Mülleriyan anomaliler ve cerrahi tedavileri

Abstract

Genel toplumda % 0,2-3 oranında Mülleriyan anomaliye rastlanır. Bu derlemede konjenital uterin anomalilerin tipleri, fertiliteye etkileri, obstetrik sonuçları üzerinde durulup, tedavi seçenekleri incelenmiştir. Mülleriyan anomalili birçok hastada fertilite etkilenmezken gebelik sonuçları oldukça kötüdür. Biz bu derlemede Mülleriyan anomalisi olan hastaların tanı ve tedavilerindeki yolları vurguladık. Mullerian anomalies and surgical treatments Mullerian anomalies are known to have an incidence of 0.2-3 percent. In this review we aim to discuss types of uterine anomalies and their effects on fertility emphisizing on obstetric results along with treatments options. Fertility is usually unaffected in patients diagnosed with a Mullerian anomaly but obstetric results are mostly worse. In this review we will focus on diagnostics and treatment modalities in patients with Mullerian anomalies. J. Exp. Clin. Med., 2012; 29:258-264

Keywords

• Mülleriyan anomaliler; uterin septum; bikornuat uterus; obstrükte hemiuteri; Septat uterus; uterus didelfis (Mullerian anomalies; uterine septum; bicornuate uterus; obstructed hemiuteri; septate uterus; uterus didelphys)

References

1. Acien, P., Acien, M., Sanchez-Ferrer, M., 2004. Complex malformations of the female genital tract. New types and revision of classification. Hum. Reprod. 19, 2377.
2. A.F.S. (The American Fertility Society), 1998. 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. 49, 944-955.
3. Barbot, J., 1995. Hysteroscopy and hysterography. Obstet. Gynecol. Clin. North. Am. 22, 591-603.
4. Buss, J.G., Lee, R.A., 1989. McIndoe procedure for vaginal agenesis: Results and complications. Mayo. Clin. Proc. 64, 758-761.
5. Capraro, V.J., Chuang, J.T., Randall, C.L., 1968. Improved fetal salvage after metroplasty. Obstet. Gynecol. 31, 97-103.
6. Creatsas, G., Cardmakis, E., Hassan, E., 1994. Congenital uterine anomalies with obstructed cervix, hemivagina, or both during adolescence: Report of 22 cases. J. Gynecol. Surg. 10, 159-167.
7. Dabirashrafi, H., Mohammad, K., Moghadami-Tabrizi, N., 1996 . Is estrogen necessary after hysteroscopic incision of the uterine septum? J. Am. Assoc. Gynecol. Laparosc. 3, 623-625.
8. DeCherney, A.H., Russell, J.B., Graebe, R.A., Polan, M.L., 1986. Resectoscopic management of mullerian fusion defects. Fertil. Steril. 45, 726-728.

