Blind hemivagina: long-term follow-up and reproductive performance in 42 cases

Abstract

Our purpose was to analyse the reproductive performance of women with obstructed hemivagina after surgical treatment. After laparoscopic exploration of 42 cases (mean age: 18 years), didelphic and complete septate uterus were found in 78 and 22% of cases respectively. Resection of vaginal septum and hemihysterectomy with ipsilateral hemicolpectomy were performed in 88% and 12% of the cases, respectively, between 1970 and 1997. Long-term results were assessed by a questionnaire and obtained for 38 patients (mean years after treatment and range: 6.5; 1-23). Dysmenorrhoea and abdominal pain were resolved in 87% and 100% of the cases, respectively. Nine patients experienced 20 pregnancies (13 living children, four early spontaneous abortions, two early terminations and one ectopic pregnancy). Nine offspring (69% of live births) were delivered after 37 weeks. Four patients had four pregnancies ipsilateral to blind hemivagina after vaginal septum resection (two living children, one early spontaneous abortion and one ectopic pregnancy). These results suggest that laparoscopic exploration and resection of vaginal septum are the appropriate treatments for obstructed hemivagina. Subsequent reproductive performance was comparable to that reported following treatment of the associated uterine malformation.

A Rare Obstetric Outcome in Uterus Didelphys with Obstructed Hemivagina and Ipsilateral Renal Agenesis

“…5 As it includes only two of the three components of the triad, it enables the inclusion of uterine anomalies, other than the more common uterus didelphys, such as a completely septated uterus (in up to 22% of cases, in some series). 10 Given the lack of uniformity in the denomination of the syndrome, review of the literature is also difficult. For example, although the word ''septum'' usually describes the midline longitudinal and nonobstructive septum of the isolated uterus didelphys, in the context of the abovementioned triad it has been used to describe the medial wall of the upper unilateral hematocolpos.…”

“…Several series reported other anomalies or even patients with two normal kidneys. 5,7,8,10 Smith and Laufer, in the largest series limited to modern management described to date, including 27 cases of obstructed hemivagina and ipsilateral renal anomaly, reported: 20 cases of ipsilateral renal agenesis (74%), 1 case of dysplastic and 1 case of polycystic kidney, 3 cases of bilateral normal kidneys, 1 contralateral duplex collecting system, 1 urethral diverticulum, and 1 rectovesical band. 5 Other anomalies, such as an ectopic ureter, have also been described.…”

“…4,[6][7][8] The literature review described few women who had pregnancies in the previously obstructed uterus. [4][5][6][7][8][9]10 An unusual case in which pregnancy occurred alternatively in both hemiuteri is presented here. Moreover, the last pregnancy (contralateral to the affected side) was simultaneous with a hematocolpos and a hematometra because of vaginal stenosis consequent to an incomplete vaginal septum resection.…”

A case of didelphic uterus and blind hemivagina with renal dysplasia and ectopic ureter presenting with vulvodynia and recurrent fever

“…If this septum is obstructive on one side, this is almost invariably associated with ipsilateral renal or ureteric anomalies. To the best of our knowledge, only three cases of didelphic uterus and obstructed hemivagina with normal urinary tracts have been reported in the literature [5][6][7].…”

“…It has been demonstrated that endometriosis occurs more frequently in patients with didelphic uterus, probably due to retrograde menstruation [14]. A retrospective study of 41 cases of obstructed hemivagina found associated complications including hematosalpinx, pyosalpinx, pelvic adhesions, and endometriosis in 39% of cases [5].…”