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Inverted balloon vaginoplasty technique was performed for a case with segmental vaginal aplasia and upper hematocolpos within 50 min operative time without any complications. The neovagina was naturally covered, 11 cm in depth and communicated with dimple at hymen''s site. Regular painless menstruations were reported. [Copyright &y& Elsevier]

Objective: We sought to estimate whether the presence of a maternal uterine anomaly is associated with adverse pregnancy outcomes. Study Design: This retrospective cohort study included singleton pregnancies undergoing routine anatomic survey from 1990 through 2008 at a major tertiary care medical center. Pregnancies with a diagnosis of uterine anomaly (uterine septum, unicornuate uterus, bicornuate uterus, uterine didelphys) were compared to those with normal anatomy. Primary outcomes of interest were spontaneous preterm birth (PTB), breech presentation, and cesarean delivery. Results: The presence of an anomaly was associated with PTB <34 weeks (adjusted odds ratio [aOR], 7.4; 95% confidence interval [CI], 4.8–11.4; P < .01), PTB <37 weeks (aOR, 5.9, 95% CI, 4.3–8.1; P < .01), primary nonbreech cesarean delivery (aOR, 2.6; 95% CI, 1.7–4.0; P < .01), preterm premature rupture of membranes (aOR, 3.2; 95% CI, 1.8–5.6; P < .01), and breech presentation (aOR, 8.6; 95% CI, 6.2–12.0; P < .01). Conclusion: Women with a uterine anomaly are at risk for PTB, highlighting an at-risk population that needs additional study for possible interventions for PTB prevention. [ABSTRACT FROM AUTHOR]

Objective: To report a patient with Mayer-Rokitansky-Kuster-Hauser syndrome with functional endometrium treated with preoperative continuous combined low-dose monophasic oral contraceptives. Design: Case report. Setting: University hospital. Patient(s): A 12-year-old nulligravid adolescent girl. Intervention(s): Preoperative continuous combined low-dose monophasic oral contraceptives for 7 months, and laparoscopic resection of the rudimentary uterus and uterine horns with unilateral salpingo-oophorectomy. Main Outcome Measure(s): Relief of pain after hormonal treatment and the operative procedure. Result(s): Successful preoperative treatment of endometriosis and pain before definitive diagnosis and removal of müllerian remnants in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome. Conclusion(s): Patients with obstructive müllerian malformations with functional endometrium can be preoperatively managed with continuous combined low-dose monophasic oral contraceptives to control pain and treat endometriosis. This may permit a delay in surgical intervention to facilitate other investigations and to allow thorough counselling of the patient and her family about the implications of the diagnosis. [Copyright &y& Elsevier]

Abstract: Study Objective: To highlight the coexistence of uterine septum in cases diagnosed as bicornuate uterus on basis of the external shape of uterine fundus. Study Design: Case report with description of the technique. Setting: Women’s Health Assiut University Hospital. Participants: An adolescent female with progressive pains dating since menarche. Interventions: Hysteroscopic resection under laparoscopic monitoring through an intact hymen. Main Outcome Measure: Operative time, complications, postoperative abdominal pain, appearance of the uterine cavity Results: A patient with a septate uterus with a fundal depression and hemiuterine obstruction underwent hysteroscopic resection under laparoscopic monitoring. Laparoscopy was beneficial in diagnosis and treatment of associated pathology and monitoring the hysteroscopic procedure. Hysteroscopic metroplasty was performed and resulted in unification of the lower two thirds of the uterus. Dysmenorrhea was dramatically improved after the procedure. Subsequent office hysteroscopy confirmed restoration of a unified lower uterine corpus anatomy mimic to the original bicornuate state. Conclusions: External fundal depression which characterizes bicornuate uterus was associated with a septate uterus with hemi uterine obstruction. This report demonstrates the coexistence of the two anomalies. Endoscopic management of this patient was safe and successful. [Copyright &y& Elsevier]

We evaluated the feasibility and operative and postoperative outcomes of office balloon vaginoplasty. Office balloon vaginoplasty was performed successfully for a case with vaginal aplasia. She was currently married and presenting with minimal penetration and dyspareunia. We successfully performed the procedure through retro-pubic space under local anesthesia within 25 min total operative time and it was well tolerated by the patient. No operative complications were reported. The resulting neovagina was cosmetically attractive and 10 cm in depth. Sexual intercourse was started on the day of catheter removal. Penetration and satisfaction scores increased up to 90 points for both partners. [ABSTRACT FROM AUTHOR]

Objective: To report a case of cervical dysgenesis presenting with hematometra. Design: Case report. Setting: Teaching and research hospital. Patient(s): A 12-year-old girl presented with primary amenorrhea. At laparoscopic examination she was found to have a ball-shaped enlarged uterus without any type of connection to the upper normal-appearing cervix. Intervention(s): Conservative surgery with end-to-end anastomosis of the upper blunt end of the cervix to the lower part of the uterus was performed. Main Outcome Measure(s): Preserve fertility and/or maintain cyclic menstrual cycles. Result(s): After having normal menses for 3 months, the patient was admitted again with occlusion at the anastomosis site. Hematometra was drained and hysteroscopic and laparoscopic observations proved a normal-appearing uterus, endocervical canal, and cervix. Conclusion(s): Conservative surgical treatment with intact cervical and uterine segments, with an end-to-end cervicouterine anastomosis is a feasible and effective option in patients with cervical transverse fragmentation. [ABSTRACT FROM AUTHOR]

