China
Africa
Explore chapters and articles related to this topic
The Origins of Endometriosis
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
The genitalia, irrespective of genetic sex, develop from 2 pairs of genetic ducts, the mesonephric ducts and the paramesonephric ducts, which are an invagination of the coelomic epithelium on the anterolateral side of the genital ridge, running initially laterally to the paramesonephric ridge but crossing ventrally to fuse in the midline, initially with a septum but then fusing to form the uterine canal. It is the failure of this fusion that may lead to uterine anomalies, such as uterus didelphys and, the more common variants, such as a uterine septum. Caudally, the tubes fuse to form the Mullerian tubercle and enter the urogenital sinus alongside the paramesonephric ducts.
Recurrent pregnancy loss
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Christine E. Ryan, Danny J. Schust
One common current theory holds that the causative factor for loss in patients with a septate uterus is implantation on the septum itself. This is thought to result in inadequate placentation secondary to poor septal vascularity and resultant early demise. This theory is supported by the timing of losses: early first trimester with septate uteri versus second-trimester losses or preterm deliveries with bicornuate and unicornuate uteri (13). In addition, although the vascular density of septa is similar to normal myometrium (14), a study of 12 pregnancies in women with septate uteri revealed that the only four successful pregnancies were those that had implanted away from the septum (15). Furthermore, several uncontrolled studies have shown that septum resection leads to an improved rate of successful subsequent pregnancy. A retrospective case series showed that 70% to 85% of RPL patients who underwent surgical correction of bicornuate and septate uteri delivered viable infants in the next pregnancy (16). Hysteroscopic resection of uterine septa leads to comparable subsequent pregnancy rates with those seen after metroplasty (16), leading the American College of Obstetricians and Gynecologists (ACOG) to make a compendium recommendation supporting hysteroscopic resection. No prospective controlled studies have been undertaken. Extensive surgical procedures, such as Strassman unification, are rarely undertaken.
How Long Does it Take Uterine Scar(s) to Heal?
Published in John C. Petrozza, Uterine Fibroids, 2020
A uterine septum is the most common congenital uterine anomaly. The American Society for Reproductive Medicine (ASRM) uterine septum practice committee guidelines published grade C evidence that hysteroscopic septum incision is associated with a reduction in subsequent miscarriage rates and an improvement in live-birth rates in patients with a history of recurrent pregnancy loss. In terms of uterine healing, available evidence suggests that the uterine cavity is healed by 2 months postoperatively, although there is insufficient evidence to advocate a specific length of time before a woman should conceive [9,7,11,12].
MRI image features and differential diagnoses of Herlyn–Werner–Wunderlich syndrome
Published in Gynecological Endocrinology, 2020
Jinlong Zhang, Shengfang Xu, Lei Yang, Yue Songhong
Another differential diagnosis is Congenital vaginal atresia [28–29]: This is caused by defects in genitourinary sinus development, and is relatively rare in the female genital tract. The incidence of congenital vaginal atresia is approximately one in 4000–10,000, and can manifest as distal or complete vaginal atresia. The endometrium and ovaries of the patients are normally developed, but the vagina is partly or completely replaced by fibrous tissue. Congenital vaginal atresia can occur in the lower part of the vagina (type I), while the upper vaginal segment, uterine body, and cervix are typically normal. Type II is complete vaginal atresia, which is often associated with dysplasia of the cervix; much of the uterus can be normal or malformed, but the intima is functional. The main manifestations of congenital vaginal atresia on MRI are dilatation and hemorrhage of the uterine cavity, cervical canal, and mid-upper vaginal segment above the obstruction point. A third differential diagnosis is longitudinal septum of vagina [30–31]. This is an abnormal fusion of the lateral side of the gyne duct. The longitudinal septum of vagina can be complete or partial, depending on whether the lateral fusion of the gyneduct is complete. Complete longitudinal septum of vagina is often accompanied by uterine septum, a double uterus, or a double cervix and urinary system. Simple longitudinal septum of vagina is rare; most cases have no obvious clinical symptoms, and some are only found when examined for sexual concerns or infertility. MRI often manifests as a longitudinal muscle signal separation in the vagina.
Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI
Published in Journal of Obstetrics and Gynaecology, 2022
Bulat Aytek Sık, Ozkan Ozdamar, Ozan Ozolcay, Alper Sismanoglu, Yilda Arzu Aba, Serkan Oral, Mehmet Koc
In line with the controversies in its definition, data regarding the reproductive implications of the uterine septa are limited and conflicting. Uterine septum is frequently diagnosed during the infertility work-up and the incidence is reported to be higher in infertility population, suggesting a possible link between septum and infertility (Acien 1993; Raga et al. 1997; Tomaževič et al. 2010; Venetis et al. 2014). Although many women with septate uteri are known to experience efficient reproductive function (Valle and Ekpo 2013; ASRM 2016), a variety of adverse reproductive outcomes, including infertility, pregnancy loss, and poor obstetrical outcomes, such as malpresentation and preterm delivery, have been attributed to the presence of uterine septa (Chan et al. 2011).
Aetiology of recurrent miscarriage and the role of adjuvant treatment in its management: a retrospective cohort review
Published in Journal of Obstetrics and Gynaecology, 2018
Samuel James Alexander Dobson, Kanna Mannadiar Jayaprakasan
Following ultrasound scanning, 16/242 (6.6%) patients were found to have a either a bicornuate uterus (10/16 (4.1%)) or septate uterus (6/16 (2.5%)). In the septum group, one patient underwent resection of uterine septum with a subsequent live birth. The remaining patients received a mixture of aspirin (n = 2), progesterone (n = 2), LMWH (n = 2) and early pregnancy support alone (n = 11). Of these 15 patients, nine had a subsequent pregnancy resulting in 5 live births. The overall successful live birth rate in this group was 60%.