Uterine Anomalies Research Articles

7986 Laparoscopic Left Adnexal Cystectomy in a Pediatric Patient with Infected Ohvira

<h3>Study Objective</h3> Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) is an abnormality of Mullerian development typically diagnosed after menarche with painful menses due to the obstructed outflow of one hemivagina. Microperforations may occur in the vaginal septum which can lead to infected hematometrocolpos, intermenstrual bleeding, and abnormal discharge. <h3>Design</h3> We present a video demonstrating the case of a twelve-year-old girl with history of renal anomaly and painful menses with intermenstrual bleeding and persistent discharge. Preoperative imaging suggested OHVIRA with an eight-centimeter adnexal cyst on preoperative imaging. Differential diagnosis of the adnexal cyst included tubo-ovarian abscess, ovarian or paratubal cyst, and ectopic ureter leading to a fluid collection. <h3>Setting</h3> Concurrent laparoscopic and vaginal surgery at an academic children's hospital medical center. <h3>Patients or Participants</h3> Twelve-year-old girl with history of renal anomaly and gynecologic symptoms. <h3>Interventions</h3> The vaginal septum was removed in the operating room, revealing purulent hematocolpos consistent with infection. Laparoscopy allowed for diagnosis of paratubal cyst with adnexal inflammation and concurrent cystectomy, in addition to permitting confirmation of uterine anatomy for future guidance. <h3>Measurements and Main Results</h3> Postoperatively, the patient healed well from laparoscopy. Her vaginas were unified, and she was counseled that she has two cervices and hemi-uteri for future gynecologic planning. <h3>Conclusion</h3> While a majority of cases of OHVIRA may be surgically corrected with vaginal surgery alone, the addition of laparoscopy allowed for diagnosis and treatment of the concurrent paratubal cyst at the time of vaginal septum resection.

Minimally Invasive Surgical Approach to Tubo-Ovarian Abscess in Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome

<h3>Study Objective</h3> We present a case of an acute presentation of tubo-ovarian abscess in the setting of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) syndrome in a non-sexually active adolescent, and demonstrate the surgical principles and techniques used int the management of the tubo-ovarian abscess and obstructed hemivagina/septum. <h3>Design</h3> Case report and surgical video. <h3>Setting</h3> Vaginoscopy and four port laparoscopy. <h3>Patients or Participants</h3> An adolescent female who has never been sexually active, presenting with a tubo-ovarian abscess on a background of OHVIRA syndrome. <h3>Interventions</h3> Vaginoscopy for identification of patent cervix and vaginal septum, laparoscopic drainage of tubo-ovarian abscess, adhesiolysis, and right salpingectomy, vaginoscopic septal resection with monopolar Collins knife. <h3>Measurements and Main Results</h3> A 15-year-old female, who had never been sexually active, presented with lower abdominal pain, fevers and malodorous vaginal discharge. Imaging of the pelvis demonstrated a right tubo-ovarian abscess of 5.8 × 4.7 × 5.8cm, uterine didelphys, obstructed right vaginal cavity, and right renal agenesis, suggesting OHVIRA syndrome. Medical management with intravenous antibiotics was unsuccessful, and the patient was managed surgically in a minimally invasive manner. Vaginoscopy identified a normal left cervix, and a small perforation was noted in the vaginal septum. Laparoscopy revealed a right sided tubo-ovarian complex adherent to the right pelvic side wall, bowel, and omentum. Blunt dissection and electrosurgical techniques were used to adhere to tissue planes. Drainage of multiple collections and a subsequent right salpingectomy was performed. A monopolar Collins knife was used with the vaginoscopy to resect the vaginal septum. The patient recovered well and was discharged shortly after her procedure. <h3>Conclusion</h3> Vaginoscopic septal resection is feasible in the setting of OHVIRA syndrome and in non-sexually active patients. Pre-operative imaging allows correct diagnosis of OHVIRA and assist in surgical planning. Care must be taken in tissue dissection to avoid injury.

