Ishodi trudnoća u žena s jednorogom maternicom

master's thesis

• Title (english): Pregnancy outcomes in women with a unicornuate uterus
• Author: Blanka Vasić
• Mentor: Hrvoje Vrčić (mentor)
• Committee member: Lana Škrgatić (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Hrvoje Vrčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2021-09-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Jednoroga je maternica kongenitalna anomalija koja nastaje poremećajem razvoja jednog Müllerovog kanala. Iako rijetka u općoj populaciji, češća je među neplodnim ženama i onima koje pate od ponavljanih pobačaja. Najčešće je asimptomatska, no može se prezentirati dismenorejom, kroničnom zdjeličnom boli, hematometrom i hematosalpinksom. Incidencija neplodnosti u ovih žena je visoka zbog smanjene mišićne mase maternice, nedostatne vaskulature i lokalnih defekata stijenke. Trudnoća je moguća u hemi-uterusu i rudimentarnom rogu te se smatra visokorizičnom. Trudnoća u rudimentarnom rogu je opasna zbog moguće rupture roga. Trudnoće u hemi-uterusu su rizične zbog visoke učestalosti spontanih pobačaja u 1. i 2. tromjesečju, komplikacija (IUGR, IUFD, cervikalna insuficijencija, abnormalnosti posteljice, malprezentacija) i preuranjenog porođaja. Većina trudnoća dovršava se carskim rezom, a nije rijetkost da se tek tada ustanovi postojanje malformacije. Pravovremena dijagnoza često izostaje zbog asimptomatske naravi malformacije, nespecifičnosti fizikalnog nalaza te neiskustva kliničara u uočavanju ove malformacije na konvencionalnom 2D ultrazvuku. Dijagnoza se postavlja kombinacijom fizikalnog nalaza s ultrazvukom, histerosalpingografijom i MR-om. Kirurška korekcija hemi-uterusa nije moguća, stoga je ključna rana dijagnoza, prije pojave ginekoloških tegoba, neplodnosti ili prve trudnoće. Trudnoće je nužno je intenzivno nadzirati kao visokorizične, ekspektativnim pristupom, kako bi se prevenirali nepovoljni ishodi.

Abstract (english)

Unicornuate uterus is a congenital anomaly resulting from a developmental disorder of one Müllerian duct. Although rare in the general population, it is more common among infertile women and those suffering from recurrent misscarriage. It is most often asymptomatic, but may present with dysmenorrhea, chronic pelvic pain, hematometra and hematosalpinx. The incidence of infertility among these women is high due to reduced uterine muscle mass, insufficient vasculature and local uterine wall defects. Pregnancy is possible in the hemi-uterus and rudimentary horn and is considered high-risk. Pregnancy in the rudimentary horn is dangerous due to possible horn rupture. Pregnancy in the hemi-uterus is high-risk due to the high
frequency of miscarriages in the 1st and 2nd trimesters, complications (IUGR, IUFD, cervical insufficiency, placental abnormalities, malpresentation) and premature birth. Most pregnancies are completed by caesarean section, and it is not uncommon for the existence of the malformation to be established only then. Timely diagnosis is often lacking due to the asymptomatic nature of the malformation, the nonspecificity of the physical finding, and the inexperience of clinicians in spotting this malformation on conventional 2D ultrasound. Diagnosis is made by a combination of physical findings with ultrasound, hysterosalpingography, and MR. Surgical correction of the hemi-uterus is not possible, therefore early diagnosis is crucial, before the onset of gynecological problems, infertility or the first pregnancy. Pregnancies need to be intensively monitored as high-risk, with a “watchful waiting” approach, in order to prevent adverse outcomes.

• Keywords: ishodi trudnoća; jednoroga maternica; neplodnost; ponavljani pobačaj; hemi-uterus; rudimentarni rog
• Keywords (english): pregnancy outcomes; unicornuate uterus; infertility; recurrent misscarriage; hemi-uterus; rudimentary horn
• Language: croatian
• URN:NBN: urn:nbn:hr:105:037261
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-05-19 08:04:11