Pregnancy in asymmetric blind hemicavity of Robert’s uterus—a previously unreported phenomenon

Singhal, Savita Rani; Agarwal, Umber; Sharma, Damyanti; Sirohiwal, Daya

doi:10.1016/s0301-2115(02)00238-5

Cited by 33 publications

(21 citation statements)

References 3 publications

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“…1,6 This could be explained by a partly functional endometrium lining the blind hemi-cavity. This possibility has been previously suggested by Shinghal et al, 5 who reported a pregnancy in a patient with a Robert's uterus and no preceding history of dysmenorrhea. The embryologic origin of this malformation is unclear and it is infrequently diagnosed in the pediatric age group.…”

Section: Discussionmentioning

confidence: 51%

Menstrual Retention In a Robert's Uterus

Capito¹,

Sarnacki²

2009

Journal of Pediatric and Adolescent Gynecology

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Section: Discussionmentioning

confidence: 51%

Menstrual Retention In a Robert's Uterus

Capito¹,

Sarnacki²

2009

Journal of Pediatric and Adolescent Gynecology

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“…(2012)SeptateComplete septate uterusSeptateSeptateImperforate hymenImperforate hymenU 2b C 1 V 3 Acién et al (2009) (case 5) and Lev-Toaff et al (1992)SeptateComplete septate uterusBicervicalDouble normalNormalNormalU 2b C 2 V 0 Balasch et al (1996), Brown and Badawy (2013), Caliskan et al (2008), Celik and Mulayim (2012), Chang et al (2004), Duffy et al (2004), Fatum et al (2003), Guo et al (2011), Heinonen (2006), Hundley et al (2001), Ignatov et al (2008). La Fianza et al (1997), McBean and Brumsted (1994), Nigam et al (2010), Oakes et al (2010), Patton et al (2004), Pavone et al (2006), Ribeiro et al (2010), Saygili-Yilmaz et al (2004) and Wai et al (2001)SeptateComplete septate uterusCervical duplication or Double normalDouble normalSeptateLongitudinal non-obstructing vaginal septumU 2b C 2 V 1 Hur et al (2007), Fedele et al (2013) (10/87 cases) and Acién et al (2004c)*SeptateComplete septate uterusDouble cervicesDouble normalUnilaterally obstructed vaginal septumLongitudinal obstructing vaginal septumU 2b C 2 V 2 * In the case of Acién et al (2004c) associated malformation : an ectopic ureter joined to ipsilateral hemi-cervixCapito and Sarnacki (2009)*, Gupta et al (2007)*, Hucke et al (1992) (2/3 cases), Perino et al (1995), ...…”

Section: Resultsmentioning

confidence: 99%

“…A precise categorization of single or complex anomalies was reached in 38 out of the 39 different types studied. In the following cases a consultation with the fourth reviewer was necessary before classification: Capito and Sarnacki (2009), Gupta et al (2007) and Singhal et al (2003) (Robert's uterus or Complete septate uterus/unilateral cervical aplasia/normal vagina ESHRE/ESGE Class U 2b C 3 V 0 ), Nezhat and Smith (1999) (Hemi-uterus with rudimentary cavities/ESHRE/ESGE Class U 4a C 0 V 0 ), Wright et al (2011) (Aplastic uterus with bilateral rudimentary cavities ESHRE/ESGE Class U 5a C 0 V 0 ), Sadik et al (2002) (Aplastic uterus/cervical aplasia/normal vagina/ESHRE/ESGE Class U 5b C 4 V 0 ), Medema et al (2008) (Normal uterus with rudimentary horns/ESHRE/ESGE Class U 6 ). The case reported by Nezhat and Smith (1999) having a hemi-uterus with ipsilateral rudimentary horns with cavity could be classified as Hemi-uterus with rudimentary cavity (ESHRE/ESGE Class U 4a C 0 V 0 ) since the presence of the cavity and not the number is the clinically important parameter for the classification.…”

