Uterine Anomalies Research Articles

Evaluation of preoperative ultrasound signs associated with bladder injury during complex Cesarean delivery: case-control study.

Intraoperative hemorrhage and peripartum hysterectomy are the main complications in patients presenting with a low-lying placenta or placenta previa undergoing repeat Cesarean delivery (CD). Patients with a high probability of placenta accreta spectrum (PAS) at birth also have a higher risk of intraoperative urologic injury. The aim of this study was to evaluate the ultrasound signs and intraoperative features associated with these injuries. This was a retrospective case-control study of consecutive singleton pregnancies included in a prospective cohort of patients with a history of at least one prior CD and diagnosed prenatally with an anterior low-lying placenta or placenta previa at 32-36 weeks' gestation. All patients underwent investigational preoperative transabdominal and transvaginal ultrasound examination within 48 h prior to delivery. Ultrasound anomalies of uterine contour and uteroplacental vascularity, and gross anomalies of the lower uterine segment (LUS) and surrounding pelvic tissue at delivery, were recorded using a standardized protocol, which included evaluation of the extent of uterine contour anomalies. The diagnosis of PAS was established when one or more placental lobules could not be separated digitally from the uterine wall at delivery or during the gross examination of the hysterectomy or partial myometrial resection specimens, and was confirmed by histopathology. Data were compared between cases complicated by intraoperative bladder injury and controls from the same cohort matched at a 1:3 ratio by parity and the number of prior CDs using conditional logistic regression. There were 16 (9.4%) patients with an intraoperative bladder injury in a cohort of 170 managed by the same multidisciplinary team during the study period. There were no patients diagnosed with ureteric or bladder trigone damage. There were 14 (87.5%) patients with a bladder injury that had histopathologic evidence of PAS at birth, including 11 (68.8%) cases described on microscopic examination as placenta increta and three (18.8%) as placenta creta. There was a significant (P = 0.03) difference between cases and controls in the distribution of the intraoperative LUS vascularity, whereby the higher the number of enlarged vessels, the higher the odds of bladder injury. Multivariable regression analysis revealed that both gestational age at delivery and LUS remodeling on transabdominal ultrasound were associated with bladder injury. A longer gestational age was associated with lower risk of injury. A higher LUS remodeling grade on transabdominal ultrasound was associated with an increased risk of bladder injury. Patients with Grade-3 remodeling (involving > 50% of the LUS) had 9-times higher odds of a bladder injury compared to patients with Grade-1 remodeling (involving < 30% of the LUS). Preoperative ultrasound examination is useful in the evaluation of the risk of intraoperative bladder injury in patients with a history of prior CD presenting with a low-lying placenta or placenta previa. The larger the remodeling of the LUS on transabdominal ultrasound, the higher the risk of adverse urologic events. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The Role of Sonography in the Case of Congenital Uterine Abnormality: Potential for an Improved Pregnancy Outcome

Three-dimensional (3D) sonography is a valuable imaging technique to evaluate the uterus and distinguish the different types of congenital uterine abnormalities. The provided case series demonstrates the unique diagnostic patient findings of a bicornuate uterus and an incompetent cervix. The patient presented over a series of multiple pregnancies that used cervical cerclage, to achieve an improved maternal-fetal outcome. In this patient, her uterine anomaly was diagnosed prior to pregnancy. During each gestation, close diagnostic attention was paid to the shape of the uterus, the location of the gestational, and the cervical length, by using transvaginal sonography. This imaging surveillance played an important diagnostic role in providing a better patient outcome for the patient’s multiple pregnancies. Continued research into the use of 3D sonography, for this specific diagnostic application, is needed to accelerate its use in determining the specific location of gestational sac(s).

Developmental uterovaginal anomalies and histologic findings in transgender patients receiving gender-affirming hysterectomies: A large case series.

To describe the incidence of uterovaginal anomalies and histologic findings in transgender and nonbinary (TGNB) patients seeking hysterectomies. All patients receiving gender-affirming hysterectomies between 2013 and 2023 were retrospectively reviewed. Primary outcomes included uterovaginal anomalies and histological findings. Multivariable logistic regressions were performed to evaluate relationships between variables of interest and whether they predict findings of uterovaginal anomalies, inactive endometrium, adenomyosis, leiomyoma, endometriosis, and cervical atrophy. 278 patients received hysterectomies at an average age of 29.2 ± 8.3 years. Seven patients (2.5%) were found to have a developmental anomaly, including two bicornuate uterus (0.7%), two unicornuate uterus (0.7%), one septate uterus (0.4%), and two vaginal septum (0.7%). 60 patients (21.6%) were found to have inactive endometrium and 26 patients (9.4%) had cervical atrophy. Although 262 patients (94.2%) were on testosterone therapy, hormone duration was not a significant predictor of any uterine findings. This study describes uterovaginal anomalies in a large cohort of patients receiving gender-affirming hysterectomies. Although long-term testosterone use is commonly believed to be associated with endometrial and cervical atrophy, this study shows no such association.