Repair of Isthmocele Following Embolization of Uterine Arteriovenous Malformation

<h3>Study Objective</h3> Discuss advantages of ethylene vinyl alcohol copolymer (EVAC) use for uterine arterio-venous malformation (AVM). Demonstrate technique for vascular control during robotic repair of isthmocele. <h3>Design</h3> Video documentation of the surgical procedure (instructive video). <h3>Setting</h3> University of California, San Francisco Hospital operating room with patient placed in dorsal lithotomy positioning. <h3>Patients or Participants</h3> A 37-year-old woman, status-post embolization of uterine AVM, presenting with a 3.5 × 2.5 cm uterine isthmocele. <h3>Interventions</h3> Discuss embolization of a uterine AVM. Then, present a case of AVM with isthmocele, review the patient's imaging, and show a stepwise approach to the procedure. Hysteroscopy is performed to identify the isthmocele location and visualize the cavity post-embolization. The robotic platform was chosen as the mode of surgery. Entry into the retroperitoneum with transient occlusion of the uterine arteries is planned due to proximity of isthmocele to left uterine artery as seen on MRI. Once the pararectal space is entered the ureter is localized on the medial leaf of the broad ligament. The uterine artery is then isolated and skeletonized. This procedure is performed bilaterally. Vascular clamps are then placed on the uterine arteries at their respective origins. The bladder is also backfilled to aid in creation of a bladder flap given the history of c-section. With firefly technology, the borders of the isthmocele are identified. This area is resected, the residual copolymer is removed from the defect, and the hysterotomy is repaired in two layers using unidirectional barbed suture. At the conclusion of the case, the vascular clamps are removed and vascular supply is restored. <h3>Measurements and Main Results</h3> Isthmocele resection and repair was achieved with an estimated blood loss of 25mL. The patient's symptoms resolved. <h3>Conclusion</h3> Evaluation of pathology on pre-operative imaging can impact surgical approach. Transient occlusion of the uterine arteries can aid in repair of isthmocele with minimal blood loss.

MRI Evaluation of Mullerian Duct Anomalies: Practical Classification by the New ASRM System.

To describe variable mullerian duct anomalies using magnetic resonance imaging (MRI) and to classify these anomalies according to the available classification systems, namely the American Fertility Society (AFS) system, the European Society of Human Reproduction and Embryology (ESHRE) system, and the new American Society for Reproductive Medicine (ASRM) system. Retrospective chart review. The pelvic MRI studies and the clinical records of 64 females with mullerian congenital anomalies were retrospectively reviewed between January 2010 and December 2021. The mean age was 22 years (age range 2-63 years). Detailed imaging findings were recorded, and the resulting mullerian anomalies were then classified according to the three classification systems of interest. Variable mullerian anomalies were found among patients with multiple frequencies. Mullerian agenesis and hypoplasia were found in 12 patients (19%) and 16 patients (25%), respectively. Uterus didelphys was found in 5 patients (8%). Twelve (19%) patients had septate uterus, while 8 (12.5%) had a bicornuate anomaly. Unicornuate uterus was present in 7 patients (11%). Isolated vaginal anomaly was diagnosed in 4 patients (6%). Renal/urinary tract imaging was available for 27 (42%) patients, and accompanying urinary tract anomalies were noted in 10 of them (37%). Few ovarian and other extra-renal anomalies were observed. MRI could efficiently delineate the mullerian anomalies regardless of their complexity. Most of these anomalies were more efficaciously categorized by the ESHRE and the new ASRM systems, compared to the originally widely used AFS system. The new ASRM classification was found to be more practical as it is a modification of the original AFS system, using drawings with clear descriptions instead of symbols. This is particularly helpful in the radiological era, saving time and effort.

A case of Uterine didelphis with cervical atresia: A Case Report

Congenital uterine malformations are deviations from normal anatomy resulting due to defective fusion of Mullerian ducts or the paramesonephric ducts in the developing embryo. The prevalence of female genital tract anomalies is 4%-7% in general population and up to 8%-10% in women who have recurrent pregnancy loss.(1) The type and degree of anatomical distortion has associated health implications that may include, cyclical abdominal pain, reproductive failure, obstructed menses and inability to engage in sexual intercourse.(2) Uterus didelphys (double uterus) is a developmental abnormality that results from the failure of fusion of the Mullerian ducts leading to separate uterine cavities and 2 cervices 1. It is a rare anomaly accounting for 5% of all uterine anomalies. (3) Cervical agenesis is a rare Mullerian anomaly with an incidence of 1 in 80,000 females. (4) It represents 3% of all uterine anomalies. It is rarely associated with a functioning uterus (4.8%). Cervical agenesis is often associated with vaginal atresia (less than 50%). It is important to classify these anomalies for easy diagnosis and plan appropriate preoperative treatment.

