Hysteroscopic Outpatient Metroplasty To Expand Dysmorphic Uteri (HOME-DU Technique): A Pilot Study

Sardo, Attilio Di Spiezio; Nazzaro, G.; Spinelli, Marialuigia; Bettocchi, Stefano; Scognamiglio, M; Nappi, Carmine

doi:10.1016/j.jmig.2012.08.191

Cited by 8 publications

(23 citation statements)

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“…Seven studies mentioned the etiology of T‐shaped uterus 2,124,126,129,131,133,137 , however, we found no research focusing on the cause of T‐shaped uterus. Şükür et al 137 .…”

Section: Resultsmentioning

confidence: 88%

“…All of the retrospective observational studies included in the systematic review were considered to be of poor quality 2,123–130,133,135–140 , except for the study of Fox et al 134 ,. which was rated as moderate quality (it was useful for the study of prevalence and clinical relevance of T‐shaped uterus) (Table S3).…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies mentioned the diagnostic methods and/ or criteria for T-shaped uterus (Table S1) 2,9,[123][124][125][126][127][128][129]132,133,[135][136][137][138]140 . The most commonly cited diagnostic method was 3D-US (11 studies), while other methods mentioned were magnetic resonance imaging (MRI), hysteroscopy, hysterosalpingography and two-dimensional ultrasound.…”

Section: Diagnosis Of T-shaped Uterusmentioning

confidence: 99%

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Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

Neto

Ludwin

Martins³

2021

Ultrasound in Obstet & Gyne

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Objectives To summarize in a systematic review the current evidence regarding definitions, diagnosis, prevalence, etiology, clinical relevance and impact of surgical treatment for T‐shaped uterus not related to diethylstilbestrol (DES) exposure, and to highlight areas on which future research should focus. Methods A search of PubMed, Scopus and EMBASE was performed on 9 April 2020 using the search terms ‘t‐shaped OR t‐shape OR infantile OR (lateral indentation) OR (diethylstilbestrol OR DES) AND (uterus OR uterine OR uteri) AND (anomaly OR anomalies OR malformation OR malformations)’. Additionally, the reference lists of the included studies were searched manually for other relevant publications. All studies presenting data on T‐shaped uterus not associated with DES exposure and including at least 10 women were considered eligible. Studies regarding DES‐related T‐shaped uterus were excluded because DES has not been used since 1971. There were no restrictions on language, date of publication or status of publication. Results Of 2504 records identified by the electronic search, 20 studies were included in the systematic review. The majority of studies were of poor quality. In 11 of 16 studies reporting on the diagnosis of T‐shaped uterus, the diagnostic method used was three‐dimensional ultrasound. There is no consensus on the definition of T‐shaped uterus, but the most cited criteria (4/16 studies) were of the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy (ESHRE/ESGE; 2013). The prevalence of T‐shaped uterus varied from 0.2% to 10% in the four included studies reporting such data. With respect to etiology (except for DES), T‐shaped uterus was considered a primary condition in three studies and secondary to adhesions in five and adenomyosis in one. T‐shaped uterus was related to worse reproductive outcome based on subfertility (nine studies), miscarriage (seven studies), preterm delivery (two studies), ectopic pregnancy (one study) and repeat implantation failure (seven studies). Of the 12 studies that reported on the effects of surgical treatment of T‐shaped uterus by hysteroscopic metroplasty, some mentioned an improvement in pregnancy rate (rates ranging from 49.6% to 88%; eight studies), live‐birth rate (rates ranging from 35.1% to 76%; seven studies) and term‐delivery rate (four studies) and a reduction in miscarriage (rates ranging from 7% to 49.6%; five studies) and ectopic pregnancy (one study). However, the evidence is of very low quality with serious/critical risk of bias toward overestimating the intervention effect. Some authors reported no complications related to the procedure, while others mentioned persistence of the dysmorphism (rates ranging from 1.4% to 11%; three studies), bleeding (1.3%; one study), infection (2.6%; one study) and adhesions (11.1% and 16.8%; two studies). Conclusions The prevalence, etiology and clinical relevance, with respect to reproductive outcome, of T‐shaped uterus remain unclear and there is no conse...

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“…Seven studies mentioned the etiology of T‐shaped uterus 2,124,126,129,131,133,137 , however, we found no research focusing on the cause of T‐shaped uterus. Şükür et al 137 .…”

Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Diagnosis Of T-shaped Uterusmentioning

confidence: 99%

See 1 more Smart Citation

Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

Neto

Ludwin

Martins³

2021

Ultrasound in Obstet & Gyne

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“…Small observational studies report a beneficial effect of hysteroscopic metroplasty in women with a dysmorphic uterus, but the evidence is not robust enough to support routine surgical intervention for these women.…”

