Update in Müllerian anomalies: diagnosis, management, and outcomes
- 1 October 2010
- journal article
- adolescent and-pediatric-gynecology
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Obstetrics and Gynecology
- Vol. 22 (5), 381-387
- https://doi.org/10.1097/gco.0b013e32833e4a4a
Abstract
Purpose of review Müllerian anomalies include a fascinating constellation of congenital malformations. There is significant diversity in anatomic variants and their respective long-term sexual and reproductive outcomes. We review the current controversies in classification and management of vaginal, uterine, and fallopian tube anomalies. Recent findings Comparative trials of preoperative magnetic resonance imaging (MRI) and laparoscopic intraoperative evaluation have demonstrated a moderately well correlated prediction of anatomic description. Three-dimensional ultrasound technology appears to be equivalent to MRI in detecting uterine anomalies; however MRI is a consistently superior method of evaluating the vaginal and cervical anatomy. Despite advances in both modalities, care at an experienced center is most highly associated with an accurate preoperative diagnosis and a decrease in the number of inappropriate surgical procedures. Large case series continue to be the main vehicle by which treatment and surgical management of these unique anomalies are described and recommended. Case reports continue to provide information on novel approaches to improve operative techniques. In the absence of prospective studies, these series provide the only emerging information on the long-term sexual and reproductive function of women with vaginal and uterine anomalies. Summary Recent developments in three-dimensional ultrasonography and MRI improve our ability to accurately describe and diagnose female reproductive tract anomalies. With the description of new complex malformations, which do not fall into the recognized American Society of Reproductive Medicine, formerly American Fertility Society (AFS) classification system, questions arise regarding embryologic development upon which this classification system is based and support attempts to devise a new, comprehensive classification. Advances in surgical correction have expanded the options for the reconstructive surgeon when approaching a patient with an anomaly of the reproductive tract.Keywords
This publication has 46 references indexed in Scilit:
- Congenital malformations of the female genital tract: the need for a new classification systemFertility and Sterility, 2010
- Three‐dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imagingUltrasound in Obstetrics & Gynecology, 2010
- Should Progressive Perineal Dilation be Considered First Line Therapy for Vaginal Agenesis?Journal of Urology, 2009
- Magnetic resonance imaging for uterine and vaginal anomaliesCurrent Opinion in Obstetrics and Gynecology, 2009
- Magnetic resonance imaging in the preoperative assessment of Mayer-Rokitansky-Kuster-Hauser syndromeLa radiologia medica, 2009
- Müllerian AnomaliesObstetrics and Gynecology Clinics of North America, 2009
- Committee Opinion No. 355: Vaginal Agenesis: Diagnosis, Management, and Routine CareObstetrics & Gynecology, 2006
- A Comparison of MRI and Laparoscopy in Detecting Pelvic Structures in Cases of Vaginal AgenesisJournal of Pediatric and Adolescent Gynecology, 2002
- Management of vaginal agenesis: review of 10 years practice at a tertiary referral centreAustralian and New Zealand Journal of Obstetrics and Gynaecology, 2000
- REVIEW: Embryological observations on the female genital tractHuman Reproduction, 1992