8849 Niamh Joyce MD, OBSTETRICS AND GYNECOLOGY, MRCOG, Fellow in Reproductive Medicine

<h3>Study Objective</h3> Video demonstration of fertility sparing laparoscopic treatment for a symptomatic Müllerian Tract abnormality <h3>Design</h3> Single Case Report. <h3>Setting</h3> Tertiary Academic Hospital. 3 port laparoscopy, with patient in Trendelenburg Lithotomy position <h3>Patients or Participants</h3> A 16-year-old nulliparous patient presented with intractable dysmenorrhea since menarche aged 15, associated with syncope. There was no response to analgesia or hormonal contraception and the impact on quality-of-life necessitated surgical review. Initial assessment by pelvic ultrasound identified normal ovaries and uterus but a solid appearing right adnexal lesion. Further imaging by MRI showed evidence of a double uterus with only the left sided uterus communicating with the vagina in keeping with an ASRM class II(b) abnormality. Differential diagnosis included Mullerian duct abnormality and accessory and cavitated mass. A uterine didelphys with only a left ostia was seen on hysteroscopy. Laparoscopy showed a uterine didelphys with a non-communicating, engorged right uterus and right fallopian tube. Her case was discussed at a multidisciplinary meeting where it was decided the most suitable treatment was to perform a laparoscopic hemi-hysterectomy with right salpingectomy to remove the right sided non communicating cavity and tube. This procedure was recorded with the patient's consent and will be shown as part of the video presentation. <h3>Interventions</h3> Laparoscopic hemi-hysterectomy for resection of non-communicating uterine horn. EBL minimal. Operative time 37 Mins, hospital stay 1 night. <h3>Measurements and Main Results</h3> A successful laparoscopic intervention was performed, and the patient was discharged day 1 post op. Review at clinic revealed completed resolution of symptoms, normal menses. Future fertility was a primary concern and was successfully conserved. Histology demonstrated a functioning endometrial cavity with focal adenomyosis. <h3>Conclusion</h3> Class II Müllerian abnormalities are uncommon, affecting around 0.06% of females. Symptoms can include pain or menstrual dysfunction as well as fertility/obstetric complications. When necessary, a minimally invasive approach can be utilized to treat these conditions.

RF34 | PMON19 Biallelic Variants in the INHA Gene Are the Cause of Gonadal Dysgenesis, Primary Amenorrhea and Absence of Puberty in the Setting of Hypergonadotropic Hypogonadism

Abstract Background Hypergonadotropic hypogonadism can be caused by congenital or acquired causes. These can range from chromosomal abnormalities, enzymatic defects or mutations that cause gonadotropin resistance, trauma, chemotherapy, infections etc. It is uncommon in females other than in Turner syndrome and not all the genetic etiologies are known. Clinical Case A 15 10/12 year old female with primary amenorrhea and absent pubertal development presented with FSH and LH levels of 35.24 mIU/mL and 14.38 mIU/mL, respectively and non-pubertal estradiol levels of 4 pg/mL consistent with hypergonadotropic hypogonadism. Her evaluation showed a normal 46,XX female karyotype and no evidence of hyperandrogenism or thyroid dysfunction. Ultrasound showed no evidence of ovaries and a rudimentary uterus measuring 0.9 cm×1.4 cm×1.2 cm with a delayed bone age of 12 years. Family history was positive for mother having delayed puberty with menarche at 16.5 years of age. Patient was started on hormone replacement therapy with transdermal estrogen. Four months after treatment she developed breast buds and vaginal discharge. After 1.5 years, the uterus measurements were 5.7 cm x3.7 cm x2.2 cm although no ovarian tissue or follicles were identified on MRI. Her biochemical profile also showed decreases in FSH (3.48 mIU/mL) and LH (0.99 mIU/mL) and an increase in estradiol (38pg/mL). Exome sequencing was performed and revealed biallelic missense variants c.766C&amp;gt;T, p.(Pro256Ser) and c.1036G&amp;gt;C p.(Gly346Arg) in exon 2 of the INHA (NM_002191) gene. Both variants are rare in the human population, seen in a heterozygous state with a global allele frequency (gnomADv2.1) of 0 and 0.00002790 (rs780833794), respectively, and predicted to be damaging by bioinformatic tools. INHA, a member of the transforming growth factor-β (TGF-β) superfamily, encodes the alpha subunit of glycoprotein hormones inhibin A and B. Studies in animal models indicate that inhibin A negatively regulates follicle stimulating hormone (FSH) secretion by suppressing FSHR expression and plays a crucial role in ovarian steroid hormone production, follicular development, proliferation and apoptosis of granulosa cells, and oocyte maturation. Heterozygous pathogenic variants in the INHA gene have been reported in patients with primary ovarian insufficiency (POI) and secondary amenorrhea1, while our patient with biallelic variants in INHA is affected by gonadal dysgenesis, primary amenorrhea, absence of puberty, a more severe POI phenotype. Conclusion To our knowledge, this is the first case of biallelic mutations in INHA gene leading to a severe phenotype (gonadal dysgenesis, primary amenorrhea and absence of puberty) compared to heterozygous mutations that lead to POI with secondary amenorrhea. 1