9. Dillon, W.P., Mudaliar, N.A., Wingate, M.B., 1979. Congenital atresia of the cervix. Obstet. Gynecol. 54, 126-129.
10. Donnez, J., Nisolle, M., 1992. Hysteroscopic surgery. Curr. Opin. Obstet. Gynecol. 4, 439-446.
11. Donenfeld, A.E., Chrager, D.S., Corson, S.L., 1992. Update on a family with hand-foot-genital syndrome: Hypospadias and urinary tract abnor- malities in two boys from the fourth generation.Am. J. Med. Genet. 44, 482-484.
12. Doyle, M.B., 1992. Magnetic resonance imaging in müllerian fusion defects. J. Reprod. Med. Jan. 37, 33-38.
13. Duncan, P.A., Shapiro, L.R., Stangel, J.J., 1979. The MURSC association: Mullerian duct aplasia, renal aplasia, and cervicothorasic somite dysplasia J. Pediatr. 95, 399-402.
14. Dungy, C.I., Aptekar, R.G., Cann, H.M., 1971. Hereditary hydrometrocolpos with polydactyly in infancy. Pediatrics. 47,138-141.
15. Elias, S., Simpson, J.L., Carson, S.A., 1984. Genetic studies in incomplete mullerian fusion. Obstet. Gynecol. 63, 276-279.
16. Fedele, L., Bianchi, S., Tozzi, L., Marchini, M., Busacca, M., 1995. Fertility in women with unicornuate uterus. Br. J. Obstet. Gynaecol. 102, 1007-1009.
17. Fedele, L., Bianchi, S., 1995. Hysteroscopic metroplasty for septate uterus. Obstet. Gynecol. Clin. North. Am. 22, 473-489.
18. Fedele, L., Bianchi, S., Marchini, M., 1996. Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproduc- tive outcome. Hum. Reprod. 11, 727-729.
19. Griffen, J.E., Creighton, E., Madde, J.D., 1976. Congenital absence of the vagina: The Mayer-Rokitansky-Kuster-Hauser syndrome. Ann. Intern. Med. 85, 224-236.
20. Golan, A., Langer, R., Wexler, S., 1990. Cervical cerclage-its role in the pregnant anomalous uterus. Int. J. Fertil. 35, 164-170.
21. Goldstein, D.P., 1978. Incompetent cervix in offspring exposed to diethylstilbestrol in utero. Obstet. Gynecol. 52, 73-75.
22. Gray, S.E., Roberts, D.K., Franklin, R.R., 1984. Fertility after metroplasty of the septate uterus. J. Reprod. Med. 29, 185-188.
23. Harger, J.H., Archer, D.F., Marchese, S.G., 1983. Etiology of recurrent pregnancy loss and outcome of subsequent pregnancies. Obstet. Gynecol. 62, 574-581.
24. Heinonen, P.K., 1997. Unicornuate uterus and rudimentary horn. Fertil. Steril. 68, 224-230.
25. Hojsgaard, A., Villadsen, I., 1995. McIndoe procedure for congenital vaginal agenesis: Complications and results. Br. J. Plast. Surg. 48, 97- 102.
26. Hurst, B.S., Rock, J.A., 1992. Preoperative dilatation to facilitate repair of the high transverse vaginal septum Fertil. Steril. 57, 1151-1153.
27. Ingram, J.M., 1981. The bicycle seat stool in the treatment of vaginal agenesis and stenosis: A preliminary report. Am. J. Obstet. Gyneco. 140, 867-873.
28. Israel, R., March, C.M., 1984. Hysteroscopic incision of the septate uterus. Am. J. Obstet. Gynecol. 149, 66-73.
29. Karande, V.C., Lester, R.G., Muasher, S.J., 1990. Are implantation and pregnancy outcome impaired in diethylstilbestrol-exposed women after in vitro fertilization and embryo transfer? Fertil. Steril. 54, 287-291.
30. Kerjean, A., Poirot, C., Epelboin, S., Jouannet, P., 1999. Effect of in-utero diethylstilbestrol exposure on human oocyte quality and fertilization in a programme of in-vitro fertilization. Hum. Reprod. 14, 1578-1581.
31. Lavergne, N., Aristizabal, J., Zarka, V., Erny, R., Hedon, B., 1996. Uterine anomalies and in vitro fertilization: what are the results? Eur. J. Obstet. Gynecol. Reprod. Biol. 68, 29-34.
32. Lin, P.C., Bhatnagar, K.P., Nettleton, G.S., 2002. Female genital anomalies affecting reproduction. Fertil. Steril. 78, 899-915.
