anomalies has prognostic importance with respect to obstetric and gynecologic complications. The American Fertility Society’s 1988 classification6 has been adopted as the main classification system for almost 2 decades. It consists of 7 basic groups that were essentially analyzed on the basis of mullerian development and its relationship to fertility: (1) agenesis and hypoplasias, (2) unicornuate uteri, (3) didelphys uteri, (4) bicornuate uteri, (5) septate uteri, (6) arcuate uteri, and (7) anomalies related to diethylstilbestrol exposure syndrome. This classification, however, does not specify the diagnostic methods or criteria that should be used to diagnose uterine anomalies. The diagnosis is thus solely based on the subjective impression of the clinician performing the test. Additional findings referring to the vagina, cervix, fallopian tubes, ovaries, and urinary system must be addressed separately. However, many congenital uterovaginal anomalies and complex genitourinary anomalies are not encompassed in this system. In fact, Jones7 had already reported the independence of duplication anomalies of the uterus, cervix, and vagina. In some of these cases, two volumes, one to study the fundus and cavity and another to study the cervix and cervical canal, are needed to clearly evaluate the anomaly. Three-dimensional (3D) sonography enables the clinician to assess uterine morphologic characteristics completely, thus alleviating the need for invasive tests. Silvina M. Bocca, MD, PhD, Alfred Z. Abuhamad, MD

Cystic Malformation of Lower Female Genital Tract Resulting in Hydrops Fetalis: A Case Report

Genitourinary tract malformations causing hydrops fetalis are rare. The authors report a case of a female delivered at 32 weeks gestational age following a prenatal diagnosis of an abdominopelvic cystic mass with hydrops fetalis. The neonate was persistently hypoxic with unstable cardiovascular status and survived only 7 days. At autopsy, a cystic malformation replaced the vagina and uterus, associated with lower vaginal atresia and anorectal agenesis. The cyst had interfered with the normal process of Müllerian duct fusion, leading to a longitudinal vaginal septum and bifurcation of endocervix, with absent uterus and fallopian tubes. The urinary bladder was compressed by the cyst, resulting in bilateral hydronephrosis. The cyst impeded the inferior vena caval and umbilical venous circulations and impinged upon the thoracic cavity with resultant pulmonary hypoplasia. This malformation, which might be termed "cystic dysplasia" of the vagina, represents an extreme form of hydrometrocolpos that resulted in hydrops fetalis.

Imperforated Hymen: An Unexpected Cause of Pediatric Abdominal Pain,Case Report and Review of Literature

Introduction: Imperforate Hymen is the most common female genital tract malformation with prevalence of up to 0.1% and can present with wide variety of symptoms, ranging from abdominal pain to urinary retention. Case: Case of 11 y/o female with cyclical abdominal pain and palpable mass up to umbilicus. Patient diagnosed with imperforate hymen and taken to operating room (OR) by Gynecology team for hymenotomy; 2,500 mL of blood was evacuated. Discussion: Imperforate Hymen is an uncommon cause of abdominal pain. Presentation varies from abdominal pain and difficulty urinating, to urinary retention and tenesmus. Ultrasound is the study of choice for further evaluation and definite treatment is via hymenotomy. Conclusion: Imperforate hymen is an easily missed diagnosis in the Emergency Department (ED). It has to be included in the differential diagnosis for abdominal pain in pre-menarchal females.

A new case of HDR syndrome with severe female genital tract malformation: Comment on “Novel Mutation in the Gene Encoding the GATA3 Transcription Factor in a Spanish Familial Case of Hypoparathyroidism, Deafness, and Renal Dysplasia (HDR) Syndrome With Female Genital Tract Malformations” by Hernández et al.

A new case of HDR syndrome with severe female genital tract malformation: Comment on “Novel Mutation in the Gene Encoding the GATA3 Transcription Factor in a Spanish Familial Case of Hypoparathyroidism, Deafness, and Renal Dysplasia (HDR) Syndrome With Female Genital Tract Malformations” by Hernández et al.

The history of female genital tract malformation classifications and proposal of an updated system†

A correct classification of malformations of the female genital tract is essential to prevent unnecessary and inadequate surgical operations and to compare reproductive results. An ideal classification system should be based on aetiopathogenesis and should suggest the appropriate therapeutic strategy. We conducted a systematic review of relevant articles found in PubMed, Scopus, Scirus and ISI webknowledge, and analysis of historical collections of 'female genital malformations' and 'classifications'. Of 124 full-text articles assessed for eligibility, 64 were included because they contained original general, partial or modified classifications. All the existing classifications were analysed and grouped. The unification of terms and concepts was also analysed. Traditionally, malformations of the female genital tract have been catalogued and classified as Müllerian malformations due to agenesis, lack of fusion, the absence of resorption and lack of posterior development of the Müllerian ducts. The American Fertility Society classification of the late 1980s included seven basic groups of malformations also considering the Müllerian development and the relationship of the malformations to fertility. Other classifications are based on different aspects: functional, defects in vertical fusion, embryological or anatomical (Vagina, Cervix, Uterus, Adnex and Associated Malformation: VCUAM classification). However, an embryological-clinical classification system seems to be the most appropriate. Accepting the need for a new classification system of genitourinary malformations that considers the experience gained from the application of the current classification systems, the aetiopathogenesis and that also suggests the appropriate treatment, we proposed an update of our embryological-clinical classification as a new system with six groups of female genitourinary anomalies.

Analysis of clinical effect of laparoscopy in diagnosis 468 female infertility patients

Objective To explore clinical effects of laparoscopy applied in the female patients with infertility. Methods 468 cases of female infertility patients were diagnosed and treated by laparoscopy and 168 cases received follow-up survey. Results Among those infertility patients, the patients of normal pelvic cavity and the abnormal one were 49(10.47% ) and 419( 89.53% ). Among those patients of abnormal pelvic cavity .fallopian tube disease in 276 cases(65.87% ) was at the first place. The constituent ratio of endometriosis,ovary tumor,polycystic ovary,uterine myoma,female genital tract malformation and pelvic tuberculosis was 14. 80% ,5. 97% ,4. 30% ,3. 82% , 3. 34% and 1.91% .respectively. The patients of primary infertility and the secondary ones were 208 and 260 cases. In secondary infertility patients 69.23% (180/260) of patients were caused due to fallopian tube diseases,and the constituent ratio was higher than that in primary infertility 46.15% (96/208) (x2 = 14.05 ,P <0.05),while in primary infertility,the constituent ratio of endometriosis and normal pelvic cavity were 20.19% ,15.38% ,which were higher than that in secondary infertility respectively(x2 = 11. 78,11. 16, all P < 0.05). The pregnancy rate of 168 cases followed-up was 45.24% (76/168).47.37% ,84.21% pregnancy occurred within 6,12 months with laparoscopy. The shortest and longest time of pregnancy was 2 and 30 months, respectively. The median was 8months. Conclusion Laparoscopy playd an important role in diagnosis of infertility and improvement of pregnancy rate. Key words: Laparoscopy; Infertility, female

Cervical Agenesis: Progress and Pitfalls in Creation of Uterovaginal Anastomoses

Cervical agenesis is a rare form of female genital tract malformation. It is seen with otherwise structurally normal uterine structures as well as with duplicated systems. Management of cervical agenesis varies widely, with some surgical procedures rendering the young woman infertile by undertaking a hysterectomy, and others preserving fertility with procedures such as uterovaginal canalization, anastomosis or hemi-hysterectomy in the presence of a duplicated system where one uterine horn is functional.