Bala Bhagavath1, Greiner Ellie2, Kara M Griffiths3, Tom Winter4, Snigdha Alur-Gupta5, Carter Richardson6, Steven R Lindheim7. 1. Associate Professor, Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY. 2. Medical Student, Wright State University, Boonshoft School of Medicine. 3. Resident, Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH. 4. Professor, Department of Radiology, University of Utah, Salt Lake City, UT. 5. Fellow, Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA. 6. Undergraduate Student, Centre College, Danville, KY. 7. Professor, Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, OH.
Abstract
IMPORTANCE: The prevalence of uterine malformations has been reported in up to 7% of the general population and 18% of those with recurrent pregnancy loss. The diagnosis, classification, management, and outcome of the management have been subject to debate for decades. OBJECTIVE: The aim of this article is to summarize the current knowledge regarding the genetics of müllerian anomalies, the varied classification schemes, the appropriate diagnostic modalities, the surgical methods, and the obstetric outcomes related to these surgical methods. EVIDENCE ACQUISITION: An extensive literature review using the key words uterine anomaly, classification, mullerian, agenesis, unicornuate, didelphys, bicornuate, septate, arcuate, DES, and diethyl stilbestrol was conducted using PubMed. Only English-language publications were reviewed. Relevant references within these publications were also obtained and reviewed in preparing this article. CONCLUSIONS: Current evidence favors continued use of the American Society of Reproductive Medicine classification. Three-dimensional sonography, especially when combined with saline infusion, can be very helpful in accurately classifying müllerian anomalies. RELEVANCE: Müllerian anomalies are relatively common. Accurate knowledge of the advantages and limitations of various diagnostic modalities, the limitations of the classification systems, the surgical options available where appropriate, and the obstetric outcomes after these surgeries will help in the optimal management of these patients.
IMPORTANCE: The prevalence of uterine malformations has been reported in up to 7% of the general population and 18% of those with recurrent pregnancy loss. The diagnosis, classification, management, and outcome of the management have been subject to debate for decades. OBJECTIVE: The aim of this article is to summarize the current knowledge regarding the genetics of müllerian anomalies, the varied classification schemes, the appropriate diagnostic modalities, the surgical methods, and the obstetric outcomes related to these surgical methods. EVIDENCE ACQUISITION: An extensive literature review using the key words uterine anomaly, classification, mullerian, agenesis, unicornuate, didelphys, bicornuate, septate, arcuate, DES, and diethyl stilbestrol was conducted using PubMed. Only English-language publications were reviewed. Relevant references within these publications were also obtained and reviewed in preparing this article. CONCLUSIONS: Current evidence favors continued use of the American Society of Reproductive Medicine classification. Three-dimensional sonography, especially when combined with saline infusion, can be very helpful in accurately classifying müllerian anomalies. RELEVANCE: Müllerian anomalies are relatively common. Accurate knowledge of the advantages and limitations of various diagnostic modalities, the limitations of the classification systems, the surgical options available where appropriate, and the obstetric outcomes after these surgeries will help in the optimal management of these patients.