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- W2018018911 abstract "Atypical Müllerian anomalies are frequently misdiagnosed in an attempt to conform to the American Society of Reproductive Medicine (ASRM) unidirectional classification system adopted in 1988. We present 3 cases of anomalies that challenge the current system and highlight the need for revision. Case Series. Three patients from our practice with atypical Müllerian anomalies are discussed. Case 1 presented with abdominal pain, and surgical exploration revealed a non-communicating, blood-filled right horn, fused with a left hemiuterus with one contiguous fundus, one cervix and normal vagina, previously misdiagnosed as a bicornuate or septate uterus. This patient's pain resolved after unifying her uterus. As she is an adolescent, her reproductive capacity is unknown. Cases 2 and 3 presented with a complete uterine septum, duplicated cervix and longitudinal vaginal septum, both originally misdiagnosed as a didelphys. Both of these patients conceived and delivered term babies after we resected their uterine and vaginal septae. These misdiagnoses delayed appropriate reproductive management. Current ASRM categorization of Müllerian anomalies is insufficient to encompass all variations. Numerous anomalies can be found in the literature that are not explained by this classification. The anomalies presented demonstrate the segmental and bidirectional nature of fusion and resorption possible during Müllerian development. Alternate classification theories have been proposed, such as Acién's segmental theory in 2004 and Musset's bidirectional theory in 1967. Neither of these alone adequately classifies all our anomalies. Misdiagnosis may occur in an effort to categorize within the current system. How clinicians view anomalies affect treatment and reproductive outcomes. Embracing a bidirectional classification based on segmental location of defects allows for accurate diagnosis. We believe the time has come for adopting a new classification system into the mainstream." @default.
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- W2018018911 date "2013-09-01" @default.
- W2018018911 modified "2023-09-26" @default.
- W2018018911 title "Challenging the unidirectional theory of müllerian development" @default.
- W2018018911 doi "https://doi.org/10.1016/j.fertnstert.2013.07.738" @default.
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