Functional and Reproductive Outcomes Following Surgical Management of Congenital Anomalies of the Cervix: A Systematic Review

Abstract

The purpose of this systematic review was to evaluate surgical treatment for malformations of the cervix in terms of short-and long-term postoperative function and relevant reproductive outcomes. Data Sources: International Prospective Register of Systematic Reviews (ID No CRD42019128899). Electronic databases were searched for eligible studies up to October 2019 on Medline/PubMed (1966−2019), Scopus/Elsevier (1950−2019), and Google Scholar (up to 2019. Search terms included "congenital cervical malformations/anomalies," "uterocervical aplasia/dysgenesis/agenesis," "cervical aplasia/dysgenesis/ agenesis," "m€ ullerian anomalies/dysgenesis/agenesis," "uterovaginal anastomosis," "cervical reconstruction," "uterocervical reconstruction/canalization," "cervical canalization," "reproductive/pregnancy/functional outcome," "menstruation," "pregnancy," and "regular periods." Methods of Study Selection: Studies were chosen and included with clear description of preoperative diagnosis via sonography, magnetic resonance imaging, and surgical confirmation; assessment and clear description of gynecologic anatomy and any concomitant anomalies; meticulous description of the operative technique; follow-up of at least 6 weeks postoperatively; and postoperative end points including menstrual and reproductive outcomes. We included randomized controlled trials, case-control studies (both prospective and retrospective), and case reports. Data registries, studies without clearly described primary or secondary outcomes, and studies not in the English language were excluded from the analyses. Tabulation, Integration, and Results: The literature search returned 745 studies; 546 records were initially excluded (397 not related to the topic, 15 not related to humans, 134 non-English language); 111 full-text articles were further excluded (patients underwent hysterectomy or no surgery); 88 studies with a total of 249 patients were suitable for analysis. Almost all patients had preoperative amenorrhea (248/249, 99.6%). Postoperatively, of 249 patients, resolution of menstruation occurred in 228 patients (91.6%), and hysterectomy was performed in 22 patients (8.8%); overall, there were 30 (12.0%) conceptions that resulted in 27 (10.8%) viable and 24 (9.6%) term pregnancies. Indications for hysterectomy were stenosis of the genital tract and sepsis. Coexisting vaginal agenesis and use of full thickness skin graft for creation of neocervix was associated with negative surgical outcomes. Conclusion: This review suggests that conservative surgical approaches result in better clinical and reproductive outcomes than more aggressive reconstructive surgeries for patients with malformations of the cervix.

Utero-vaginal anastomosis in cases of cervical malformations: long-term follow-up and fertility challenges

“…In a review article published in 2021, it is reported that 249 cases of cervical malformations were managed by different techniques of conservative surgeries and resulted in successful outcome by achieving menstruation in 228/249 patients (91.6%). Regarding fertility, 30 pregnancies (12.0%) were reported: 17 of 155 patients with cervical agenesis (11.0%) and 13 of 71 patients with cervical obstruction (18.3%) [8]. Unfortunately, in this review article, there was no information whether pregnancies occurred naturally or not and no information about the difficulties of the ART if used.…”

An Investigation of Depressive Symptoms in Patients with Congenital Cervical and Vaginal Aplasia: A Cross-Sectional Study

“…Patients with cervical and vaginal aplasia are more likely to have upper genital tract lesions, which may affect the possibility of natural conception to some extent, so assisted reproductive techniques can be suggested appropriately. 8,33,34 One of the limiting factors is that congenital cervical and vaginal aplasia is a rare malformation, so the sample size was small. Another limitation is that the data in this study only reflected the current psychological states of the patients and could not reflect their long-term depressive symptoms.…”

“…Patients with cervical and vaginal aplasia are more likely to have upper genital tract lesions, which may affect the possibility of natural conception to some extent, so assisted reproductive techniques can be suggested appropriately. 8 , 33 , 34 …”

The current and future state of surgery in reproductive endocrinology

“…Utero-vaginal and utero-neovaginal anastomoses have good outcomes. Creation of neo-cervix is associated with poorer outcomes followed by use of full-thickness skin graft for creating a neovagina [36 ▪ ].…”