Konjenital Uterin Anomaliler ve Obstetrik Sonuçları
Özet
Konjenital uterin anomaliler (KUA), embriyolojik dönemde Müllerian kanalların organogenez, füzyon veya septal rezorpsiyon aşamalarındaki aksaklıklardan kaynaklanan yapısal sapmalardır. Birçok olgu asemptomatik seyretse de KUA; pelvik ağrı, anormal kanama, tekrarlayan gebelik kayıpları, preterm doğum ve fetal malprezentasyon gibi klinik sorunlara yol açabilmektedir. KUA prevalansı genel popülasyonda %5.5 civarındayken, tekrarlayan düşük ve infertilite öyküsü olan grupta %24.5'e kadar yükselmektedir. Olgularda %20-30 oranında renal anomaliler de eşlik edebilmektedir. Tanıda geleneksel 2D ultrasonografi ve HSG'nin yanı sıra günümüzde altın standart olan 3D ultrasonografi ile MR son derece hassas sonuçlar vermektedir. Sınıflandırmada AFS, ESHRE/ESGE ve son olarak 2021 ASRM sistemleri kullanılmaktadır. Klinik olarak en kötü obstetrik sonuçlar septat uterusta görülmektedir. Yönetimde, didelfis ve bikornuat yapılarda metroplasti sadece kötü üreme öyküsünde tercih edilirken; septat uterus olgularında histeroskopik metroplasti (septumun kesilmesi) spontan düşük oranlarını anlamlı ölçüde azaltan, daha az komplikasyonlu güncel bir cerrahi tedavi seçeneğidir.
Congenital uterine anomalies (CUAs) are structural deviations resulting from developmental defects in the organogenesis, fusion, or septal resorption phases of the Müllerian ducts during the embryological period. Although many cases remain asymptomatic, CUAs can lead to clinical issues such as pelvic pain, abnormal bleeding, recurrent pregnancy loss, preterm birth, and fetal malpresentation. While the prevalence of CUAs is around 5.5% in the general population, it rises up to 24.5% in groups with a history of infertility and recurrent miscarriages. Accompanying renal anomalies are also observed in 20-30% of cases. Along with conventional 2D ultrasonography and HSG, 3D ultrasonography—the current gold standard—and MR imaging provide highly accurate diagnostic results. For classification, AFS, ESHRE/ESGE, and most recently the 2021 ASRM systems are utilized. Clinically, the poorest obstetric outcomes are observed in the septate uterus. In management, metroplasty for didelphys and bicornuate structures is preferred only in the presence of an adverse reproductive history; whereas for septate uterus cases, hysteroscopic metroplasty (septum incision) stands out as a current surgical treatment option with fewer complications that significantly reduces spontaneous abortion rates
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