Abstract
Background
The nonobstructive group of anatomic variants involving the reproductive tract includes
vaginal agenesis as well as the congenital anomalies of the vagina and uterus, occurring
without pain during the pubertal years.
Objective
The objective is to discuss the non-obstructive morphologic variations in anatomy
of the uterus and vagina.
Design
Systematic review using the GRADE system.
Results
These congenital anomalies are not associated with abnormalities of the external genitalia
and therefore may be missed on routine physical examination. When these anomalies
do cause symptoms they may be as minor as difficulty with menstrual hygiene or more
significant such as primary amenorrhea, dyspareunia, recurrent pregnancy loss, and
reproductive complications.
Conclusions
Women with non-obstructive reproductive tract anomalies present at various ages due
to the asymptomatic nature or late symptom onset of certain conditions. An MRI is
the gold standard in evaluation of such conditions to aid in confirming the müllerian
variant. Each condition requires careful counseling because obstetric and gynecologic
risks and consequences may differ. Treatment is individualized in cases of uterovaginal
agenesis with both nonsurgical and surgical options available for neovagina creation.
In cases of uterine or vaginal septae, the treatment timing may vary depending on
patient history. Finally, in cases of non-obstructive communicating uterine horns,
the risk of ectopic pregnancy is high in the remnant horn. Should a pregnancy occur
in this small underdeveloped horn, therefore, excision is recommended.
Key Words
Level of Evidence
Grading of recommendations
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Article info
Publication history
Published online: July 17, 2014
Footnotes
This Clinical Recommendation has been prepared under the direction of the NASPAG Education Committee, and reviewed by the NASPAG Board and JPAG editors
Committee Opinion NASPAG 2014
The authors indicate no conflicts of interest.
The authors would like to thank Marc Laufer, MD, for conducting the expert review for this document.
The information contained in this Clinical Recommendation reflects the currently available best evidence for practice at the time of publication. The information is designed to aid practitioners in making decisions about appropriate patient care, but should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. This information has been reviewed and approved by the North American Society for Pediatric and Adolescent Gynecology.
Identification
Copyright
© 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
