Template talk:Classification of Uterine Anomalies ESHRE/ESGE

Classification of Uterine Anomalies ESHRE/ESGE
Uterine anatomy is the basis of the new system. Embryological origin has been adopted as the secondary basic characteristic in the design of the main classes. Cervical and vaginal anomalies are classified in independent co-existent sub-classes. Class U0 - incorporates all cases with normal uterus. Class U1 - (Dysmorphic uterus) incorporates all cases with normal uterine outline but with an abnormal shape of the uterine cavity excluding septa. Class I is further subdivided into three categories Class U1a - (T-shaped uterus) characterized by a narrow uterine cavity due to thickened lateral walls with a correlation 2/3 uterine corpus and 1/3 cervix, Class U1b - (uterus infantilis) characterized also by a narrow uterine cavity without lateral wall thickening and an inverse correlation of 1/3 uterine body and 2/3 cervix Class U1c - (others) which is added to include all minor deformities of the uterine cavity including those with an inner indentation at the fundal midline level of less than 50 % of the uterine wall thickness. Class U2 - (septate uterus) internal indentation >50 % of the uterine wall thickness & external contour straight or with indentation <50 % Class U2a - (partial septate uterus) characterized by the existence of a septum dividing partly the uterine cavity above the level of the internal cervical os Class U2b - (complete septate uterus) characterized by the existence of a septum fully dividing the uterine cavity up to the level of the internal cervical os. Class U3 - (bicorporeal uterus) external indentation >50 % of the uterine wall thickness Class U3a - (partial bicorporeal uterus) characterized by an external fundal indentation partly dividing the uterine corpus above the level of the cervix Class U3b - (complete bicorporeal uterus) width of the fundal indentation at the midline >150 % of the uterine wall thickness) completely dividing the uterine corpus up to the level of the cervix Class U3c - (bicorporeal septate uterus) characterized by the presence of an absorption defect in addition to the main fusion defect. Class U4 - (hemi-uterus) incorporates all cases of unilateral formed uterus. Hemi-uterus is defined as the unilateral uterine development; the contralateral part could be either incompletely formed or absent. Class U4a - (hemi-uterus with a rudimentary (functional) cavity) characterized by the presence of a communicating or non-communicating functional contralateral horn Class U4b - (hemi-uterus without rudimentary (functional) cavity) characterized either by the presence of non-functional contralateral uterine horn or by aplasia of the contralateral part. Class U5 - (aplastic uterus) incorporates all cases of uterine aplasia, formation defect characterized by the absence of any fully or unilaterally developed uterine cavity. Class U5a - (aplastic uterus with rudimentary (functional) cavity) characterized by the presence of bi- or unilateral functional horn Class U5b - (aplastic uterus without rudimentary (functional) cavity) characterized either by the presence of uterine remnants or by full uterine aplasia. Class U6 - is kept for still unclassified cases.
Co-existent cervical anomalies
Sub-class C0 or normal cervix incorporates all cases of normal cervical development. Sub-class C1 or septate cervix incorporates all cases of cervical absorption defects. It is characterized by the presence of a normal externally rounded cervix with the presence of a septum. Sub-class C2 or double cervix incorporates all cases of cervical fusion defects. It is characterized by the presence of two distinct externally rounded cervices; these two cervices could be either fully divided or partially fused. It could be combined with a complete bicorporeal uterus as a class U3b/C2 in the formerly Didelphys uterus. Sub-class C3 or unilateral cervical aplasia incorporates all cases of unilateral cervical formation. It is characterized by the unilateral, only, cervical development; the contralateral part could be either incompletely formed or absent. Obviously, this has happened in class U4 patients; however, this is not necessary to be mentioned in the final classification report (class U4 instead of class U4/C3) as being apparent. On the other hand, this sub-class gives the opportunity to classify other seldom anomalies such as complete bicorporeal uterus with unilateral cervical aplasia as class U3b/C3, which is a severe obstructing anomaly. Sub-class C4 or cervical aplasia incorporates all cases of complete cervical aplasia but also those of severe cervical formation defects. It is characterized either by the absolute absence of any cervical tissue or by the presence of severely defected cervical tissue such as cervical cord, cervical obstruction and cervical fragmentation. The decision to include all variants of cervical dysgenesis in sub-class C4 was made in order to avoid an extremely extensive sub-classification, which does not seem to be user friendly. This sub-class could be combined with a normal or a defected uterine body and gives the opportunity to classify all obstructing anomalies due to cervical defects.
Co-existent vaginal anomalies
Sub-class V0 or normal vagina incorporates all cases of normal vaginal development. Sub-class V1 or longitudinal non-obstructing vaginal septum. The incorporated anomaly in this sub-class is clear; it gives the opportunity to classify variants of septate or bicorporeal uteri together with septate or double cervices. Sub-class V2 or longitudinal obstructing vaginal septum. The incorporated anomaly in this sub-class is also clear, and its utility for the effective classification of obstructing anomalies due to vaginal defects is obvious. Sub-class V3 or transverse vaginal septum and/or imperforate hymen. This sub-class incorporates obviously different vaginal anomalies and their variants (mainly those of transverse vaginal septa); this was decided in order to avoid an extremely extensive sub-classification for the classification system’s simplicity. The decision to put together those vaginal anomalies in this sub-class is due to the fact that they are usually present as isolated vaginal defects and they have the same clinical presentation (obstructing anomalies). Sub-class V4 or vaginal aplasia incorporates all cases of complete or partial vaginal aplasia.