Laparoscopic Hemi-Hysterectomy for Excision of a Functional Rudimentary Uterine Horn Keys to Success

<h3>Study Objective</h3> To present a case of unicornuate uterus with a non-communicating rudimentary horn complicated with hematometra and describe important steps for successful laparoscopic surgical management. <h3>Design</h3> Description of the relevant anatomy and surgical technique with the use of video. <h3>Setting</h3> academic tertiary hospital. <h3>Patients or Participants</h3> A 19-yo female patient with history of dysmenorrhea. Exam revealed normal vagina and cervix deviated to the left, with an adnexal mass on the right. Ultrasound and MRI further delineated a right rudimentary horn with active endometrium, possible hematometra. A renal ultrasound ruled out renal anomaly. Hysteroscopy revealed a normal appearing unicornuate uterus with a tubal ostium. A Rummi manipulatorwas placed. Then, laparoscopic pelvic survey confirmed a left unicornuate uterus with an enlarged right rudimentary horn, no endometriosis was found. Next, ureterolysis was performed, followed by right salpingectomy with ovarian preservation. Vasopressin was injected to the base of the horn (20 units in 100 ml of normal saline). The right utero-ovarian and round ligament were taken down with ligasure device and bladder flap was developed. Next, monopolar L hook was used to resect the rudimentary horn. This was followed by uterine closure in two layers with 2-0 V lock barbed suture. Rudimentary horn was exteriorized in a 10 cm endobag. <h3>Interventions</h3> surgical procedure: diagnostic hysteroscopy, laparoscopic hemihysterectomy for excision of a functional non communicating rudimentary horn. <h3>Measurements and Main Results</h3> Patient was discharged on the same day of the procedure and had an uncomplicated postsurgical course. <h3>Conclusion</h3> Understanding the nature of the uterine anomaly before surgery is of paramount importance for the management of obstructive anomalies of the female genital tract. Laparoscopy is a safe and effective treatment modality to provide pain relief, avoid sequelae, and allow for the preservation of reproductive function.

7378 Correction of Uterine Anomalies and Its Effect on Infertility and Recurrent Miscarriages in a Study Including 10000 Patients over 6 Years

<h3>Study Objective</h3> use of hysteroscopic metroplasty to enhance and promote the uterine receptivity in infertile women and those who had recurrent miscarriages. <h3>Design</h3> prospective study for 6 years from 2016 including 12000 cases of primary infertility and recurrent miscarriages. <h3>Setting</h3> operative hysteroscopy both 5mm and 9mm, patient on lithotomy position under either general or spinal anaesthesia. <h3>Patients or Participants</h3> cases were selected as primary infertility for more than 2 years, recurrent IVF or ICSI failure, recurrent miscarriages who had 3D transvaginal ultrasound assessment that revealed anomalies including Narrow T shaped, tubular, subseptated and septated cavities. <h3>Interventions</h3> hysteroscopic metroplasty to reach the normal cavity shape and dimensions. If excessive raw area levonorgestril triple dose for 21 days used post operative to enhance healing and putting Foleys catheter size 10 F for 3 days post operative. <h3>Measurements and Main Results</h3> 3D transvaginal ultrasound +or - saline sono hystrography done post hysteroscopic correction by one cycle to compare the shape and dimensions with the preoperative one and to ensure absence of intrauterine adhesions. 88% of cases had successfully got pregnant and continued their pregnancy beyond 36 weeks, 6 % had preterm labour between 30-36 weeks, 2% had preterm labour 28-30 weeks and 4 % still under follow up. <h3>Conclusion</h3> correction of uterine anomalies has a strong significance on success of implantation in cases of infertility, recurrent IVF and ICSI failure and recurrent miscarriages after prober 3D transvaginal ultrasound.

