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Congenital anomalies of the reproductive tract
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Maggie Dwiggins, Veronica Gomez-Lobo
Cervical agenesis occurs when the cervix fails to develop with an otherwise normal reproductive tract (Figure 6.6).26 Cervical agenesis can encompass isolated agenesis of the cervix or agenesis of the cervix and vagina. Several types of cervical agenesis have been described (Figure 6.7). This anomaly is rare with true incidence unknown but estimated to be 1:80,000, and the classical treatment has been by total hysterectomy27; while this does definitely relieve symptoms of obstruction, it renders the patient irreversibly infertile.
Müllerian Anomalies
Published in Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero, Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
Betlem Graupera, Jean L. Browne
Cervical anomalies can be classified according to the ESHRE-ESGE classification.2 Patients with cervical agenesis and with a functioning endometrium present with primary amenorrhea and cyclic pelvic pain due to the obstruction to menstrual outflow. The presence of a normal uterus and an abnormal cervix is infrequent. Patients with cervical anomalies have vaginal agenesis in 50% of cases, particularly those with cervical agenesis. One-third of them will have a uterine anomaly.32 Xie et al. described four types of cervical atresia. Ultrasound reveals liquid accumulation in the uterine cavity and a variable degree of cervical anomalies (Figure 7.21).33
Gynaecological disorders in children
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Lisa M Allen, Rachel F Spitzer
From the list of options above, choose which one is the most appropriate surgical therapy in each of the clinical scenarios. Each option may be used once, more than once, or not at all. A 16-year-old with symptomatic cervical agenesis.A 16-year-old with a unicornuate uterus and functional rudimentary horn.A 16-year-old with a bicornuate uterus.A 16-year-old with a transverse vaginal septum.
Functioning left uterine horn with cervico-vaginal atresia and ovarian maldescent – an unclassified Müllerian anomaly treated with horn-vaginal anastomosis
Published in Journal of Obstetrics and Gynaecology, 2018
Rashmi Bagga, Tanuja Muthyala, Pradeep Kumar Saha, Jasvinder Kalra, Rimpi Singla, Aashima Arora, Tulika Singh
Uterine cervical agenesis is a rare congenital malformation and is classified as class II b variant in the ASRM classification. These girls present with primary amenorrhoea, symptoms of outflow tract obstruction and around half of them have partial or complete vaginal agenesis (Fujimoto et al. 1997). History, loco-regional examination, sonography and MRI help to diagnose obstructive Müllerian anomalies and plan surgery. Reconstructive surgery in the form of cervical canalisation has been performed using an abdomino-perineal approach and a neo-ostium is created by drilling through the atretic cervix to establish a communication between the endometrial cavity and the vagina. Its patency is maintained by stents with or without an overlying skin graft, but fibrotic obliteration occurs in 40–60%. Post-operative adverse effects such as fibrosis of the tract, infection and sepsis have led to recommend hysterectomy for this anamoly (Fujimoto et al. 1997).
Management of partial vaginal agenesis according to the Wharton-Sheares-George technique – a long-term follow-up
Published in Journal of Obstetrics and Gynaecology, 2020
Xuyin Zhang, Xiaoyan Tang, Yan Ding, Keqin Hua
From January 2009 to December 2017, 52 patients with congenital partial (lower section/middle and lower section) vaginal atresia were admitted to the Department of Gynecology, at Fudan University in China. The patients were aged 12–19 years old. The diagnosis was based on physical examination, ultrasonography and MRI. Congenital transverse vaginal septum, hymenal atresia, Mayer-Rokitansky-Küster-Hauser syndrome and cervical agenesis were excluded. The patients’ data were analysed retrospectively. The study was approved by the Ethics Committee of Obstetrics and the Gynecology Hospital of Fudan University.
The accuracy of three-dimensional ultrasonography in the diagnosis of Müllerian duct anomalies and its concordance with magnetic resonance imaging
Published in Journal of Obstetrics and Gynaecology, 2022
Yasin Ertug Cekdemir, Uygar Mutlu, Demet Acar, Canan Altay, Mustafa Secil, Omer Erbil Dogan
Cervical agenesis/dysgenesis constitutes another diagnostic challenge. Careful examination of the axial views demonstrating the cervix may be useful to avoid errors in classification of MDAs. MRI may poorly demonstrate small uterine remnants and tissues without specific radiological features. 3D-US has advantages such as acceptable high-spatial resolution and visualisation of small structures sufficiently (Salim et al. 2003).