Utérus DES. Polémiques sur l'hystéroplastie d'agrandissement. Arguments pour

F. X. Aubriot, Charles Chapron
In: Gynécologie Obstétrique & Fertilité · 2007 · vol. 35(9) , pp. 826–831 · doi:10.1016/j.gyobfe.2007.07.011 · PMID:17766166 · W2077160170
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This paper argues for the use of enlargement hystroplasty in cases of uterine DES exposure, addressing ongoing controversies surrounding the procedure.

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Abstract

The diethylstilbestrol (DES) is a synthetic estrogen which was prescribed from 1941 onwards for the prevention of miscarriage. As well as a possible risk of cancer, another side effect of this treatment was the possible abnormality of the genitalia in the female issue of the prescribed user. Apart from possibly having a hypoplasic uterus, the patient is also prone, in the case where she has an undersized uterus, to having a much narrower than normal cavity. Consequently, there is a tendency for an excess of muscle tissue on the uterus walls. This can be observed on a RMN. The most significant characteristics of this abnormality are: constriction rings around the proximal uterine segment, a T shaped uterus, uterus with an arched base. The idea of the plastic enlargement operation (metroplasty) is to widen the cavity by making careful incisions of the excess muscle tissue located on the uterus wall. The objective of this is to obtain a triangular shaped cavity taking care though to weaken the walls themselves. 61 patients were treated. We observed 37 pregnancies after 16 months with 30 ongoing pregnancies. Generally, the anatomic results are excellent but it is difficult to measure the functional results of the success rate in future pregnancies. The reason for this is the enlarging of the cavity alone does not guarantee successful fertility. There are other problems to take into account e.g. implantation, miscarriage and premature labor. There are risks with this operation, such as placenta percreta, a possible rupture of the uterus, though this can happen at any time with DES patients. This operation can only be recommended once a thorough examination of the patient has been made.

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