Pipelle Endometrial Sampling With a Full Bladder Compared With Standard Care: A Randomized Controlled Trial.

To compare insertion failure rates for Pipelle endometrial sampling with a full bladder compared with the standard process (not taking into account bladder status) without cervical manipulation. A single-masked randomized trial was conducted in a single tertiary care center from July 2021 to January 2022. Two hundred fourteen participants aged 18 years or older who were scheduled for outpatient Pipelle endometrial sampling were randomized: 107 each to having a full bladder (by oral water intake) or standard process (without delayed sampling and bladder status not taken into account). Women with known cervical stenosis, gynecologic malignancy, uterine anomalies, leiomyoma distorting the uterine cavity, acute cervicitis, urge bladder dysfunction, intense anxiety, need for anesthesia or analgesic before the procedure, positive pregnancy test, or previous failed office endometrial sampling were excluded. The primary outcome was the insertion failure rate of endometrial sampling at first attempt. Secondary outcomes were pain during procedure, satisfaction score, analgesia use, procedure duration, and need for cervical manipulation. Factoring in a baseline insertion failure rate of 30.0%, relative risk of 0.45, α of 0.05, 80.0% power, and a dropout rate of 10.0%, we needed 107 participants in each arm. The insertion failure rate was significantly lower in the full bladder group compared with standard process: 25 of 107 (23.4%) compared with 45 of 107 (42.1%) (relative risk 0.56, 95% CI, 0.37-0.84; number needed to treat to benefit 6.0, 95% CI, 3.20-15.70). Pain score (median) during the procedure (interquartile range) was 4 (3-6) compared with 5 (3-8) (P=.004); patient satisfaction score was 8 (7-9) compared with 7 (4-8) (P<.001); and mean±SD procedure duration was 3.0±2.4 compared with 4.7±2.9 minutes (P<.001) for the full bladder and standard process arm, respectively. Other secondary outcomes of cervical laceration, analgesia use, and adequacy of endometrial tissue for histopathologic assessment were not significantly different between groups. Pipelle endometrial sampling with a full bladder reduces the initial insertion failure rate, procedure-related pain, and duration of sampling and increases patient satisfaction compared with the standard process. ISRCTN, ISRCTN33938192.

Challenges in Diagnosis and Management of Recurrent Uterine Arteriovenous Malformation: A Case Report

Challenges in Diagnosis and Management of Recurrent Uterine Arteriovenous Malformation: A Case Report

Uterine Balloon Tamponade under Ultrasound Guidance in Women with Postpartum Hemorrhage: A Retrospective Cohort Study.

Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant'Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage.

An unusual case of severe asphyxia with the fetal position unexpectedly inverted in a malformed uterus: a case report

BackgroundWe present a severe neonatal consequence due to the unexpected and crucial inversion of the fetal position after sudden termination of tocolysis during early labor of a woman with congenital uterine anomaly. It has been reported that congenital uterine anomalies latently affect the fetal position. The clinical pitfalls in childbirth with uterine anomalies are discussed here on the basis of clinical evidence.Case presentationAt a perinatal medical center in Japan, a 29-year-old Japanese mother who had a history of bicornuate uterus, received tocolysis to prolong her pregnancy for 5 days during the late preterm period after preterm-premature rupture of the membrane. She gave birth to a 2304 g male neonate of the gestational age of 35 weeks and 5 days with severe asphyxia by means of crash cesarean section for fetal sustained bradycardia after sudden termination of tocolysis. We found the fetal position to reverse from cephalic to breech position during early labor. He ended up having severe cerebral palsy after brain cooling against hypoxic-ischemic encephalopathy for 3 days. The mechanism of inversion from cephalic to breech position without amnionic fluid remains unclear, although women with a known diagnosis of a uterine anomaly have higher risk of adverse outcomes such as malpresentation.ConclusionsWhen considering the clinical course of this case on the basis of the medical reports, we suspected that uterine anomalies and changes in intrauterine pressure could cause fetal malpresentation and adverse neonatal outcomes.

