Pregnancy in asymmetric blind hemicavity of Robert’s uterus—a previously unreported phenomenon
26 Mar 2003-European Journal of Obstetrics & Gynecology and Reproductive Biology (Elsevier)-Vol. 107, Iss: 1, pp 93-95
TL;DR: An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death with suspicion of non-communicating uterine horn with bicornuate uterus.
About: This article is published in European Journal of Obstetrics & Gynecology and Reproductive Biology.The article was published on 2003-03-26. It has received 29 citations till now. The article focuses on the topics: Bicornuate uterus & Hysterotomy.
Citations
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TL;DR: Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture are present, and surgical removal before pregnancy is recommended.
262 citations
Cites background from "Pregnancy in asymmetric blind hemic..."
...However, the rudimentary horn has been described in the literature under various terms, including unicornuate uterus with rudimentary horn, uterus bicornis unicollis with rudimentary horn, uterus bicornis unicollis with atretic horn, uterus bicornis with accessory horn, Roberts uterus, and hernia uterus inguinale.(12,35,47,111,124) This freedom of terminology makes an assessment of this condition more difficult....
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TL;DR: The clinical presentation and management of complex malformations, including Rokitansky syndrome, are reported, including anomalies of the cloaca and urogenital sinus, including congenital vagino-vesical fistulas and cloacal anomalies; malformative combinations and other complex mal Formations.
Abstract: Background Common uterine anomalies are important owing to their impact on fertility, and complex mesonephric anomalies and certain Mullerian malformations are particularly important because they cause serious clinical symptoms and affect woman's quality of life, in addition to creating fertility problems. In these cases of complex female genital tract malformations, a correct diagnosis is essential to avoid inappropriate and/or unnecessary surgery. Therefore, acquiring and applying the appropriate embryological knowledge, management and therapy is a challenge for gynaecologists. Here, we considered complex malformations to be obstructive anomalies and/or those associated with cloacal and urogenital sinus anomalies, urinary and/or extragenital anomalies, or other clinical implications or symptoms creating a difficult differential diagnosis. Methods A diligent and comprehensive search of PubMed and Scopus was performed for all studies published from 1 January 2011 to 15 April 2015 (then updated up to September 2015) using the following search terms: 'management' in combination with either 'female genital malformations' or 'female genital tract anomalies' or 'Mullerian anomalies'. The MeSH terms 'renal agenesis', 'hydrocolpos', 'obstructed hemivagina' 'cervicovaginal agenesis or atresia', 'vaginal agenesis or atresia', 'Herlyn-Werner-Wunderlich syndrome', 'uterine duplication' and 'cloacal anomalies' were also used to compile a list of all publications containing these terms since 2011. The basic embryological considerations for understanding female genitourinary malformations were also revealed. Based on our experience and the updated literature review, we studied the definition and classification of the complex malformations, and we analysed the clinical presentation and different therapeutic strategies for each anomaly, including the embryological and clinical classification of female genitourinary malformations. Results From 755 search retrieved references, 230 articles were analysed and 120 studied in detail. They were added to those included in a previous systematic review. Here, we report the clinical presentation and management of: agenesis or hypoplasia of one urogenital ridge; unilateral renal agenesis and ipsilateral blind or obstructed hemivagina or unilateral cervicovaginal agenesis; cavitated and non-communicating uterine horns and Mullerian atresias or agenesis, including Rokitansky syndrome; anomalies of the cloaca and urogenital sinus, including congenital vagino-vesical fistulas and cloacal anomalies; malformative combinations and other complex malformations. The clinical symptoms and therapeutic strategies for each complex genitourinary malformation are discussed. In general, surgical techniques to correct genital malformations depend on the type of anomaly, its complexity, the patient's symptoms and the correct embryological interpretation of the anomaly. Most anomalies can typically be resolved vaginally or by hysteroscopy, but laparoscopy or laparotomy is often required as well. We also include additional discussion of the catalogue and classification systems for female genital malformations, the systematic association between renal agenesis and ipsilateral genital malformation, and accessory and cavitated uterine masses. Conclusions Knowledge of the correct genitourinary embryology is essential for the understanding, study, diagnosis and subsequent treatment of genital malformations, especially complex ones and those that lead to gynaecological and reproductive problems, particularly in young patients. Some anomalies may require complex surgery involving multiple specialties, and patients should therefore be referred to centres that have experience in treating complex genital malformations.
