Abstract
Purpose
Several classification systems for female genital tract anomalies exist but are of limited use in clinical practice. We, therefore, assessed the applicability and ease of use of the new ESHRE/ESGE classification, using only patient records.
Methods
This retrospective, single-center, proof-of-principle study systematically analyzed the surgical reports and other hospital records of 920 inpatients and outpatients treated for confirmed female genital tract congenital malformations at a major German university hospital during 2003–2013. Using only this information, a non-expert (medical student) assigned patients to an ESHRE/ESGE class, rating ease of classification based on the time and the number of additional medical records required. Results were verified by an expert gynecologist, who also classified any malformations previously left unclassified. Data analysis used descriptive statistics.
Results
The non-expert successfully classified 859/920 patients (93.4%), rating classification as “easy” for 836/859 (90.9%) and “moderately difficult” for 23/859 (2.5%) patients. The expert gynecologist successfully classified 60 (60/920, 6.5%) of the remaining 61 patients rated as “difficult” by the non-expert, but was unable to accurately subclassify 1 patient (1/920, 0.1%) because the operative report lacked the relevant details. 251/920 (27.3%) patients had associated non-Müllerian anomalies, most frequently renal (20.9%) and skeletal (9.1%) malformations.
Conclusions
The ESHRE/ESGE classification provides a generally applicable, comprehensive, and adequately specific classification of female genital tract congenital malformations. It offers an efficient basis for communication between non-experts and experts in the field and is, therefore, useful in clinical management and treatment planning.
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Abbreviations
- AFS:
-
American Fertility Society, now the American Society for Reproductive Medicine
- ASRM:
-
American Society for Reproductive Medicine
- ESGE:
-
European Society for Gynaecological Endoscopy
- ESHRE:
-
European Society of Human Reproduction and Embryology
- ICD-10:
-
International classification of diseases, 10th revision
- MRKHS:
-
Mayer–Rokitansky–Küster–Hauser syndrome
References
Nahum GG (1998) Uterine anomalies. How common are they, and what is their distribution among subtypes? J Reprod Med 43(10):877–887
Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A (2011) The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update 17(6):761–771. https://doi.org/10.1093/humupd/dmr028
Byrne J, Nussbaum-Blask A, Taylor WS, Rubin A, Hill M, O’Donnell R, Shulman S (2000) Prevalence of Mullerian duct anomalies detected at ultrasound. Am J Med Genet 94(1):9–12
Acién P (1997) Incidence of Mullerian defects in fertile and infertile women. Hum Reprod 12(7):1372–1376
Saravelos SH, Cocksedge KA, Li TC (2008) Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update 14(5):415–429. https://doi.org/10.1093/humupd/dmn018
Marten K, Vosshenrich R, Funke M, Obenauer S, Baum F, Grabbe E (2003) MRI in the evaluation of mullerian duct anomalies. Clin Imaging 27(5):346–350
Oppelt P, von Have M, Paulsen M, Strissel PL, Strick R, Brucker S, Wallwiener D, Beckmann MW (2007) Female genital malformations and their associated abnormalities. Fertil Steril 87(2):335–342. https://doi.org/10.1016/j.fertnstert.2006.07.1501
Oppelt PG, Lermann J, Strick R, Dittrich R, Strissel P, Rettig I, Schulze C, Renner SP, Beckmann MW, Brucker S, Rall K, Mueller A (2012) Malformations in a cohort of 284 women with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH). Reprod Biol Endocrinol 10:57. https://doi.org/10.1186/1477-7827-10-57
Acién P, Acién M, Sánchez-Ferrer M (2004) Complex malformations of the female genital tract. New types and revision of classification. Hum Reprod 19(10):2377–2384. https://doi.org/10.1093/humrep/deh423
Brucker S, Bungartz J, Rall K (2009) Die 3 A (Asymptomatisch, Amenorrhö, Aplasie) der Vaginalaplasie—kein differenzialdiagnostisches Chamäleon. Geburtshilfe Frauenheilkd 69(6):568–575
Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann H, Gianaroli L, Campo R (2013) The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 28(8):2032–2044. https://doi.org/10.1093/humrep/det098
Di Spiezio Sardo A, Campo R, Gordts S, Spinelli M, Cosimato C, Tanos V, Brucker S, Li TC, Gergolet M, De Angelis C, Gianaroli L, Grimbizis G (2015) The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system. Hum Reprod 30(5):1046–1058. https://doi.org/10.1093/humrep/dev061