Sonographic Features of Uterine Arteriovenous Malformation: A Case Series.

Uterine arteriovenous malformation (AVM) is very rare but potentially life-threatening. Early and accurate diagnosis is the cornerstone of its management. The objective of this study is to encourage sonographers to become familiar with a variety of grayscale sonographic features, facilitating rapid recognition of the patterns and prompting them to apply color flow Doppler for a diagnosis of uterine AVM and possible further investigations or interventions. We present six cases of uterine AVM presenting with abnormal uterine bleeding at varying degrees of severity, from abnormal menstruation to life-threatening bleeding following curettage. All initially provided some clues of uterine AVM upon grayscale ultrasound, leading to the application of color Doppler flow to support a diagnosis, with confirmation using abdominal computer tomography angiography (CTA) in most cases, resulting in definitive treatment using uterine artery embolization or other interventions. Most importantly, this study provides various sonographic features of uterine AVM, such as appearances of small tubular structures, spongy patterns, a conceptive-product-like appearance, and spaghetti-like patterns. Hopefully, familiarity with these sonographic features can facilitate practitioners to make an early diagnosis, leading to proper further investigation and intervention, and to prevent serious complications from potentially being caused by this subtle but very serious disorder.

Magnetic resonance imaging features of complete androgen insensitivity syndrome in comparison to Mayer-Rokitansky-Küster-Hauser syndrome.

Complete androgen insensitivity syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) share common clinical features such as female phenotype, vaginal hypoplasia, and primary amenorrhea. Magnetic resonance imaging (MRI) is performed to investigate the cause of primary amenorrhea. However, the MRI features are also similar in both disorders. They are ultimately diagnosed by chromosome testing, but there is a possibility of misdiagnosis if chromosome testing is not performed. This study aimed to identify MRI features that are useful for differentiating CAIS from MRKHS. This multicenter retrospective study included 12 patients with CAIS and 19 patients with MRKHS. Three radiologists blindly evaluated the following features: (1) detection of vagina, (2) detection of nodular and cystic structures in the lateral pelvis; undescended testicles and paratesticular cysts in CAIS and rudimentary uteri and ovaries in MRKHS, (3) their location, (4) number of cysts in the cystic structures, and (5) signal intensity on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values of the nodular structures. Statistical comparisons were performed using Mann-Whitney U and Fisher's exact tests. Compared with MRKHS, the CAIS group showed significantly detectable vagina, more ventrally located nodular and cystic structures, fewer cysts within the cystic structures, and nodular structures with higher signal intensity on DWI and lower ADC values. MRI features of detectable vagina, location of nodular and cystic structures, number of cysts within the cystic structures, signal intensity on DWI and ADC values of the nodular structures were useful in differentiating CAIS from MRKHS.

Fetal Outcome in Younger Age Pregnant Female; A Tertiary Care Hospital

Background: The efficacy of Caesarean section in managing breech births surpasses that of a vaginal birth. Risk factors associated with breech presentation include prematurity,recurrent pregnancies, uterine anomalies, and fetal abnormalities. this study aimed toassess fetal outcomes in younger age pregnant female.Materials and Methods:This cross-sectional study was performed in Department of Obstetrics and Gynecology at Mardan Medical Complex, Mardan. The study conducted in 12 months duration from January to December 2020. All data including patients' history,and clinical tests were collected through designed proforma. All recruited patients and fetal were monitor. All data were analyzed through Microsoft excel 2016.Results: Fetal outcomes revealed that out of the total cases, 53.6% found in age group 18-25 years and 46.4% in age 26-33 years. Apgar scores found low in 17.8%, low birth weight fetus observed in 17.8%, birth asphyxia in 32.9%, brachial plexus in 12.5%, andfetal distress in 11.4%.Conclusion: This study highlights that fetal birth issues including low birth weight, birth asphyxia, brachial plexus, and detal distress are common here in our region. It is a crucial to take additional precautions, including vigilant labor monitoring and thorough preparation for infant resuscitation, to mitigate these issues within our local Khyber Pakhtunkhwa community. Awareness of the risks associated with each option can aid in personalized decision-making regarding breech delivery, adding value to the decision-making process. Therefore, the choice of delivery method for breech presentations should be informed by the findings of this study.

Perinatal features of children with Silver-Russell syndrome due to 11p15 loss of methylation.

