Surgical management of congenital uterine anomalies
- Ronald E Iverson, Jr, MD
Ronald E Iverson, Jr, MD
- Associate Professor
- Department of Obstetrics and Gynecology
- Boston University
- Alan H DeCherney, MD
Alan H DeCherney, MD
- Chief, Reproductive Biology and Medicine Branch
- National Institute of Child Health and Human Development
- National Institutes of Health
- Marc R Laufer, MD
Marc R Laufer, MD
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
Congenital uterine anomalies are associated with a variety of gynecological and obstetrical problems [1,2]. Restoration of normal uterine architecture and preservation of fertility are the goals of surgical treatment of uterine anomalies (table 1 and figure 1). However, normal or near-normal architecture cannot always be achieved and merely creating a normal uterine cavity may not be therapeutic because uterine vascularization and myometrial and cervical function may also be abnormal.
Surgical management of congenital uterine anomalies is reviewed here. The evaluation and diagnosis of women with congenital uterine anomalies is discussed separately. (See "Clinical manifestations and diagnosis of congenital anomalies of the uterus".)
Surgical repair of congenital uterine anomalies is primarily directed toward women with uterine septa, bicornuate uteri, and obstructed hemi-uteri. Women with unicornuate or arcuate uteri are generally not candidates for reconstructive procedures because surgery does not improve pregnancy outcome .
The most common indications for repair of congenital uterine anomalies are pelvic pain and repetitive pregnancy loss. Prior to surgical intervention, however, other causes of these problems should be excluded. (See "Evaluation of couples with recurrent pregnancy loss".)
Dysmenorrhea in women with septate uteri may be considered an indication for hysteroscopic metroplasty if medical therapy is not effective. Laparoscopic evaluation for coexistent endometriosis (common in women with structural abnormalities of the reproductive tract) should be undertaken.
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- OBSTRUCTED UTERINE RUDIMENTARY HORNS
- HYSTEROSCOPIC REPAIR OF THE SEPTATE UTERUS
- Postoperative care
- LAPAROSCOPIC/ABDOMINAL TRANSMYOMETRIAL REPAIR OF THE SEPTATE UTERUS
- Jones metroplasty
- Tompkins metroplasty
- UTERINE TRANSPLANTATION
- Fetal salvage
- Reduction in pregnancy complications
- Reduction in dysmenorrhea
- SUMMARY AND RECOMMENDATIONS