OBSTETRIC OUTCOMES IN WOMEN WITH CONGENITAL UTERINE ANOMALIES: A BIG DATA APPROACH

Populational data on obstetric outcomes in women with congenital uterine anomalies (CUAs) has been lacking due to limited sample sizes and the fact that many women are asymptomatic until presentation at time of delivery or pregnancy loss. Preconception counseling has therefore presented a challenge for the reproductive endocrinologist.

Abortion in Patient with Obstructive Longitudinal Vaginal Adhesion following Vaginal Prolapse Surgery: A Case Report

A vaginal adhesion is an uncommon complication of vaginal surgery. While treatment options for radiation-induced vaginal stenosis and vaginal septum have been well-characterized, there is little to guide surgeons providing care to patients with intravaginal adhesions.

A Case Report On Imperforated Hymen

At pubescence, a patient with a flawless hymen commonly gives a vaginal lump of flimsy hymeneal tissue with a dim or somewhat blue tone brought about by the hematocolpos behind it. Different discoveries that might be available incorporate stomach bulk, incontinence of urine, obstruction, and dysphasia. The objective of evaluation is to distinguish a perfect hymen from other blocking anatomical causes; such are the distal vaginal artesian, urogenital sinus, cross-over vaginal septum, and labial connections. Careful mediation is fundamental just in suggestive pre adolescent client. Following the declaration of the conclusion, Most of the time, careful intervening is permitted prior to pubertal estrogenization because the flawless hymen might open precipitously at pubescence. Finishing a stomach and a perinea examination is significant. Further imaging is not necessary if an ultrasound reveals hematocolpos and a genuine assessment shows a swollen hymen. Nonetheless, on the off chance that the results are uncertain or alternatively, A cross-over or longitudinal vaginal septum, immaculate or cervical arteriosclerosis, an obstructed uterine horn, or any of these conditions may be present, according to attractive reverberation imaging. The ideal time for careful mediation on hymnal tissue is before the beginning of agony and after the beginning of the pubertal turn of events when the vaginal tissue is nitrogenised. Careful administration of clinically critical hymnal varieties includes extraction of the hymeneal tissue and seldom is related to long-haul squeal. If the patient is concerned for whatever reason a cross-over vaginal septum or a distal vaginal artesian, the patient should have skilfully alluded to the middle in the treatment of these illnesses. A thin strip of stratified squamous epithelium called the hymen surrounds the vaginal introits. An imperforate hymen is one that does not spontaneously rupture throughout a new-born’s growth. The female genital and urinary systems may become obstructed during pregnancy, childhood, or adolescence due to an imperforate hymen, an uncommon reason for primary amenorrhea. When endogenous maternal oestrogen is stimulated in infants with the virginal membrane, a mucosal. The Müllerian duct and the urogenital sinus make up the transverse vaginal septum. Which is a remnant of the vaginal plate? The failure of the membrane among the urogenital sinuses and the vaginal cavity to perforate leads to an imperforate hymen. We describe a rare instance of these two situations coexisting. A 16-year-old woman was referred to our hospital after receiving multiple puncture therapies for hematomata and hematocolpos when she was 16 years old owing to her monthly incidence of lower abdomen discomfort without menstrual flow. The growth of the vaginal fornix, hematomata, and hematocolpos were seen on magnetic resonance imaging. The imperforate hymen was cut, and there was a little adhesion that could be detached at the lower vaginal cavity. After that, a 5 mm thick full transverse vaginal septum was found. After a puncture that was guided by ultrasonography, it was removed. Melamine persisted although there were two cycles of menstrual flow. Six months after the initial procedure, a second operation was carried out; when it was observed that there was once again adhesion in the lower vaginal cavity. She was given a silicon dilator but was unable to use it at home, so she substituted a tampon. Four months following the second operation, cyclical menstrual bleeding is seen.

