Classification and reproductive surgery of uterovaginal anomalies
Zograb Makiyan (RU), Leyla Adamyan (RU), Alexander Danilov (RU), Assia Stepanian (RU), Kristina Farkhat (RU), Nadezhda Miroshnikova (RU)
[Makiyan] Federal State Scientific Center of obstetrics, gynecology and perinatology, Moscow, Russia, [Adamyan] Federal State Scientific Center of obstetrics, gynecology and perinatology, Moscow, Russia, [Danilov] Federal State Scientific Center of obstetrics, gynecology and perinatology, Moscow, Russia, [Stepanian] , [Farkhat] Federal State Scientific Center of obstetrics, gynecology and perinatology, Moscow, Russia, [Miroshnikova]
Context: Successful reproductive outcomes after surgical corrections of uterovaginal anomalies reach to 25-37%. The validity of the current classification systems of female genital malformations has been challenged. Objective: To optimize reproductive outcomes for females with uterovaginal malformations. Methods: Clinical examination, ultrasonography, MRI, laparoscopy, hysteroscopy and morphological investigations. Patients: Totally the 2025 patients with various uterovaginal anomalies have operated between 1992 and 2016. Interventions: Surgical correction of genital malformations performed according to clinical manifestations: obstruction of menstrual outflow, abdominal pain, infertility, miscarriage, sexual problems. Main Outcome Measures: In (352) patients with utero-vaginal aplasia performed peritoneal creation of neovagyna; removing of rudimentary horn in 245 patients; vagynoplasty (240) for partial vaginal aplasia; hysteroresectoscopic dissection of intrauterine septum in 445 cases. For patients with uterus duplex (296) and bicornuate uterus (210) performed the correction of concomitant infertile factors. Cervico-vaginal aplasia had 64 patients – hysterectomy of rudimental uterus performed in 45 cases, for 21 patients successfully created the neo-cervical stentation. Results: More than 52% patients had concomitant infertile factors: tubal and peritoneal adhesions (34%), intrauterine synechia (7%), polycystic ovary (17%) and hormonal disorders – anovulation (19%), ovarian hypofunction (8%). The endometriosis was still the major cause of pain and infertility - in 56% females. The new classification of uterovaginal anomalies have suggested, accordingly to anatomy and embryological stages. Conclusion: The reconstructive surgical correction, assisted reproduction methods appears to improve reproductive outcomes of 57% women with uterovaginal anomalies.