The clinical management of maldevelopment of the uterine cervix

Objectives: To outline the anatomical variations of malformations of the uterine cavity and to discuss the clinical management of cervical agenesis and dysgenesis. Design: Patients who were treated for cervical malformations during a 55-year interval are reviewed and followed prospectively. The diagnosis of cervical agenesis or dysgenesis is assigned at the time of exploratory laparotomy. Setting: Hospital based tertiary care reproductive endocrine-infertility units. Main Outcome Measures: All surgical findings were carefully reviewed to determine the anatomical 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. Results: Patients were found to lack a cervix (cervical agenesis) or to have 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 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. Conclusions: There are two basic types of anatomic congenital cervical malformations, the second of which may be considered as three distinct variations. The weight of the international clinical experience suggests that women with cervical agenesis or fragmentation should receive hysterectomy, whereas women with cervical dysgenesis may benefit from a reconstruction operation.