Reproductive significance of changes in the endometrial cavity associated with exposure in utero to diethylstilbestrol

Pillsbury, S.Gainer

doi:10.1016/0002-9378(80)90772-3

Cited by 11 publications

(3 citation statements)

References 8 publications

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“…In this regard, women exposed in utero to DES exhibit a characteristic spectrum of structural malformations of the Fallopian tube, uterine corpus, and cervix (Kaufman et al, 1977(Kaufman et al, , 1980Haney et al, 1979;DeCherney et al, 1981;Goldstein, 1978;Pillsbury, 1980;Stillman, 1982), all of which can be interpreted as perturbations in the structure, organization, and differentiation of uterine mesenchymal derivatives.…”

Section: Des Dosage (Pg)mentioning

confidence: 98%

Histologic, morphometric, and immunocytochemical analysis of myometrial development in rats and mice: II. Effects of DES on development

Brody

Cunha

1989

Am. J. Anat.

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The effects of diethylstilbestrol (DES) treatment on myometrial development from the prenatal to adult period were examined in rats and mice by histologic and immunocytochemical methods using anti-actin, -vimentin, and -laminin to assess cytodifferentiation of smooth muscle and fibroblastic cells, and by morphometric procedures to assess quantitatively the effect of DES on the expression of cellular orientation in the emerging inner circular myometrial layer. Neonatal rats and mice were treated with DES from day 0 (day of birth) to day 2 with dosages known to perturb myometrial development. Neonatal treatment with DES increased the degree of circular orientation within the uterine mesenchyme, an effect detectable following as little as 24 hr of DES treatment. This effect on spatial organization of the mesenchyme was followed by an increase in the thickness of the actin-positive middle layer (prospective circular myometrium) of uterine mesenchyme during days 3-15; from day 15 onward, however, the circular myometrial layer began to fragment into irregular bundles of smooth muscle, and the longitudinal myometrial layer became thinner and more irregularly organized than controls. Vimentin localization in rats treated with DES neonatally was more intense than in controls within the circularly orientated uterine mesenchyme at 5 days. By 60 days the circular and longitudinal myometrial layers of DES-treated animals showed strands and bundles of vimentin-positive cells, which were not present in controls. Both rats and mice show comparable effects of DES treatment.

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Section: Des Dosage (Pg)mentioning

confidence: 98%

Histologic, morphometric, and immunocytochemical analysis of myometrial development in rats and mice: II. Effects of DES on development

Brody

Cunha

1989

Am. J. Anat.

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“…Of these, 729 were duplicates and 1674 were excluded after reading the title and abstract as they were not related to T‐shaped uterus (Figure 1). We evaluated 132 potentially eligible records in full text, of which 112 were excluded because T‐shaped uterus was related to DES exposure ( n = 64) 5,13–75 ; the article was not related to T‐shaped uterus ( n = 26) 76–101 ; the study included fewer than 10 women with a T‐shaped uterus ( n = 15) 4,102–115 ; no detailed results for T‐shaped uterus were reported ( n = 4) 116–119 ; and the article was a descriptive review ( n = 3) 120–122 . Therefore, 20 studies were eventually included in this systematic review 2,9,123–140 (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

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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“…However, approximately two-thirds of women exposed to DES in utero have reproductive tract anomalies and a significantly increased risk of cervical insufficiency. [3][4][5] Acquired cause include surgical trauma to the cervix and various obstetric injuries. Diagnosis of cervical insufficiency can be made by history of previous mid trimester loss, on clinical evaluation or sonographically by measuring cervical length or seeing funnelling of OS.…”

Section: Introductionmentioning

confidence: 99%

A study of short cervix in mid trimester of pregnancy

Kotwal,

Vyas,

Shah

et al. 2024

Int J Reprod Contracept Obstet Gynecol

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Background: Preterm birth is truly a global problem. Cervical length is one of the major determinants of preterm births. Diagnosis of cervical insufficiency can be made by history of previous mid trimester loss, on clinical evaluation or sonographically by measuring cervical length or seeing funnelling of OS. The mainstay treatment of cervical insufficiency is the cervical cerclage. Methods: Present study includes 55 cases of cervical length less than or equal to 2.5 cm on TVS examination between 18 to 22 weeks of gestation of singleton pregnancy was conducted at department of obstetrics and gynaecology at SMT NHL medical municipal hospital, Ahmedabad from July 2022 to December 2023 and shows comparison of rate of full term and preterm deliveries. Results: Out of 55 patients with cervical incompetence, 22 (40%) patients were diagnosed on examination. Out of 55 patients with cervical incompetence 33 (60%) patients had preterm births and only 19 (35%) patients delivered full term, 3 (5%) had abortions. Present study shows there were 35% full term deliveries, 60% preterm deliveries and 5% had abortion among patients having cervical length less than or equal to 2.5 cm. Conclusions: Internal OS status of every patient should always be examined by ultrasound between 18 to 22 weeks. Thus, cervical length is very useful in prognostication and prediction of preterm birth. There are highest chances of late preterm in cervical incompetent patients. Our study showed better outcome with OS tightening group compared to conservative group.

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Reproductive significance of changes in the endometrial cavity associated with exposure in utero to diethylstilbestrol

Cited by 11 publications

References 8 publications

Histologic, morphometric, and immunocytochemical analysis of myometrial development in rats and mice: II. Effects of DES on development

Histologic, morphometric, and immunocytochemical analysis of myometrial development in rats and mice: II. Effects of DES on development

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

A study of short cervix in mid trimester of pregnancy

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