Creasy and resnick pdf
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The reproductive performance of the unicornuate and didelphys uteri was poor, while that of the septate and bicornuate uteri was better than expected. Nevertheless, fertile patients with normal reproductive performance do exist, and Müllerian defects can permit an absolutely normal obstetric outcome. It is concluded that uterine anomalies are relatively frequent in fertile women, and more frequent in infertile patients.
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The arcuate uterus presented a live birth rate of 82.7%. In all these abnormalities, early miscarriages (25-38%) and preterm deliveries (25-47%) were quite common. The reproductive potential of the bicornuate uterus showed a live birth rate of 62.5% and the septate uterus showed a live birth rate of 62%. The performance of the unicornuate and didelphys uteri was similar with a chance of having a living child of 37-40%. Each malformation was individually analysed in fertile and infertile patients, in order to ascertain its actual reproductive impact.
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Septate (33.6%) and arcuate (32.8%) uteri were the most common malformations observed. Infertile patients (6.3%) had a significantly (P < 0.05) higher incidence of Müllerian anomalies, in comparison with fertile (3.8%) and sterile (2.4%) women. The overall frequency of uterine malformations was 4.0%. The population analysed included fertile, infertile and sterile patients. A total of 3181 patients in whom the morphology of the uterus was ascertained by hysterosalpingography (HSG) and laparoscopy/laparotomy during the years 1980-1995 was included in the study. This retrospective longitudinal study was undertaken in order to determine the incidence and reproductive impact of uterine malformations on women desiring to conceive during their reproductive years. This is one of the few case reports in literature and will further add credence to the body of knowledge of a different aspect to the presentation and management of cases of Mullerian anomalies. The second attempt of surgical management was successful, and she was subsequently discharged.
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This was particularly challenging as the cervix was flushed with the vaginal vault making delineating and dilatation of the cervical OS difficult hence sustaining a perforation of the left uterine cavity.
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She had an initial unsuccessful surgical management of miscarriage with uterine perforation of one of the uterine cavities, hysteroscopy and diagnostic laparoscopy and subsequently had a repeat examination under anaesthesia and second attempt at evacuation of retained products or a laparoscopy plus hysterotomy. These were all diagnosed on ultrasound scan. This case report elucidates the presentation of a multiparous lady with uterine didelphys who had a previous successful pregnancy in one of the uterine canals but presented in the second pregnancy with a missed miscarriage at 12 weeks gestational age. The incidence uterine didelphys has been quoted as 1 in 2000 women.
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Uterine didelphys is one of the Mullerian or paramesonephric duct anomalies occurring as a result of duplication of the uterine canal with two cervical canals and a single vagina. Mullerian anomalies are defects in the embryological development of the urogenital systems as these organs begin to form at about the 5 and 6th week of intrauterine life.
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