Abstract: A wide variety of Müllerian anomalies has been described in the literature. Various combinations of anomalies may coexist in a single subject. Precise identification of the various components of the anomaly is paramount in choosing and planning the appropriate conservative and surgical treatment. In this report, we present a rare case of combined vertical fusion and transverse canalization defects in a single subject. A review of the literature along with an overview of the pertinent embryologic processes and management concepts for such cases are presented. [Copyright &y& Elsevier]

Abstract: Background: Goltz syndrome, or focal dermal hypoplasia, is a rare congenital mesoectodermal syndrome. It is characterized primarily by extensive cutaneous and musculoskeletal defects. Case: We report on a 17-year-old menarchal girl diagnosed with a severe form of Goltz syndrome who was referred to the Gynecology Division at the Children''s Hospital Boston. A complete evaluation revealed a septate hymen, a normal vagina with a single cervix, a bicornuate uterus, and a unilateral kidney. To our knowledge, there have been no documented cases of congenital anomalies of the female reproductive tract in patients with Goltz syndrome. Conclusions: The development of the female reproductive tract is a complex process involving all three embryonic cell layers. Female patients with multiple abnormalities of ectodermal and mesodermal origin warrant complete evaluations of their reproductive tracts. [Copyright &y& Elsevier]

Objective: The aim of our study was to determine the success rate of vaginal birth after cesarean section among patients with Müllerian anomalies in comparison to the success rate of vaginal birth after cesarean section in patients with normal uterus with emphasis on the rate of uterine rupture. Study Design: A retrospective population-based study was designed, including all patients with a previous cesarean section that attempted vaginal birth after cesarean section during the study period. Women with known Müllerian anomalies were included in the study group. The control group consisted of women with normal uterus. The rates of vaginal birth after cesarean section, uterine rupture, maternal morbidity, and perinatal outcome were compared between the groups. Results: Of 5571 eligible patients, 165 (2.96%) had Müllerian anomalies. The rate of vaginal birth after cesarean section was significantly lower among patients with Müllerian anomalies than in patients with normal uterus, 37.6% (62/165) vs 50.7% (2740/5406), respectively (P = .0009). During the study period, there were 10 cases of uterine rupture, all in patients with normal uterus. The major indication for repeated cesarean delivery among Müllerian anomalies patients was malpresentation, 58.3% (60/103) vs 14.4% (385/2666) in patients with normal uterus (P < .001). Conclusion: A trial of vaginal birth after cesarean section in patients with uterine Müllerian malformations and cephalic presentation is not associated with a higher rate of maternal morbidity and uterine rupture. [Copyright &y& Elsevier]

Objective: To assess the possibility of laparoscopic management of cervical agenesis. Design: Case report. Setting: Patient recruited from a tertiary referral hospital. Patient(s): Adult female with diagnosis of cervical agenesis. Intervention(s): Laparoscopic uterovaginal anastomosis. Main Outcome Measure(s): The patency of the anastomosis site was assessed with hysteroscopy. Result(s): Patient was menstruating normally and had been sexually active at 6 months after the procedure. Conclusion(s): Laparoscopic treatment of these cases is feasible and should be considered as a first-line treatment option. [Copyright &y& Elsevier]

Interstitial, angular, and cornual pregnancies and intrauterine pregnancies in an anomalous uterus are separate entities, and the impact of each condition on obstetric outcomes is completely different. However, there is considerable confusion in understanding and managing the natural course of each condition due to a lack of uniform terminology. The single most important factor for differentiating these types of pregnancies is to make an early diagnosis. The differences between interstitial, angular, and cornual pregnancies on 2-dimensional (2D) sonography are subtle. Although magnetic resonance imaging can be used to differentiate these conditions, it is not preferred as the initial assessment tool because of its limited availability and cost-effectiveness. Three-dimensional (3D) sonography has the advantage of providing views of the uterus that cannot be obtained with conventional 2D sonography. We describe 3 cases of interstitial, angular, and intrauterine pregnancies in a septate uterus that were clearly differentiated by 3D sonography. We demonstrate the differences in diagnostic imaging findings and emphasize the importance of 3D sonography in differentiating these entities., (© 2014 by the American Institute of Ultrasound in Medicine.)

Although many Müllerian duct anomalies do not require treatment, surgical intervention is sometimes necessary to enable sexual activity or to preserve fertility. The identification of these anomalies is important for optimal clinical management or surgical treatment. Magnetic resonance (MR) imaging is a robust method for adequately evaluating and characterizing uterine and vaginal anomalies. The information provided by MR imaging allows for a more complete understanding of the malformation, facilitating management decisions and potentially changing the outcome. In this article, the embryology, classification, and MR imaging findings of Müllerian duct and related anomalies in children and adolescents are reviewed., (Copyright © 2013 Elsevier Inc. All rights reserved.)