33. Lobaugh, M.L., Bammel, B.M., Duke, D., Webster, B.W., 1994. Uterine rupture during pregnancy in a patient with a history of hysteroscopic metroplasty. Obstet. Gynecol. 83, 838-840.
34. Maclaughlin, D.T., Donahoe, P.K., 2004. Sex determination and differentiation. N. Engl. J. Med. 350, 367-378.
35. March, C.M., Israel, R., 1987. Hysteroscopic management of recurrent abortion caused by septate uterus. Am. J. Obstet. Gynecol.156, 834- 842.
36. Musich, J.R., Behrman, S.J., 1978. Obstetric outcome before and after metroplasty in women with uterine anomalies. Obstet. Gynecol. 52, 63.
37. Nicolini, U., Bellotti, M., Bonazzi, B., 1987. Can ultrasound be used to screen uterine malformations. Fertil. Steril. 47, 89-93.
38. Querleu, D., Brasme, T.L., Parmentier, D., 1990. Ultrasound-guided transcervical metroplasty. Fertil. Steril. 54, 995-998.
39. Patton, P.E., 1994. Anatomic uterine defects. Clin. Obstet. Gynecol. 37, 705-721.
40. Petrozza, J.C., Gray, M.R., Davis, A.J., Reindollar, R.H., 1997. Congenital absence of the uterus and vagina is not commonly transmitted as a dominant genetic trait. A outcomes of surrogate pregnancies. Fertil. Steril. 67, 387.
41. Propst, A.M., Hill, J.A., 2000. Anatomic factors associated with recurrent pregnancy loss. Semin. Reprod. Med. 18, 341-350.
42. Raga, F., Bonilla-Musoles, F., Blanes, J., Osborne, N.G., 1996. Congenital Müllerian anomalies: Diagnostic accuracy of three-dimensional ultrasound. Fertil. Steril. 65, 523-528.
43. Raga, F., Bauset, C., Remohi, J., 1997. Reproductive impact of congenital mullerian anomalies. Hum. Reprod. 12, 2277-2281.
44. Reindollar, R.H., Tho, S.P., McDonough, P.H., 1993. Pubertal amenorrhea: A subset of 290 patients. Adoles. Pediatr. Gynecol.
45. Rock, J.A., Schlaff, W.D., Zacur, H.A., Jones, H.W., 1984. The clinical management of congenital absence of the uterine cervix. Int. J. Gynaecol. Obstet. 22, 231-235.
46. Rock, J.A., Murphy, A.A., Cooper, W.H., 1987. Resectoscopic techniques for the lysis of a class V: Complete uterine septum. Fertil. Steril. 48, 495-496.
47. Rock, J.A., 1992. Surgery for anomalies of the mullerian ducts. In : Thompson, J.D., Rock, J.A., eds: Te Linde’s Operative Gynecology.7th ed. Philadelphia: J.B. Lippincott. 603-646.
48. Sadler, T.W., 1990, Langman’s medical embryology. 6th ed. Baltimore: Williams & Wilkins, 111-128.
49. Sanfilippo, J.S., Wakim, N.G., Schikler, K.N., Yussman, M.A., 1986. Endometriosis in association with uterine anomaly. Am. J. Obstet. Gynecol. 154, 39-43.
50. Slavotinek, A.M., Biesecker, L.G., 2000. Phenotypic overlap of McKusick-Kauman Syndrome with Bardet-Biedel syndrome: A literature re- view. Am. J. Med. Genet. 25, 79-82.
51. Suidan, F.G., Azoury, R.S., 1979. The transversevaginal septum: A clinicopathologic evaluation. Obstet. Gynecol. 54, 278-283.
52. Tonguc, E.A., Var, T., Yilmaz, N., Batioglu, S., 2010. Intrauterine device or estrogen treatment after hysteroscopic uterine septum resection. I.J.O.G. 109, 226-229.
53. Tonguc, E.A., Var, T., Batioglu, S., 2011. Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility. Int. J. Gynaecol. Obstet. 113, 128-130.
54. Valle, R.F., Sciarra, J.J., 1986. Hysteroscopic treatment of the septate uterus. Obstet. Gynecol. 67, 253-257.
55. Vercellini, P., Fedele, L., Arcaini, L., 1989. Value of intrauterine device insertion and estrogen administration after hysteroscopic metroplasty. J. Reprod. Med. 34, 447-450.
56. Wood, E.G., Batzer, F.R., Corson, S.L., 1999. Ovarian response to gonadotrophins, optimal method for oocyte retrieval and pregnancy outcome in patients with vaginal agenesis. Hum. Reprod. 14, 1178-1181.