A diagnosis of Silver-Russell syndrome (SRS), a rare imprinting disorder responsible for foetal growth restriction, is considered for patients presenting at least four criteria of the Netchine-Harbison clinical scoring system (NH-CSS). Certain items of the NH-CSS are not assessable until the age of 2 years. The objective was to determine perinatal characteristics of children with SRS to allow an early diagnosis. We retrospectively compared the perinatal characteristics of children with SRS (n = 17) with those of newborns small for gestational age (SGA) due to placental insufficiency (PI) (n = 21). Children with SRS showed earlier and more severely altered foetal biometry than SGA newborns due to PI. Twenty-three percent of patients with SRS showed uterine artery Doppler anomalies. SRS children were significantly smaller at birth (birth length <-3 SDS in 77% of cases in the SRS group vs. 15% in the PI group, p = 0.0001). The diagnosis of SRS must be evoked in the neonatal period for SGA newborns with a growth delay present from the second trimester of pregnancy, a birth length <-3 SDS and a relative macrocephaly. Doppler anomalies, classically used to orient the cause of SGA towards PI, did not rule out the diagnosis of SRS.

Complex cervical dysgenesis and concurrent uterine anomalies: a dynamic case presentation and management

Complex cervical dysgenesis and concurrent uterine anomalies: a dynamic case presentation and management

Review Article: Early Recurrent Pregnancy Loss

Recurrent pregnancy loss, which affects 2%–5% of individuals, is just a significant concern for women's health. Uterine malformations, antiphospholipid syndrome, metabolic or endocrine diseases, as well as chromosomal abnormalities are among the often reported established reasons. Alternative aetiologies, like chronic uterine infections, hereditary thrombophilias, luteal stage insufficiency, or excessive male DNA disintegration rates, have been put forward yet remain regarded as debatable. The results for individuals who experience recurrent miscarriage had increased throughout time because to evidence-based therapies including surgical repair of chromosomal abnormalities, aspirin as well as anticoagulation in anticardiolipin disorder. About 50% of the instances, though, are still unsolved, so they are managed effectively with estrogen augmentation, anticoagulation, and/or immunostimulatory therapies. Regardless of the reason, couples who experience recurrent fetal death have a favourable long-term outlook and also the majority ultimately has a safe live delivery. Several miscarriages, though, may have a major psychological impact just on afflicted people, and numerous attempts are now being undertaken to enhance therapies or shorten the time it takes to conceive successfully. With an emphasis on inexplicable repeated fetal loss as well as the current usage of empiric therapies, this article reviews the recognised or contentious aetiologies as well as the suggested therapeutic approaches. As well, it covers the present use of pre - implantation genetic screening inside the treatment of repeated miscarriages.

How Often Do We Discover an Abnormality of The Uterus at Delivery? Single Center Experience

Objective: In this study, we aimed to determine the incidence of incidental uterine anomalies in the patient population who gave birth in our centre and to evaluate the perinatal outcomes. Methods: We conducted a retrospective analysis of outcomes of patients with incidental uterine anomalies who delivered at a tertiary care center between January 2023 and December 2023. Patient data were obtained by searching hospital records. Results: The data of 782 pregnant women who had given birth in the last eleven months were analyzed retrospectively. Three patients were found who could be included in the classification of uterine anomaly and who had not received prior diagnosis and treatment. The mean age was 30.0 years and the mean body mass index was 25.6 kg/m2. The mean gestational age of the patients was 37+0 weeks. Conclusion: In this study, we found uterine abnormalities in 3 patients during cesarean delivery. It is important to note that these uterine abnormalities correlate least with pregnancy complications or fertilization success.

Most Unusual Twin Pairs: A Look at Uterus Didelphys / Twin Research Reviews: Prenatal Aneuploidy Screening for Twin Pregnancies; Twin Conceptions by Same-Sex Male Couples; Legal Personality of Conjoined Twins; Twin Study of Cannabis Use / Human Interest and Importance: Being Taken for Twins Saved Sisters; Twin Children of Jailed Nobel Prize Winner; British 'Biracial' Twins; Triplets Born at Start of Russian Attack on Ukraine; Twins Born in Different Years.

A review of an unusual twin type-twins born to women with two uteri (uterus didelphys)-is presented. This review is followed by summaries of recent research and perspectives concerning prenatal aneuploidy screening for twin pregnancies, twin conceptions by same-sex male couples, legal personality of conjoined twins, and a twin study of cannabis use. Interesting information about twins that has appeared in the media is also presented, namely how being taken for twins saved a pair of sisters; twin children of a jailed Nobel Prize winner, British 'biracial' twins, triplets born at the start of Russia's attack on Ukraine, and twins born in different years.

