ABSTRACT
Congenital uterine anomalies in women often do not cause any symptoms, except when
there is an obstruction of the uterine outflow tract, which occurs infrequently. Patients
with congenital uterine anomalies often go undetected or are only discovered incidentally
during an evaluation for something else. Consequently, it is difficult to determine
the prevalence of congenital uterine anomalies in the general population, and it appears
more frequently in certain populations, namely in those with recurrent pregnancy loss
or infertility. This paper will review the pathogenesis of congenital uterine anomalies
and the standard classification for these anomalies. We will focus on ultrasound and
other diagnostic modalities (hysterosalpingogram, laparoscopy with hysteroscopy, and
magnetic resonance imaging). We will compare the accuracy and differences between
these diagnostic techniques. With the development of three-dimensional ultrasound,
the diagnosis of congenital uterine anomalies can be made accurately, effectively,
and with less invasiveness than with other procedures. We will briefly review the
treatments and pregnancy outcomes in these different anomalies.
KEYWORDS
Congenital uterine anomalies - Müllerian - 3-D ultrasound - infertility - recurrent
pregnancy loss - MRI - hysterosalpingogram
REFERENCES
- 1 Moore K L. The Developing Human: Clinically Oriented Embryology. 3rd ed. Philadelphia,
PA; WB Saunders 1982: 255-297
- 2
[No author] .
The American Fertility Society classifications of adnexal adhesions, distal tubal
occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian
anomalies, and intrauterine adhesions.
Fertil Steril.
1988;
49
944-955
- 3
Basile C, DeMichele V.
Renal abnormalities in Mayer-Rokitanski-Küster-Hauser syndrome.
J Nephrol.
2001;
14
316-318
- 4
Acien P.
Incidence or Müllerian defects in fertile and infertile women.
Hum Reprod.
1997;
12
1372-1376
- 5
Exalto N, Eskes T KAB, Hein P R.
Ultrasonographic examination of the congenitally malformed uterus.
Eur J Obstet Gynecol Reprod Biol.
1978;
8
369-375
- 6
Heinonen P K, Saarikoski S, Postynen P.
Reproductive performance of women with uterine anomalies.
Acta Obstet Gynecol Scand.
1982;
61
157-162
- 7
Kovacevic M, Lusic N, Vukic R.
Congenital uterine anomalies in pregnancy.
Jugosl Ginekol Perinatol.
1990;
30
117-119
- 8
Musich J R, Behrman S J.
Obstetric outcome before and after metroplasty in women with uterine anomalies.
Obstet Gynecol.
1978;
52
63-66
- 9
Raga F, Bonilla-Musoles F, Blanes J, Osborne N G.
Congenital Mullerian anomalies: diagnostic accuracy of three-dimensional ultrasound.
Fertil Steril.
1996;
65
523-528
- 10
Salim R, Regan L, Woelfer B, Backos M, Jurkovic D.
A comparative study of the morphology of congenital uterine anomalies in women with
and without a history of recurrent first trimester miscarriage.
Hum Reprod.
2003;
18
162-166
- 11
Salim R, Woelfer B, Backos M, Regan L, Jurkovic D.
Reproducibility of three-dimentional ultrasound diagnosis of congenital uterine anomalies.
Ultrasound Obstet Gynecol.
2003;
21
578-582
- 12
Soares S R, Barbosa dos Reis M MB, Camargos A F.
Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography
in patients with uterine cavity diseases.
Fertil Steril.
2000;
73
406-411
- 13
Stein A L, March C HM.
Pregnancy outcome in women with Mullerian duct anomalies.
J Reprod Med.
1990;
35
411-414
- 14
Ugur M, Karakaya S, Zorlu G et al..
Polycystic ovaries in association with Müllerian anomalies.
Eur J Obstet Gynecol Reprod Biol.
1995;
62
57-59
- 15
Vercellini P, Constantini W, Uglietti A.
Treatment of uterine malformations.
Hum Reprod.
1999;
12
95
- 16
Woelfer B, Salim R, Banerjee S, Elson J, Regan L, Jurkovic D.
Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional
ultrasound screening.
Obstet Gynecol.
2001;
98
1099-1103
- 17
Wu M H, Hsu C C, Huang K E.
Detection of congenital Mullerian duct anomalies using three-dimensional ultrasound.
J Clin Ultrasound.
1997;
25
487-492
- 18
Zlopasa G, Skrablin S, Kalafatic D, Banovic V, Lesin J.
Uterine anomalies and pregnancy outcome following resectoscope metroplasty.
Int J Gynaecol Obstet.
2007;
98
129-133
- 19
Braun P, Grau F V, Pons R M, Enguix D P.