Section: Resultsmentioning

confidence: 99%

The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system

et al. 2015

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STUDY QUESTIONHow comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies?SUMMARY ANSWERThe ESHRE/ESGE classification provides a comprehensive description and categorization of almost all of the currently known anomalies that could not be classified properly with the American Fertility Society (AFS) system.WHAT IS KNOWN ALREADYUntil now, the more accepted classification system, namely that of the AFS, is associated with serious limitations in effective categorization of female genital anomalies. Many cases published in the literature could not be properly classified using the AFS system, yet a clear and accurate classification is a prerequisite for treatment.STUDY DESIGN, SIZE AND DURATIONThe CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group.PARTICIPANTS/MATERIALS, SETTING, METHODSAmong the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies.MAIN RESULTS AND THE ROLE OF CHANCEThe congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of anomalies, while multiple organs and/or segments of Müllerian ducts (complex anomaly) were involved in 27 (69.2%) types. Uterus was the organ most frequently involved (30/39: 76.9%), followed by cervix (26/39: 66.7%) and vagina (23/39: 59%). In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly. A precise categorization was reached in 38 out of 39 types studied. Only one case of a bizarre uterine anomaly, with no clear embryological defect, could not be categorized and thus was placed in Class 6 (un-classified) of the ESHRE/ESGE system.LIMITATIONS, REASONS FOR CAUTIONThe review of the literature was thorough but we cannot rule out the possibility that other defects exist which will also require testing in the new ESHRE/ESGE system. These anomalies, however, must be rare.WIDER IMPLICATIONS OF THE FINDINGSThe comprehensiveness of the ESHRE/ESGE classification adds objective scientific validity to its use. This may, therefore, promote its further dissemination and acceptance, which will have a positive outcome in clinical care a...

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“…The above case is one of two reports of a pregnancy occurring in the non‐communicating hemicavity, and the only one resulting in a live birth. The other report is of a pregnancy discovered at 26 weeks at laparotomy following multiple failed attempts to terminate the pregnancy for preceding intrauterine death 4 . Pregnancy in the non‐communicating horn is thought to occur by intraperitoneal migration of sperm or fertilised ova.…”

Section: Discussionmentioning

confidence: 99%

Live birth after rupture of a non‐communicating horn of a bicornuate uterus

Ashelby

Toll

Patel

et al. 2005

BJOG

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Case reportA 33-year-old woman presented with abdominal pain at 30 weeks of gestation. A previous pregnancy had resulted in a ventouse delivery of a live boy. Her second pregnancy had been complicated by first trimester vaginal bleeding. First and second trimester ultrasound confirmed a bicornuate uterus with a live fetus in the left-sided moiety. She booked with her community midwife for home delivery.At 30 weeks of gestation she presented with sudden onset of cramping abdominal pain several hours after a grape seed oil massage. She had no associated vaginal bleeding and fetal movements were normal. Examination showed an appropriate symphysio-fundal height, breech presentation and mild tenderness over the uterus. Her observations were normal and fetal cardiotocograph (CTG) was satisfactory. Three hours later her pain and uterine tenderness increased and a fetal bradycardia was followed by fetal tachycardia. She was taken to theatre for caesarean section under general anaesthetic with the likely diagnosis of concealed placental abruption.Intra-abdominal haemorrhage was found. A lower uterine segment incision was made but the fetus was not found within this cavity. A classical incision was then performed over the left side of the uterus and a female infant delivered with an Apgar score of three at 1 minute and eight at 5 minutes. She was intubated and resuscitated by the neonatologists and transferred to the neonatal intensive care unit.Following delivery the uterus was externalised for closer inspection. The uterus had ruptured at the left side of the fundus. There was a thick septum dividing the uterus into two halves with no connection between the left side and right side and no connection between the left side of the uterus and the cervix. Furthermore, there was evidence of placental implantation in the left side of the uterus (Fig. 1).The combined effect of a lower segment and classical incision, in addition to a ruptured fundus, resulted in an atonic uterus. Despite suturing, pressure, syntocinon and the prostaglandin analogue carboprost (Hemabate), haemostasis was not achieved so the decision was made to proceed to caesarean hysterectomy.Following a 10-unit blood transfusion and high dependency care she made a full recovery and was discharged on day 7. The baby required 24 hours of intubation and surfactant. She received antibiotics for three days and remained on the neonatal unit to establish feeding. She was discharged on day 40. At their postnatal appointment nine weeks later both mother and baby were doing well. DiscussionCongenital uterine anomalies occur in 0.5% of women. 1 The variant of the septate uterus where the uterus is completely divided by the septum and one of the hemicavities does not communicate with the cervix, vagina or contralateral hemicavity was described by Robert in 1969. 2 Six cases have been reported. 2,3 These have mainly presented with primary dysmenorrhoea, abdominal pain and unilateral blood or fluid collection.The above case is one of two reports of a pregnancy occurring in ...

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Pregnancy in asymmetric blind hemicavity of Robert’s uterus—a previously unreported phenomenon

Cited by 33 publications

References 3 publications

Menstrual Retention In a Robert's Uterus

Menstrual Retention In a Robert's Uterus

The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system

Live birth after rupture of a non‐communicating horn of a bicornuate uterus

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