Congenital Mullerian anomalies may lead to acute life threatening emergency in reproductive age group- An experience in a tertiary care centre in Eastern India

Congenital Mullerian anomalies are associated with higher incidence of reproductive failure and adverse obstetrical outcomes. The new ESHRE classification is a precise way to describe a genital anomaly in simple way. Many genital tract anomalies lead to devastating life-threatening conditions but under-reported and poorly explained. This study aims at finding out those anomalies which more frequently lead to specific diseases needing emergency intervention to save life of the patient. This longitudinal observational study evaluates the diagnosis and treatment of 12 patients with congenital Mullerian abnormalities which led to life threatening emergency with case discussion and pictorial documentation. Among 12 women with uterine anomalies 4 abortions, 7 delivered preterm, 1 term delivery occurred. Majority of complications associated with U3 types (58.3%). Other types with complications are U4 (25%) and U2 (16.7%). Presenting features at emergency varied like mimicking ectopic, labour complications, ruptured corpus, placenta previa and accreta as well as iatrogenic perforation. Presence of congenital uterine anomalies have adverse effect on obstetrical outcome. Majority of complications are associated with U2, U3 &amp; U4. Probably U1 doesn’t interfere with ongoing pregnancy and U5 fails to continue pregnancy. This knowledge warrants the need for a larger case control study to extrapolate these findings to the general population and also to recommend the need for universal Prenatal Screening for uterine anomalies so as to improve the obstetrical outcome in patients with uterine anomalies.

Does recurrent implantation failure exist? Prevalence and outcomes of five consecutive euploid blastocyst transfers in 123987 patients.

What are the clinical pregnancy and live birth rates in women who underwent up to two more euploid blastocyst transfers after three failures in the absence of another known factor that affects implantation? The fourth and fifth euploid blastocyst transfers resulted in similar live birth rates of 40% and 53.3%, respectively, culminating in a cumulative live birth rate of 98.1% (95% CI = 96.5-99.6%) after five euploid blastocyst transfers. The first three euploid blastocysts have similar implantation and live birth rates and provide a cumulative live birth rate of 92.6%. An international multi-center retrospective study was conducted at 25 individual clinics. The study period spanned between January 2012 and December 2022. A total of 123987 patients with a total of 64572 euploid blastocyst transfers were screened for inclusion. Patients with a history of any embryo transfer at another clinic, history of any unscreened embryo transfer at participating clinics, parental karyotype abnormalities, the use of donor oocytes or a gestational carrier, untreated intracavitary uterine pathology (e.g. polyp, leiomyoma), congenital uterine anomalies, adenomyosis, communicating hydrosalpinx, endometrial thickness <6 mm prior to initiating of progesterone, use of testicular sperm due to non-obstructive azoospermia in the male partner, transfer of an embryo with a reported intermediate chromosome copy number (i.e. mosaic), preimplantation genetic testing cycles for monogenic disorders, or structural chromosome rearrangements were excluded. Ovarian stimulation protocols and embryology laboratory procedures including trophectoderm biopsy followed the usual practice of each center. The ploidy status of blastocysts was determined with comprehensive chromosome screening. Endometrial preparation protocols followed the usual practice of participating centers and included programmed cycles, natural or modified natural cycles. A total of 105 (0.085% of the total population) patients met the criteria and underwent at least one additional euploid blastocyst transfer after failing to achieve a positive pregnancy test with three consecutive euploid blastocyst transfers. Outcomes of the fourth and fifth euploid blastocyst transfers were similar across participating centers. Overall, the live birth rate was similar with the fourth and fifth euploid blastocysts (40% vs 53.3%, relative risk = 1.33, 95% CI = 0.93-1.9, P value = 0.14). Sensitivity analyses excluding blastocysts biopsied on Day 7 postfertilization, women with a BMI >30 kg/m2, cycles using non-ejaculate or donor sperm, double-embryo transfer cycles, and cycles in which the day of embryo transfer was modified due to endometrial receptivity assay test result yielded similar results. Where data were available, the fourth euploid blastocyst had similar live birth rate with the first one (relative risk = 0.84, 95% CI = 0.58-1.21, P = 0.29). The cumulative live birth rate after five euploid blastocyst transfers was 98.1% (95% CI = 96.5-99.6%). Retrospective design has its own inherent limitations. Patients continuing with a further euploid embryo transfer and patients dropping out from treatment after three failed euploid transfers can be systematically different, perhaps with regard to ovarian reserve or economic status. Implantation failure seems to be mainly due to embryonic factors. Given the stable and high live birth rates up to five euploid blastocysts, unexplained recurrent implantation failure should have a prevalence of <2%. Proceeding with another embryo transfer can be the best next step once a known etiology for implantation failure is ruled out. None. N/A.