115 citations
Cites background from "Pregnancy in asymmetric blind hemic..."
...Pregnancy in the asymmetric blind hemi-cavity of a Robert’s uterus has also been noted (Singhal et al., 2003), but some reported cases of menstrual retention in a Robert’s uterus (Capito and Sarnacki, 2009) might correspond to accessory and cavitated uterine masses (ACUMs) (Acién et al....
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...Pregnancy in the asymmetric blind hemi-cavity of a Robert’s uterus has also been noted (Singhal et al., 2003), but some reported cases of menstrual retention in a Robert’s uterus (Capito and Sarnacki, 2009) might correspond to accessory and cavitated uterine masses (ACUMs) (Acién et al., 2012),…...
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TL;DR: In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly, and a precise categorization was reached in 38 out of 39 types studied.
Abstract: studydesign,sizeandduration: The CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group. participants/materials, setting, methods: Among the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies. main results and the role of chance: The congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of
60 citations
Cites background from "Pregnancy in asymmetric blind hemic..."
...Growdon and Laufer (2008) and Singhal et al. (2013) Didelphys Complete Bicorporeal Double Double normal Lower vaginal agenesis Vaginal aplasia U3b C2 V4...
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...…the following cases a consultation with the fourth reviewer was necessary before classification: Capito and Sarnacki (2009), Gupta et al. (2007) and Singhal et al. (2003) (Robert’s uterus or Complete septate uterus/unilateral cervical aplasia/normal vagina ESHRE/ESGE Class U2b C3 V0), Nezhat and…...
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TL;DR: A unique congenital mullerian anomaly; asymmetric septate uterus with noncommunicating right sided hemicavity and haematometra a normal extrauterine morphology with right ovarian maldescent and stage III endometriosis was diagnosed on laparotomy.
Abstract: Roberts uterus or asymmetric septate uterus is an uncommon uterine mullerian anomaly first reported by Robert in 1970. It has two uterine cavities with one being blind causing menstrual retention. Till date only 17 such cases have been reported in literature. A unique congenital mullerian anomaly; asymmetric septate uterus with noncommunicating right sided hemicavity and haematometra a normal extrauterine morphology with right ovarian maldescent and stage III endometriosis was diagnosed on laparotomy. (excerpt)
29 citations
TL;DR: Pediatric surgeons and gynecologists should be aware of this atypical obstructive Müllerian malformation and its management in order to avoid inappropriate management of these young patients.
24 citations
References
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TL;DR: The obstetric outcome improved from 10% successful pregnancies before surgery to 88% postoperatively, and the uterine anomalies grouped according to degree of failure of normal uterine development had the best fetal survival rate.
Abstract: A total of 182 women with uterine anomalies were observed over a period of 18 years. In all, 126 women had 265 pregnancies, fetal survival rate was 66%, perinatal mortality 8% and premature labors occurred in 23%. When the uterine anomalies were grouped according to degree of failure of normal uterine development, the complete septate uteri had the best fetal survival rate (86%), complete bicornuate uteri (50%) and unicornuate (40%) poorest. Cervical cerclage was applied most in the partial bicornuate uteri (17%), where fetal survival in operated cases was: before operation, 53% and after, 100%. The frequency of breech presentation was 40–50% in all groups except complete septate uteri (25%) and complete bicornuate (0%). The highest cesarean section rate (82%) was in deliveries of patients with uterus didelphys. The frequency of cesarean section among total deliveries was 53%. Metroplasty was carried out on 19 patients. The obstetric outcome improved from 10% successful pregnancies before surgery to 88% p...
261 citations
69 citations
TL;DR: It is suggested that the study of uterine morphology and structure could be a part of routine TVS examination as uterine malformations can be associated with both sterility and reproductive failure.
33 citations
Journal Article•
TL;DR: Robert's uterus or asymmetric septate uterus is a rare malformation that presents with two cavities, one of which is blind: the blind cavity, on the right side of the septum, contained retained secretions.
Abstract: Robert's uterus or asymmetric septate uterus is a rare malformation. It presents with two cavities, one of which is blind. The authors report an original case: the blind cavity, on the right side of the septum, contained retained secretions. The embryologic and physiopathologic mechanism of this anomaly still are to be discussed.
9 citations