Is hysterosalpingography able to diagnose all uterine malformations correctly? A retrospective
study.
Eur J Radiol.
2005;
53
274-279
- 20
Alborzi S, Dehbashi S, Parsanezhad M E.
Differential diagnosis of septate and bicornuate uterus by sonohysterography eliminates
the need for laparoscopy.
Fertil Steril.
2002;
78
176-178
- 21
Pellerito J S, McCarthy S M, Doyle M B, Glickman M G, DeCherney A H.
Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography
and hysterosalpingography.
Radiology.
1992;
183
795-800
- 22
Reuter K L, Daly D C, Cohen S M.
Septate versus bicornuate uteri: errors in imaging diagnosis.
Radiology.
1989;
172
749-752
- 23
Goldberg J M, Falcone T, Attaran M.
Sonohysterographic evaluation of uterine abnormalities noted on hysterosalpingography.
Hum Reprod.
1997;
12
2151-2153
- 24
Jurkovic D, Gruboeck K, Tailor A, Nicolaides K H.
Ultrasound screening for congenital uterine anomalies.
Br J Obstet Gynaecol.
1997;
104
1320-1321
- 25
Mazouni C, Girard G, Deter R, Haumonte J B, Blanc B, Bretelle F.
Diagnosis of Müllerian anomalies in adults: evaluation of practice.
Fertil Steril.
2008;
89
219-222
- 26
Fedele L, Bianchi S, Frontino G.
Septums and synechiae: approaches to surgical correction.
Clin Obstet Gynecol.
2006;
49
767-788
- 27
Gell J S.
Müllerian anomalies.
Semin Reprod Med.
2003;
21
375-388
- 28
Imaoka I, Wada A, Matsuo M, Yoshida M, Kitagaki H, Sugimura K.
MR imaging of disorders associated with female infertility: use in diagnosis, treatment,
and management.
Radiographics.
2003;
23
1401-1421
- 29
Brown M A.
MR imaging of benign uterine disease.
Magn Reson Imaging Clin N Am.
2006;
14
439-453
- 30
Wolfman D J, Ascher S M.
Magnetic resonance imaging of benign uterine pathology.
Top Magn Reson Imaging.
2006;
17
399-407
- 31
Jurkovic D, Geipel A, Gruboeck K, Jauniaux E, Natucci M, Campbell S.
Three-dimensional ultrasound for the assessment of uterine anatomy and detection of
congenital anomalies: comparison with hysterosalpingography and two-dimensional sonography.
Ultrasound Obstet Gynecol.
1995;
5
233-237
- 32
Grimbizis G R, Camus M, Tarlatzis B C, Bontis N J, Devroey P.
Clinical implications of uterine malformations and hysteroscopic treatment results.
Hum Reprod Update.
2001;
7
161-174
- 33
Marcus S, Al-Shawaf T, Brinsden P.
The obstetric outcome of in vitro fertilization and embryo transfer in women with
congenital uterine malformation.
Am J Obstet Gynecol.
1996;
175
85-89
- 34
Pui M H.
Imaging diagnosis of congenital uterine malformation.
Comput Med Imaging Graph.
2004;
28
425-433
- 35
Salim R, Jurkovic D.
Assessing congenital uterine anomalies: the role of three-dimentional ultrasonography.
Best Pract Res Clin Obstet Gynaecol.
2004;
18
29-36
- 36
Pellicer A.
Shall we operate Mullerian defects? An introduction to the debate.
Hum Reprod.
1997;
12
1371-1372
- 37
Maneschi F, Zupi E, Marconi D, Valli E, Romanini C, Macuso S.
Hysteroscopically detected asymptomatic Mullerian anomalies. Prevalence and reproductive
implications.
J Reprod Med.
1995;
40
684-688
- 38
Zorlu C G, Yalcin H, Ugur M, Ozden S, Kara-Soysal S, Gokmen O.
Reproductive outcome after metroplasty.
Int J Gynaecol Obstet.
1996;
55
45-48
- 39
Patton P E, Novy M J, Lee D M, Hickok L R.
The diagnosis and reproductive outcome after surgical treatment of the complete septate
uterus, duplicated cervix, and vaginal septum.
Am J Obstet Gynecol.
2004;
190
1669-1678
- 40
Lin P C, Bhatnagar K P, Nettleton G S, Nakajima S T.
Female genital anomalies affecting reproduction.
Fertil Steril.
2002;
78
899-915
Elizabeth PuscheckM.D.
Department of Obstetrics and Gynecology, Division of Reproductive Endocrine and Infertility,
Wayne State University Medical School
3750 Woodward Ave., Suite 200D, Detroit, MI 48201
eMail: epuschec@med.wayne.edu
