| Objective:Congenital uterine anomalies is one of the most common type of the female genital duct abnormalities.With the constant improvement of inspection methods and diagnostic techniques,the inspection rate of congenital uterine anomalies gradually increased.The presence of congenital uterine anomalies is associated with an increased risk of primary infertility,primary amenorrhea,endometriosis,spontaneous abortion,preterm birth,breech presentation, and cesarean section.Congenital uterine anomalies may exist together with other congenital anomalies, including renal anomalies and lower gastrointestinal malformations.In various types of congenital uterine anomalies,septum uterus is the most common and have poor reproductive outcomes,accounting 80%~90% of all uterine malformations.Therefore,early and accurate diagnosis together with timely, effective and reasonable treatmentit has important clinical significance,which is helpful to improve the quality of life,the ability to have children, mental and physical health in patients with congenital uterine anomalies.The objective is to analysis the clinical information in various types of congenital uterine anomalies and have a comprehensive assessment of its incidence, clinical characteristics, treatment and pregnancy and delivery conditions before and after surgery.To achieve the purpose of guiding clinical work.Methods:We restrospectively analyzed the clinical data of 132 patients with congenital uterine anomalies at the Fourth Hospital of Hebei Medical University Hospital from January 2005 to December 2012.All patients were diagnosed by ultrasound or MRI or hysteroscope and(or) laparoscope or were found in the previa cesarean section or other surgery.The incidence, clinical characteristics and treatment method is summarized,for different types of congenital uterine anomalies including congenital absence of uterus, primordial uterus, uterus didelphys, uterus bicornis, saddle form uterus, uterus septum, uterus unicornis,rudimentary horn of uterus.58 patients were selected to followed up to controlly study the pregnancy and fertility outcomes before and after operation. Statistical analysis was performed using the Chi-square test and P < 0.05 was considered to be statistically significant.Results:1 Between January 2005 and December 2012,there were 132 cases of congenital uterine anomalies,including 99 cases( 75%) of septum uterus,12cases( 9.09%) of primordial uterus,7cases( 5.30%) of uterus didelphys,5cases(3.79%)of uterus bicornis,3 cases(2.27%)of saddle form uterus,3 cases(2.27%)of congenital absence of uterus,2 cases(1.52%)of rudimentary horn of uterus,1 case(0.757%) of uterus unicornis.3 cases of septum uterus and 1 case of uterus didelphys were merger vaginal diaphragm.2 cases of uterus didelphys were merger double vaginal.2 cases of congenital absence of uterus and 12 cases of primordial uterus were merger no vagina.The left renal was deficient in 1 case of primordial uterus.2 The analysis of clinical manifestations of 132 patients with congenital uterine anomalies is as follows:37.88% cases showed spontaneous abortion,followed by 28.79% manifested as infertility,10.61% performed primary amenorrhea, 8.33% showed abnormal menstruation,2.27% showed dyspareunia,6.06% patients did not have any clinical manifestation or were diagnosed by physical examination or surgery,6.06% were founded in pregnancy or childbirth.3 The analysis of treatment of 132 patients with congenital uterine anomalies is as follows:surgical correction of deformity were performed in 110 cases,22 cases did not undergo surgical correction of deformity treatment. 92.27% deformity surgery were performed by hysteroscopy and(or) laparoscopy.It was founded by surgery that congenital uterine anomalies were associated with other diseases,including 17 cases of endometrial polypsare which was the most common,,accounting for 12.88%,followed by 6 cases of endometriosis,4 cases of polycystic ovary syndrome,4 cases of uterine fibroids,3 cases of uterine cavity adhesion,3 cases of ovarian cyst.4 Before treatment,there were 113 gestation among 132 patients with congenital uterine anomalies except for 15 patients of congenital absence of uterus and primordial uterus who could not conceive.Spontaneous abortion rate was 69.91%(79/113), preterm birth rate was 3.54%(4/113),term delivery rate was 11.5%(13/113),artificial abortion rate was 10.62%(12/113), intrautrinedeath accounted for 2.65%(3/113), ectopic pregnancy accounted for 1.77%(2/113).5 52 cases of uterine septum werw followed up,postoperative pregnancy rate was 96.15%(50/52).After treatment there was a statistically significant decrease of abortion rate from 89.58% to 18.64%(P < 0.05), and a significant increase in term delivery rate from 6.25% to 79.66%(P < 0.05).3 cases of uterus didelphys,1 case of uterus bicornis and 2 cases of rudimentary horn of uterus who manifested as infertility before operation and had fertility requirements after operation were followed up,five of them were pregnant and all have live births.Conclusion:1 In 132 cases with congenital uterine anomalies septum uterus is the most common,followed by primordial uterus, uterus didelphys, uterus bicornis,other types are rare.2 Patients with congenital uterine anomalies mainly showed spontaneous abortion,followed by infertility, primary amenorrhea, menstrual abnormalities.3 Hysteroscopy,laparoscopy,or its combined surgery finally can accurately diagnose congenital uterine anomalies and other uterine or abdominal complications.At the same time,surgical treatment was done to cure uterine anomalies and other complications.Hysteroscopy, laparoscopy, or its combined surgery almost completely replaced the open operation,which is of great clinical significance.4 After surgical correction of deformity,the reproductive function of patients with congenital uterine abnormalities significantly improved and their pregnancy outcomes improved. |
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