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Semin Reprod Med 2011; 29(2): 101-112
DOI: 10.1055/s-0031-1272472
© Thieme Medical Publishers

Treatment of Congenital Malformations

Sara Yvonne Brucker1 , Katharina Rall1 , Rudi Campo2 , Peter Oppelt3 , Keith Isaacson4
  • 1Department of Obstetrics and Gynecology, Tübingen University Hospital, Tübingen, Germany
  • 2Department Obstetrics and Gynecology, Department of Reproductive Medicine und Fertility Surgery, St. Jans Kliniek, Brussels, Belgium
  • 3Department of Obstetrics and Gynecology, AKh Hospital Linz, Linz, Austria
  • 4Department of Obstetrics and Gynecology, Newton-Wellesley Hospital, Boston, MA
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Publikationsverlauf

Publikationsdatum:
24. März 2011 (online)

    Lizenzen und Reprints

ABSTRACT

The prevalence of müllerian malformations is 1 in 200, or 0.5%. A third of the anomalies are septate, a third bicornuate uteri, 10% arcuate uterus, 10% didelphis and unicornuate uterus, and < 5% uterine and vaginal aplasia. Correct diagnosis of the malformation is most important but often very difficult. Correct treatment can only be performed if the malformation is clear. Longitudinal vaginal septums have to be removed due to potential obstetric problems. Transverse vaginal septums can cause hematocolpos and pain and have to be incised crosswise and excised so as not to shorten the vagina at the same time. Congenital vaginal agenesis occurs in Mayer-Rokitansky-Kuster-Hauser syndrome patients and in androgen insensitivity syndrome. The first choice for surgical treatment should be the new laparoscopic-assisted creation of a neovagina. Septate uterus has to be distinguished from a bicornuate uterus. Even if it is not proven to be a cause for infertility, the chance of miscarriage can be diminished by performing hysteroscopic metroplasty. Repair of a uterine septum in infertility patients often improves pregnancy rates. In contrast, surgical repair of a bicornuate uterus requires an abdominal metroplasty. This should only be performed if the patient has recurrent fetal loss due to the uterine structural defect. In a unicornuate uterus it is most important to determine if there is a second uterine horn that can cause cyclic pain if it has functioning endometrium. The only surgical option in these cases is to remove the rudimentary uterus with endometrium and hematometra, respectively.

KEYWORDS

Congenital malformation - vaginal septum - congenital vaginal agenesis - uterine septate uterus - uterus bicornis - uterus didelphys - unicornuate uterus

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Sara Yvonne BruckerM.D. 

Vice Director, Department of Obstetrics and Gynecology, Tübingen University Hospital

Calwerstrasse 7, 72076 Tübingen, Germany

eMail: sara.brucker@med.uni-tuebingen.de