Vaginal Agenesis: Diagnosis on Ultrasound and Management of a Case at the Gabriel Toure University Hospital in Bamako (Mali)

Abstract: Vaginal malformations can be diagnosed by ultrasound in a large number of cases. The prevalence of uterovaginal aplasia usually reported in the literature is 1/4000 to 1/10,000. Objectives: We tell you about the difficulties of diagnosis with ultrasound, the difficulties of managing our case of vaginal aplasia. Observation: This was a 20-year-old patient saleswoman, single. History of the Disease: was marked by cyclic pelvic headache for 6 months with primary amenorrhea. She has no particular medical-surgical history. On Physical Examination: secondary sexual characteristics were developed. On inspection of the vulva, normal pubic hair was noted. Examination of the vulva showed the labia majora and labia minora present and normal-looking. A hymen could not be identified and there was no visible vaginal opening. Faced with this clinical and paraclinical symptomatology, we made the diagnosis of vaginal agenesis. The ultrasound showed a uterus measuring about 92x71x62 mm, its parenchyma is homogeneous, its contours are regular. The presence in the uterine cavity at the corporeofundic level of a homogeneous echogenic collection of about 66.5 cc (69x35 mm). Note the congenital malformation of the cervix with agenesis). The Surgical Procedure Performed: is vaginoplasty. Conclusion: Ultrasound of uterine malformation is difficult and requires some experience from the sonographer.

Spontaneous Fistula and Abdominal Wall Endometriosis Due to Occult Existence of Unicornuate Right Uterus with Rudimentary Non-Communicating Functioning Left Horn.

Accurate diagnosis of Müllerian duct anomalies (MDA) remains a clinical challenge even by direct surgical inspection. Although obstetrical complications are more frequent in women with MDA, some subtypes allow normal reproduction, further delaying the diagnosis. Unicornuate uterus with a rudimentary non-communicating functioning horn is a rare form of MDA, susceptible to many gynecologic and obstetric complications such as miscarriages, premature birth, hematosalpinx, endometriosis, and chronic pelvic pain. We present an entire case pictorial assay including preoperative imaging as well as the surgical correction of the uterine anomaly and the associated complication of an occult unicornuate right uterus with rudimentary non-communicating functioning left horn (Class U4aC0V0/ European Society of Human Reproduction and Embryology/European Society of Gastrointestinal Endoscopy Classification) and its natural evolution following a previous incomplete surgical treatment. The patient had an emergency left adnexectomy for hematosalpinx and ovarian endometrioma at her local county hospital. After five years, the patient presented with severe dysmenorrhea and abdominal endometriosis due to blocked retrograde menstruation from a rudimentary, non-communicating functioning horn. Surgical treatment with the resection of the rudimentary uterine horn, together with the abdominal wall endometriosis lesions, was carried out with good outcomes.

Discrepancies Between Imaging Reports and Operative Findings in Patients With Cloaca: A Call for Expansion of the Mullerian Anomalies Classification

BackgroundThere is wide variation in the language used to describe Mullerian structures. To standardize terminology, the American Society of Reproductive Medicine (ASRM) created the Mullerian Anomalies Classification (MAC) in 2021. The objective of this study was to evaluate the applicability of the MAC nomenclature to pediatric patients with cloaca. MethodsA retrospective review of all patients with cloaca was performed at a single institution. Descriptions of Mullerian structures were evaluated and compared to the ASRM MAC categories. Descriptive statistics were used to report findings. Results36 patients with cloaca were identified, 13 (36%) of whom had congenital Mullerian structures that could not be adequately described by the MAC terminology. All 13 patients had two hemiuteri that were not connected in the midline and were not accurately described as uterus didelphys. Additionally, 5 of these 13 patients had reproductive anatomy that was connected by a fistula or ectopic connection to other pelvic structures. ConclusionDespite the ASRM expansion of the Mullerian anomalies nomenclature, more than a third of our patients with cloaca could not have their Mullerian structures accurately described. Describing anatomy with accurate and consistent language can improve communication between healthcare providers and may allow patients and families to better anticipate fertility options. Study TypeRetrospective. Level of EvidenceIV.