World Health Organization (2016) International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) Version: 2016. http://apps.who.int/classifications/icd10/browse/2016/en. Accessed 15 July 2017
Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ (2011) Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol 38(4):371–382. https://doi.org/10.1002/uog.10056
Oppelt P, Renner SP, Kellermann A, Brucker S, Hauser GA, Ludwig KS, Strissel PL, Strick R, Wallwiener D, Beckmann MW (2006) Clinical aspects of Mayer-Rokitansky-Kuester-Hauser syndrome: recommendations for clinical diagnosis and staging. Hum Reprod 21(3):792–797. https://doi.org/10.1093/humrep/dei381
Brucker SY, Gegusch M, Zubke W, Rall K, Gauwerky JF, Wallwiener D (2008) Neovagina creation in vaginal agenesis: development of a new laparoscopic Vecchietti-based procedure and optimized instruments in a prospective comparative interventional study in 101 patients. Fertil Steril 90(5):1940–1952. https://doi.org/10.1016/j.fertnstert.2007.08.070
Rall K, Eisenbeis S, Henninger V, Henes M, Wallwiener D, Bonin M, Brucker S (2015) Typical and atypical associated findings in a group of 346 patients with Mayer-Rokitansky-Kuester-Hauser syndrome. J Pediatr Adolesc Gynecol 28(5):362–368. https://doi.org/10.1016/j.jpag.2014.07.019
Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, Gordts S, Exacoustos C, Van Schoubroeck D, Bermejo C, Amso NN, Nargund G, Timmerman D, Athanasiadis A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Tarlatzis B, Farquharson R, Gianaroli L, Campo R (2016) The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 31(1):2–7. https://doi.org/10.1093/humrep/dev264
American Fertility Society (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril 49(6):944–955
Oppelt P, Renner SP, Brucker S, Strissel PL, Strick R, Oppelt PG, Doerr HG, Schott GE, Hucke J, Wallwiener D, Beckmann MW (2005) The VCUAM (vagina cervix uterus adnex-associated malformation) classification: a new classification for genital malformations. Fertil Steril 84(5):1493–1497. https://doi.org/10.1016/j.fertnstert.2005.05.036
Grimbizis GF, Campo R (2010) Congenital malformations of the female genital tract: the need for a new classification system. Fertil Steril 94(2):401–407. https://doi.org/10.1016/j.fertnstert.2010.02.030
Acién P, Acién MI (2011) The history of female genital tract malformation classifications and proposal of an updated system. Hum Reprod Update 17(5):693–705. https://doi.org/10.1093/humupd/dmr021
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DS participated in data collection and interpretation, wrote and reviewed the draft manuscript, and prepared the final version. MH participated in data collection and interpretation and contributed to drafting and reviewing the manuscript. DSt, HB, and FAT participated in data collection and interpretation and contributed to drafting and reviewing the manuscript. BS oversaw data analysis, participated in data interpretation, and contributed to drafting and reviewing the manuscript. KR participated in designing the study, data collection, analysis, and interpretation, and contributed to drafting and reviewing the manuscript and preparing the final version. GG and ADSS participated in data interpretation and contributed to drafting and reviewing the manuscript. SYB conceived and designed the study, participated in data collection and interpretation, and contributed to drafting and reviewing the manuscript. All authors read and approved the final manuscript.
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Ethical approval
The study received prior approval (No. 205/2014BO1) from the Ethics Committee of the Medical Faculty of the University of Tübingen. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
The study retrospectively analyzed anonymized data from existing hospital records. For this type of study, formal consent is not required. Nonetheless, all participants gave their written informed consent to use their data in scientific studies and research publications.
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Schöller, D., Hölting, M., Stefanescu, D. et al. Female genital tract congenital malformations and the applicability of the ESHRE/ESGE classification: a systematic retrospective analysis of 920 patients. Arch Gynecol Obstet 297, 1473–1481 (2018). https://doi.org/10.1007/s00404-018-4749-x
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DOI: https://doi.org/10.1007/s00404-018-4749-x