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T-Shaped Uterus

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Female Genital Tract Congenital Malformations

Abstract

Aim(s): To present the hysteroscopic treatment of T-shaped uterus and critically evaluate the results by reviewing all the available data in the literature. Brief description of the reviewed data: The T-shaped uterus is a uterine malformation restricted to a subtle cavity deformation, correctly recognized in the ESHRE/ESGE classification. It is reported that this malformation could be associated with failed implantation, increased risk of ectopic pregnancy, miscarriage and preterm delivery. Hysteroscopic correction, by lateral incision of the uterine walls, claims to achieve the normal shape of the cavity and improve the reproductive performance. The current available studies indicate a low surgical risk profile and an improved term delivery rate, nevertheless, concern exists about placentation with reported cases of placenta accreta and severe haemorrhage. Clinical implications: Patients with dysmorphic uterus and history of recurrent pregnancy loss, preterm delivery or infertility prior to entering an assisted reproductive programme could benefit from a hysteroscopic correction. Open issues for further research: The T-shaped uterus described as a rare uterine malformation seems to be a more common finding in patients with infertility and recurrent abortion. The ESHRE/ESGE classification provides the possibility of correct and unbiased group allocation. This is seen as an obligatory condition for correct prevalence studies and to design a multicentre prospective randomized controlled trial to validate the current published studies.

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References

  1. Acunzo G, Guida M, Pellicano M, Tommaselli GA, Di Spiezio Sardo A, et al. Effectiveness of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic adhesiolysis: a prospective, randomized, controlled study. Hum Reprod. 2003;18(9):1918–21.

    Article  CAS  PubMed  Google Scholar 

  2. Aubriot FX, Hamou J, Dubuisson JB, Frydman R, Fernandez H. Hysteroplasty for enlargement: apropos of the results. Gynecol Obstet Fertil. 2001;29(12):888–93.

    Article  CAS  PubMed  Google Scholar 

  3. Barranger E, Gervaise A, Doumerc S, Fernandez H. Reproductive performance after hysteroscopic metroplasty in the hypoplastic uterus: a study of 29 cases. BJOG. 2002;109(12):1331–4.

    Article  PubMed  Google Scholar 

  4. Ben-Baruch G, Menczer J, Mashiach S, Serr DM. Uterine anomalies in diethylstilbestrol-exposed women with fertility disorders. Acta Obstet Gynecol Scand. 1981;60(4):395–7.

    Article  CAS  PubMed  Google Scholar 

  5. Bermejo C, Ten Martínez P, Cantarero R, Diaz D, Pérez Pedregosa J, Barrón E, et al. Three-dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol. 2010;35(5):593–601.

    Article  CAS  PubMed  Google Scholar 

  6. Bosteels J, Weyers S, Mol BW, D’Hooghe T. Anti-adhesion barrier gels following operative hysteroscopy for treating female infertility: a systematic review and meta-analysis. Gynecol Surg. 2014;11:113–27.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Cabau A, Lion O. Accidents de la reproduction et stérilité chez les femmes exposées au DES in utero. Contracept Fertil Sex. 1996;24(4):253–8.

    CAS  PubMed  Google Scholar 

  8. Campo R, Van Belle Y, Rombauts L, Brosens I, Gordts S. Office mini-hysteroscopy. Hum Reprod Update. 1999;5(1):73–81.

    Article  CAS  PubMed  Google Scholar 

  9. Campo R, Molinas CR, Rombauts L, Mestdagh G, Lauwers M, Braekmans P, et al. Prospective multicentre randomized controlled trial to evaluate factors influencing the success rate of office diagnostic hysteroscopy. Hum Reprod. 2005;20(1):258–63.

    Article  PubMed  Google Scholar 

  10. Colacurci N, De Franciscis P, Mollo A, Litta P, Perino A, Cobellis L, et al. Small-diameter hysteroscopy with Versapoint versus resectoscopy with a unipolar knife for the treatment of septate uterus: a prospective randomized study. J Minim Invasive Gynecol. 2007;14(5):622–7.

    Google Scholar 

  11. Deffieux X, Gauthier T, Menager N, Legendre G, Agostini A, Pierre F. Hysteroscopy: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol. 2014;178:114–22.

    Article  PubMed  Google Scholar 

  12. Eichhorn V, Henzler D, Murphy MF. Standardizing care and monitoring for anesthesia or procedural sedation delivered outside the operating room. Curr Opin Anaesthesiol. 2010;23(4):494–9.