Section: Management Optionsmentioning

confidence: 99%

Reproductive Implications and Management of Congenital Uterine Anomalies

Akhtar¹,

Saravelos²,

Li³

et al. 2019

BJOG

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Plain language summary Congenital uterine anomalies (CUAs) are malformations of the womb that develop during fetal life. When a baby girl is in her mother’s womb, her womb develops as two separate halves from two tubular structures called ‘müllerian ducts’, which fuse together before she is born. Abnormalities that occur during the baby’s development can be variable from complete absence of a womb through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good in screening for CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex womb abnormality is suspected, MRI scanning may also be used, with a combination of laparoscopy in which a camera is inserted into the cavity of the abdomen, and hysteroscopy, when the camera is placed in the womb cavity. As there can be a link between CUAs and abnormalities of the kidney and bladder, scans of these organs are also usually requested. Although CUAs are present at birth, adult women typically do not have any symptoms, although some may experience painful periods. Most cases of CUA do not cause a woman to have difficulty in becoming pregnant and the outcome of pregnancy is good. However, these womb anomalies are often discovered during investigations for infertility or miscarriage. Moreover, depending upon the type and severity of CUA, there may be increased risk of first and second trimester miscarriages, preterm birth, poor growth of the baby in the mother’s womb (fetal growth restriction), pre‐eclampsia and difficult positioning of the baby for birth (fetal malpresentation). Surgical treatment is only recommended to a woman who has had recurrent miscarriages and has a septate uterus, i.e., the womb cavity is divided by a partition. In this case, surgery may improve her chances for a successful pregnancy, although the risks of surgery, especially scarring of the womb should be considered. However, further evidence from randomised controlled trials are required to provide conclusive evidence‐based recommendations for surgical treatment for septate uterus. Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These women, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up using an appropriate protocol for preterm birth as outlined in UK Preterm Birth Clinical Network Guidance.1>

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“…A patogênese do útero em forma de "T" não é clara, e a etiologia, em muitos casos, é desconhecida (3,13). O útero em "T" também pode ser de origem primária (18)(19)(20), decorrer de aderências na síndrome de Asherman (3,13,18,20,21) ou adenomiose (22). Seu diagnóstico deve se basear, exclusivamente, na forma da cavidade uterina por técnicas de imagem, sem vincular o diagnóstico a uma etiologia identificada (como ocorreu na classificação da AFS, que relacionava útero em "T" ao DES) (6).…”

Section: Tabela 5 -unclassified

Útero em forma de \"T\": definição, critérios diagnósticos, prevalência, implicações clínicas e tratamento

Neto¹,

Alencar²

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Objetivos: Avaliar se existe medida confiável e precisa para distinguir o útero em "T" do útero normal/arqueado e sumarizar a evidência disponível em relação a definições, diagnóstico, prevalência, implicações clínicas e impacto do tratamento cirúrgico para o útero em "T" não relacionado ao dietilestilbestrol (DES). Métodos: Estudo prospectivo observacional para avaliar confiabilidade/concordância com elementos de acurácia diagnóstica em uma amostra de 100 blocos de ultrassonografia tridimensional (US-3D) de úteros apresentando endentação lateral da cavidade, tendo como padrão de referência a impressão subjetiva de 15 especialistas. As medidas foram realizadas de forma independente por dois especialistas para avaliar o coeficiente de correlação de concordância (CCC), a precisão diagnóstica pela a área sob a curva (AUROC), e o melhor ponto de corte pelo índice de Youden. Para resumir a evidência disponível em relação ao útero em "T", realizou-se uma revisão sistematizada buscando estudos no PubMed, Scopus e EMBASE em mar-2020. Estudos sobre útero em "T" não relacionado ao DES incluindo 10 ou mais mulheres foram elegíveis. Resultados: No estudo de reprodutibilidade e precisão diagnóstica, foram incluídos 100 participantes (pelo padrão de referência, 20 foram julgados em "T" e 80 normais/arqueados). A concordância entre especialistas foi de 82% (kappa=0,43). As três medidas identificadas com precisão diagnóstica e seus respectivos pontos de corte foram: ângulo de endentação lateral (AUROC=0,95) ≤130°, profundidade da endentação lateral (AUROC=0,92) ≥7 mm, e ângulo "T" (AUROC=0,87) ≤40°. O ângulo "T" foi a medida com melhor reprodutibilidade interobservador (CCC=0,87). Sugere-se considerar útero em "T" na presença dos três critérios (valor preditivo positivo=0.93). Na revisão sistematizada, 2504 referências foram identificadas, e 20 estudos foram incluídos. Há apenas estudos de baixa qualidade. O diagnóstico do útero em "T" foi, comumente, realizado por US-3D, e o critério mais citado foi o da European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy (ESHRE-ESGE). A prevalência do útero em "T" variou de 0,2-10%. Sua etiologia foi relacionada à adenomiose, sinéquias e como sendo uma condição primária. Resultados reprodutivos ruins foram relacionados ao útero em "T" (infertilidade, aborto, parto pré-termo, gravidez ectópica e falha de implantação). Os benefícios do tratamento cirúrgico por metroplastia histeroscópica foram analisados em 12 estudos, que mencionaram melhora nas taxas de gravidez, nascidos vivos, parto a termo, redução de abortamento e gravidez ectópica (evidência de muito baixa qualidade). Conclusões: A concordância entre especialistas para o diagnóstico do útero em "T" foi moderada. Três medidas tiveram boa acurácia diagnóstica e confiabilidade razoável a moderada. Até o momento, prevalência, importância clínica e impacto da cirurgia nos resultados reprodutivos de mulheres com útero em "T" são desconhecidos. Alguns estudos relatam melhora nos resultados r...

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Hysteroscopic Outpatient Metroplasty To Expand Dysmorphic Uteri (HOME-DU Technique): A Pilot Study

Cited by 8 publications

References 0 publications

Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

Reproductive Implications and Management of Congenital Uterine Anomalies

Útero em forma de \"T\": definição, critérios diagnósticos, prevalência, implicações clínicas e tratamento

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