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

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.

Imaging and diagnostic accuracy of outpatient and inpatient hysteroscopy

Aim. To compare the results of visualisation and diagnostic accuracy during outpatient and inpatient hysteroscopy in women with endometrial disease.Materials and Methods. We performed a retrospective analysis of patients with uterine diseases who underwent outpatient hysteroscopy at Kemerovo City Clinical Hospital №4 (n = 300) or inpatient hysteroscopy within the hospitals (n = 300) in Kemerovo from 2018 to 2020. Confirmation of endometrial disease was carried out by manual vacuum aspiration.Results. Indications, imaging, and diagnostic accuracy did not differ for most endometrial diseases in outpatient and inpatient hysteroscopy, yet inpatient hysteroscopy was the option of choice in women with infertility (p = 0.035). Diagnostic accuracy of outpatient and inpatient hysteroscopy was highly concordant, albeit outpatient hysteroscopy more often revealed adenomyosis and uterine malformation and less often identified endometrial polyps.Conclusion. Outpatient and inpatient hysteroscopy are equally efficient, although outpatient hysteroscopy has its benefits in detecting adenomyosis and uterine malformation and be less informative in diagnosing endometrial polyps.

Diagnosing Septate Uterus Using Three-Dimensional Ultrasound Using Three Different Classifications: An Interobserver and Intraobserver Agreement Study

Objective Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed. Objective To assess the interobserver agreement of nonexpert sonographers for classifying septate uterus using the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformations by Experts (CUME) classifications. Methods A total of 50 three-dimensional (3D) volumes of a nonconsecutive series of women with suspected uterine malformation were used. Two nonexpert examiners evaluated a single 3D volume of the uterus of each woman, blinded to each other. The following measurements were performed: indentation depth, indentation angle, uterine fundal wall thickness, external fundal indentation, and indentation-to-wall-thickness (I:WT) ratio. Each observer had to assign a diagnosis in each case, according to the three classification systems (ESHRE/ESGE, ASRM, and CUME). The interobserver agreement regarding the ESHRE/ESGE, ASRM, and CUME classifications was assessed using the Cohen weighted kappa index (k). Agreement regarding the three classifications (ASRM versus ESHRE/ESGE, ASRM versus CUME, ESHRE/ESGE versus CUME) was also assessed. Results The interobserver agreement between the 2 nonexpert examiners was good for the ESHRE/ESGE (k = 0.74; 95% confidence interval [CI]: 0.55–0.92) and very good for the ASRM and CUME classification systems (k = 0.95; 95%CI: 0.86–1.00; and k = 0.91; 95%CI: 0.79–1.00, respectively). Agreement between the ESHRE/ESGE and ASRM classifications was moderate for both examiners. Agreement between the ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2. Agreement between the ASRM and CUME classifications was good for both examiners. Conclusion The three classifications have good (ESHRE/ESGE) or very good (ASRM and CUME) interobserver agreement. Agreement between the ASRM and CUME classifications was higher than that for the ESHRE/ESGE and ASRM and ESHRE/ESGE and CUME classifications.

A successful pregnancy outcome after surgical treatment for a bicornuate uterus. Case report

This article presents a clinical case in a woman with a full two-legged uterus. This pathology in the patient was revealed by ultrasound examination in 2013. There is one spontaneous miscarriage in the anamnesis; later, the patient did not become pregnant with regular sexual activity without contraception. A comprehensive examination of the patient was carried out. It was decided to conduct a hysteroscopy, during which one cervical canal was identified, in the area of the internal pharynx, a division into two hemipolostas was visualized. In the future, the patient underwent Strassmanns reconstructive plastic surgery, which is the gold standard for this pathology. Laparatomic metroplasty is a safe and effective procedure for women with a bicornuate uterine malformation. The postoperative period was uneventful. A year later, the patient became pregnant in the natural cycle. Pregnancy proceeded without complications, culminating in the birth of a healthy child.

Role of Diagnostic Hysterolaparoscopy in the Evaluation of Infertility - A Prospective Study from Telangana, India

BACKGROUND Infertility is a multidimensional health problem with social and economic consequences. Infertility affects about 10 - 15 % of reproductive age couples. 1 Hysterolaparoscopy is safe and effective method to diagnose infertility. The purpose of this study was to determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in Chalmeda Anand Rao Institute of Medical Sciences. METHODS A prospective hospital-based study was carried out in Chalmeda Anand Rao Institute of Medical Sciences over a period of 1 year from August 2019 to July 2020. Hysterolaparoscopy was done in 100 patients. Women aged 20 - 40 years with normal hormone profile without male factor infertility were included. RESULTS 100 patients with infertility were undertaken, 70 (70 %) women had primary infertility and the remaining 30 (30 %) had secondary infertility. Ovarian pathology (30 %), endometriosis (23 %), tubal pathology (14 %) and pelvic adhesion (14 %) were the most well-known anomalies recognized in laparoscopy in both primary and secondary infertility. Uterine septum was major intrauterine pathology seen in two gatherings. Out of 12 patients having uterine malformations, most regular uterine malformation in both the gatherings was 9 uterine septum and 2 unicornuate and 1 was hypoplastic uterus. CONCLUSIONS Combined hysterolaparoscopy is a safe, effective, and reliable method in comprehensive evaluation of infertility. It helps in the diagnosis of pelvic pathology which is missed by routine pelvic examinations and basic investigations done for evaluation of infertility. Hysterolaparoscopy gives the added advantage of doing a therapeutic procedure in the same sitting. Thus, hysterolaparoscopy may be considered as gold standard and definitive investigative day-care procedure for evaluation of female infertility. KEY WORDS Hysteroscopy, Infertility, Laparoscopy

Recurrent uterine rupture in third trimester of pregnancy

We report a case of recurrent upper segment uterine rupture in a 31-year-old woman at 32+5/40 weeks of gestation. She had fundal uterine rupture 3 years ago in her first pregnancy at 40 weeks of gestation. There was no history of uterine malformation or prior uterine surgery. However, we noted that she had had three laparoscopic procedures for endometriosis treatment. She was scheduled to have an elective repeat caesarean section at 34+6/40 weeks of gestation in the index pregnancy. Unfortunately, she presented at 32+5/40 weeks with features of acute abdomen and signs of fetal distress. She had a category 1 caesarean section and was found to have fundal uterine rupture at the same site. She had a smooth uneventful recovery following a timely intervention and discharged home on day 5 postoperatively in a good condition with her baby girl.

Pregnancy on a Rudimentary Unbroken Horn of a Pseudo-Unicornuate Uterus: A Case Report at The University Hospital of Angre Abidjan

The pseudo-unicornuate uterus which is a rare uterine malformation, that can be the site of a pregnancy. Pregnancies in the rudimentary horn usually result in a rupture due to a uterine wall not adapted to the level of the horn, but especially diagnostic difficulties. Their discovery is most often made in intraoperative, when an indication of laparotomy is made for hemoperitoneum in emergency. They are therefore responsible for high maternal-fetal mortality and morbidity. We report in this observation a case of pregnancy in a rudimentary unruptured horn, in a 28-year-old, 4th gesture 2nd parous, the discovery of which was made incidentally, during an indication of laparotomy posed for suspected abdominal pregnancy complicated by a surgical abdomen.