    Article  PubMed  Google Scholar 

  13. Epelboin S. Diethylstilbestrol exposure in utero. Polemics about metroplasty. The cons. Gynecol Obstet Fertil. 2007;35(9):832–41.

    Article  CAS  PubMed  Google Scholar 

  14. Fernandez H, Gervaise A, De Tayrac R. Operative hysteroscopy for infertility using normal saline solution and a coaxial bipolar electrode: a pilot study. Hum Reprod. 2000;15(8):1773–5.

    Article  CAS  PubMed  Google Scholar 

  15. Fernandez H, Garbin O, Castaigne V, Gervaise A, Levaillant JM. Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus. Hum Reprod. 2011;26(7):1730–4.

    Article  PubMed  Google Scholar 

  16. Garbin O, Dellenbach P. Hysteroscopic metroplasty for uterine enlargement: a treatment for diethylbestrol-exposed and hypoplastic uteri. J Gynecol Obstet Biol Reprod (Paris). 1996;25(1):41–6.

    CAS  Google Scholar 

  17. Garbin O, Ohl J, Bettahar-Lebugle K, Dellenbach P. Hysteroscopic metroplasty in diethylstilboestrol-exposed and hypoplastic uterus: a report on 24 cases. Hum Reprod. 1998;13:2751–5.

    Article  CAS  PubMed  Google Scholar 

  18. Guida M, Acunzo G, Di Spiezio Sardo A, Bifulco G, Piccoli R, et al. Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. Hum Reprod. 2004;19(6):1461–4.

    Article  CAS  PubMed  Google Scholar 

  19. Guida M, Di Spiezio Sardo A, Acunzo G, Sparice S, Bramante S, Piccoli R, et al. Vaginoscopic versus traditional office hysteroscopy: a randomized controlled study. Hum Reprod. 2006;21(12):3253–7.

    Article  CAS  PubMed  Google Scholar 

  20. Grimbizis GF, Gordts S, Di Spiezio SA, Brucker S, De Angelis C, Gergolet M, et al. The ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies. Gynecol Surg. 2013;10(3):199–212.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013;28(8):2032–44.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Herbst AL, Hubby MM, Blough RR, Azizi F. A comparison of pregnancy experience in DES-exposed and DES-unexposed daughters. J Reprod Med. 1980;24(2):62–9.

    CAS  PubMed  Google Scholar 

  23. Johary J, Xue M, Zhu X, Xu D, Velu PP. Efficacy of estrogen therapy in patients with intrauterine adhesions: systematic review. J Minim Invasive Gynecol. 2014;21(1):44–54.

    Article  PubMed  Google Scholar 

  24. Joo JD, In JH, Kim DW, Jung HS, Kang JH, Yeom JH, et al. The comparison of sedation quality, side effect and recovery profiles on different dosage of remifentanil patient-controlled sedation during breast biopsy surgery. Korean J Anesthesiol. 2012;63(5):431–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Jurkovic D, Geipel A, Gruboeck K, et al. Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol. 1995;5(4):233–7.

    Article  CAS  PubMed  Google Scholar 

  26. Karande V, Lester RG, Muasher SJ, Jones DL, Acosta AA, Jones Jr HW. Are implantation and pregnancy outcome impaired in diethylstilbestrol-exposed women after in vitro fertilization and embryo transfer? Fertil Steril. 1990;54(2):287–91.

    CAS  PubMed  Google Scholar 

  27. Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V. Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a ‘T-shaped’ uterus. Gynecol Obstet Invest. 1996;41(1):41–3.

    Article  CAS  PubMed  Google Scholar 

  28. Kaufman RH, Binder GL, Gray Jr PM, Adam E. Upper genital tract changes associated with exposure in utero to diethylstilbestrol. Am J Obstet Gynecol. 1977;128(1):51–9.

    CAS  PubMed  Google Scholar 

  29. Kaufman RH, Noller K, Adam E, Irwin JF, Gray M, Jefferies JA, et al. Upper genital tract abnormalities and pregnancy outcome in diethylstilbestrol-exposed progeny. Am J Obstet Gynecol. 1984;148(7):973–84.

    Article  CAS  PubMed  Google Scholar 

  30. Kaufman RH, Adam E, Noller K, Irwin JF, Gray M. Upper genital tract changes and infertility in diethylstilbestrol-exposed women. Am J Obstet Gynecol. 1986;154(6):1312–8.