Forty-two normomenstruating adolescents with Müllerian obstructive anomalies: Presentation, pitfalls in the dagnosis and surgical management.

We analyzed the frequency, presentation and pitfalls in the diagnosis and surgical management of a large group of normomenstruating adolescents with obstructive reproductive tract anomalies. Retrospective analysis of prospectively collected data. Of the 143 outpatients referred for severe dysmenorrhea and persistent pelvic pain, 42 (29.3%) young women with obstructive Müllerian anomalies and regular menstrual flow were identified. These patients were divided into four groups: (1) patients with duplicate uterine cavities, obstructed hemivagina and ipsilateral renal agenesis (n=34); (2) patients with unicornuate uterus and noncommunicating cavitated rudimentary horn (n=5); (3) patients with accessory cavitated uterine mass (n=2); (4) patients with partially obstructed transverse vaginal septum (n=1). All 42 patients were conservatively treated via laparoscopy and 35/42 patients had also vaginal surgery. Of the four groups, patients in groups 2 and 3 (n=7) were conservatively managed by laparoscopy alone; for patients in groups 1 and 4 (n=35), laparoscopy and the vaginal approach were used. Patients of group 1 were treated by resecting the obstructed vaginal septum with drainage of retained collections. In patients in group 2, surgery consisted of the removal of the rudimentary horn. Patients of group 3 were treated by the removal of myometrial neoformations. In the patient in group 4, treatment consisted of removal of the septum. All surgical procedures were successful and no major complications were recorded. Follow-up reports highlighted the disappearance of obstruction and clear improvement in pain symptoms. Unilateral obstructive anomalies of the female genital tract are difficult to identify. Early diagnosis allows the preservation of reproductive activity and avoids potential complications.

Evidences in Uterine Artery Embolization: A Radiologist's Primer

AbstractUterine artery embolization is an established minimally invasive therapy for symptomatic fibroids. It has also been used for other diseases of the uterus, including adenomyosis, uterine arteriovenous malformation, ectopic pregnancy, abnormal invasive placenta, and postpartum hemorrhage. In this review, we provide an updated and comprehensive review of uterine artery embolization based on the evidence published. We review the indications, the role of MRI, technical aspects, and complications of the procedure. The issues with a future pregnancy, risk of infertility, and fetal radiation are discussed as well.

Herlyn Werner Wunderlich Syndrome: A Very Rare Presentation in a Teenage Girl

Background: Uterus didelphys with blind hemivagina Ipsilateral renal agenesis (Herlyn Werner Wunderlich Syndrome) is a rare congenital anomaly. The true incidence of this anomaly is unknown, but it has been reported between 0.1% and 3.8%. Another name is “Double uterus-hemivaginal-renal agenesis syndrome." Case Summary: We present the case of Uterus didelphys with hemivagina with ovarian endometrioma ē Ipsilateral renal agenesis in a 14- year-old girl. Patient was symptomatically treated. She was then referred to BSMMU on 28-02-22 for further management. Conclusion: Neglected and inappropriately managed Uterus didelphys with hemivagina with ovarian endometrioma ē Ipsilateral renal agenesis can lead to endometriosis and infertility.

Term delivery of dicavity twins in a uterus didelphys by bilateral caesarian section

Twin pregnancy continuing up to term in a uterus didelphys is an extremely rare occurrence. The following is a case report of such an event at District Base Hospital, Dambulla, Sri Lanka.

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.

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.

A Rare Case: Unicornuate Uterus With Rudimentary Horn and Multiple Fibroids in Both Horns and Plexus of Varicose Vessels

Uterine malformations occur in 0.2% to 5% of the female population and depend on the patient's demographics and the examination method. The prevalence is 3.5% to 6.5% in patients with infertility and up to 38% in patients with a history of abortions [1]. The unicornuate uterus is a relatively rare type of uterine malformation, which is present in approximately 1 in 500 women, accounting for 4% to 10% of all major uterine anomalies [2]. Myomas in the rudimentary horn in the unicornuate uterus occur rarely.

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.