Congenital anomalies of the uterine cervix: lessons from 30 cases managed clinically by a common protocol.

OBJECTIVES

To outline the anatomic variations of malformations of the uterine cervix and to discuss the clinical management of cervical agenesis and dysgenesis.

DESIGN

Thirty patients who were treated for cervical malformations in six institutions during a 69-year interval are reviewed.

SETTING

Hospital-based tertiary-care reproductive endocrine infertility units.

PATIENT(S): Thirty women with congenital uterine-cervical anomalies.

INTERVENTION(S): Exploratory laparotomy with cervicovaginal reconstruction or hysterectomy.

MAIN OUTCOME MEASURE(S): All surgical findings were carefully reviewed to determine the anatomic characteristics of the malformed cervix. When cervical reconstruction was performed, the patient was followed to determine the need for reoperation or if the patient achieved a pregnancy.

RESULT(S): Patients lacked a cervix (cervical agenesis) or had one of three variants of cervical dysgenesis. Patients with cervical dysgenesis were characterized as having: 1) an intact cervical body with obstruction of the cervical os; 2) a cervical body consisting of a fibrous band or cord; or 3) cervical fragmentation. One patient conceived after reconstruction. Reoperation was less likely to occur among women who had an obstructed endocervical canal but an otherwise normal cervical body.

CONCLUSION(S): There are two forms of anatomic congenital cervical malformations, the second of which may be considered as three distinct variations.