    Article  CAS  PubMed  Google Scholar 

  31. Kerjean A, Poirot C, Epelboin S, Jouannet P. Effect of in-utero diethylstilboestrol exposure on human oocyte quality and fertilization in a programme of in-vitro fertilization. Hum Reprod. 1999;14(6):1578–81.

    Article  CAS  PubMed  Google Scholar 

  32. Lin PC, Bhatnagar KP, Nettleton GS, Nakajima ST. Female genital anomalies affecting reproduction. Fertil Steril. 2002;78(5):899–915.

    Article  PubMed  Google Scholar 

  33. Meier R, De Bruyn C, Mestdagh G, Dhont N, Ombelet W, Campo R. Reproductive outcomes after Hysteroscopic management of dysmorphic uterus: report of 100 cases. Selected abstract ESGE 23rd annual congress, Brussels; 2014.

    Google Scholar 

  34. Nagel TC, Malo JW. Hysteroscopic metroplasty in the diethylstilbestrol-exposed uterus and similar nonfusion anomalies: effects on subsequent reproductive performance; a preliminary report. Fertil Steril. 1993;59(3):502–6.

    CAS  PubMed  Google Scholar 

  35. Nappi L, Di Spiezio Sardo A, Spinelli M, Guida M, Mencaglia L, Greco P, et al. A multicenter, double-blind, randomized, placebo-controlled study to assess whether antibiotic administration should be recommended during office operative hysteroscopy. Reprod Sci. 2013;20(7):755–61.

    Article  PubMed  Google Scholar 

  36. Noyes N, Liu HC, Sultan K, Rosenwaks Z. Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome. Hum Reprod. 1996;11(12):2719–23.

    Article  CAS  PubMed  Google Scholar 

  37. Pons JC, Goujard J, Derbanne C, Tournaire M. Outcome of pregnancy in patients exposed in utero to diethylstilbestrol. Survey by the National College of French Gynecologists and Obstetricians. J Gynecol Obstet Biol Reprod (Paris). 1988;17(3):307–16.

    CAS  Google Scholar 

  38. Pons JC, Diochin P, Papiernik E. Prise en charge des grossesses des patientes exposées in utero au diethylstilbestrol : une étude prospective. Contracept Fertil Sex. 1989;17(4):319–26.

    Google Scholar 

  39. Senekjian EK, Potkul RK, Frey K, Herbst AL. Infertility among daughters either exposed or not exposed to diethylstilbestrol. Am J Obstet Gynecol. 1988;158:493–8.

    Article  CAS  PubMed  Google Scholar 

  40. Wortman M, Daggett A, Ball C. Operative hysteroscopy in an office-based surgical setting: review of patient safety and satisfaction in 414 cases. J Minim Invasive Gynecol. 2013;20(1):56–63.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Genk Institute for Fertility Technology, ZOL, Campus St Jan, Genk, Belgium

    Rose Meier MD & Rudi Campo MD

  2. Leuven Institute for Fertility and Embryology, LIFE, Leuven, Belgium

    Rose Meier MD & Rudi Campo MD

  3. European Academy for Gynaecological Surgery, Leuven, Belgium

    Rose Meier MD & Rudi Campo MD

Authors
  1. Rose Meier MD
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  2. Rudi Campo MD
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Correspondence to Rudi Campo MD .

Editor information

Editors and Affiliations

  1. Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki Medical School, Thessaloniki, Thessaloniki, Greece

    Grigoris F. Grimbizis

  2. Obstetrics and Gynaecology, Genk Institute for Fertility Technology, Leuven, Belgium

    Rudi Campo

  3. Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki Medical School, Thessaloniki, Thessaloniki, Greece

    Basil C. Tarlatzis

  4. Leuven Institute for Fertility & Embryology, Leuven, Belgium

    Stephan Gordts

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Meier, R., Campo, R. (2015). T-Shaped Uterus. In: Grimbizis, G., Campo, R., Tarlatzis, B., Gordts, S. (eds) Female Genital Tract Congenital Malformations. Springer, London. https://doi.org/10.1007/978-1-4471-5146-3_25

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  • DOI: https://doi.org/10.1007/978-1-4471-5146-3_25

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5145-6

  • Online ISBN: 978-1-4471-5146-3

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