സെർവിക്കൽ അജെനിസിസ്
| Cervical agenesis | |
|---|---|
| മറ്റ് പേരുകൾ | Cervical atresia, cervical dysgenesis |
| സ്പെഷ്യാലിറ്റി | Gynecology |
ഗർഭാശയവും യോനിയും തമ്മിലുള്ള ബന്ധിപ്പിക്കുന്ന ഘടനയായ സെർവിക്സിൻറെ അഭാവത്തിൽ സ്വയം പ്രത്യക്ഷപ്പെടുന്ന സ്ത്രീ ജനനേന്ദ്രിയ വ്യവസ്ഥയുടെ അപായ വൈകല്യമാണ് സെർവിക്കൽ അജെനിസിസ്. സെർവിക്സ് ഉള്ളതും എന്നാൽ വികലവും പ്രവർത്തനരഹിതവുമായ അവസ്ഥയുടെ മൃദുവായ രൂപങ്ങളെ സെർവിക്കൽ അട്രേസിയ അല്ലെങ്കിൽ സെർവിക്കൽ ഡിസ്ജെനിസിസ് എന്ന് വിളിക്കുന്നു.
Presentation
[തിരുത്തുക]Patients with cervical agenesis typically present in early adolescence, around the time of menarche, with amenorrhea and cyclic pelvic pain caused by the obstruction of menstrual flow from the uterus.[1]
Complications
[തിരുത്തുക]If untreated, the accumulation of menstrual fluid in the uterus caused by cervical agenesis can lead to hematocolpos, hematosalpinx, endometriosis, endometrioma and pelvic adhesions.[1][2]
Pathophysiology
[തിരുത്തുക]Cervical agenesis arises during fetal development, during which time the paramesonephric duct fails to canalize in formation of the cervix.[3]
Diagnosis
[തിരുത്തുക]The diagnosis of cervical agenesis can be made by magnetic resonance imaging, which is used to determine the presence or absence of a cervix. Although MRI can detect the absence of a cervix (agenesis), it is unable to show cervical dysgenesis (where the cervix is present, but malformed).[1] Ultrasound is a less reliable imaging study, but it is often the first choice by gynecologists to establish a diagnosis and can identify a hematometra secondary to cervical agenesis.[2]
Management
[തിരുത്തുക]The first line of therapy after diagnosis typically involves the administration of the combined oral contraceptive pill, medroxyprogesterone acetate or a gonadotropin-releasing hormone agonist to suppress menstruation and thereby relieve pain.[2] Surgically, cervical agenesis has historically been treated through hysterectomy (removal of the uterus) to relieve symptoms caused by hematocolpos (the accumulation of menstrual fluid in the vagina).[3] Other surgical methods of management involve the creation of an anastomotic connection between the uterus and vagina by neovaginoplasty or recanalization of the cervix. Outcomes in these cases are generally poor, since the natural functions of the cervix—such as mucus production and providing a barrier against ascending infection—cannot be replicated.[3] Furthermore, the success rate of uterovaginal anastomosis is less than 50% and most patients require multiple surgeries while many develop cervical stenotis.[2][3] Despite this, several pregnancies have been reported in women with cervical agenesis who underwent surgical treatment.[4]
Epidemiology
[തിരുത്തുക]Cervical agenesis is estimated to occur in 1 in 80,000 females.[4] It is often associated with deformity of the vagina; one study found that 48% of patients with cervical agenesis had a normal, functional vagina, while the rest of the cases were accompanied by vaginal hypoplasia.[1]
See also
[തിരുത്തുക]References
[തിരുത്തുക]- ↑ 1.0 1.1 1.2 1.3 Falcone, Tommaso; Hurd, William W. (2013). Clinical Reproductive Medicine and Surgery: A Practical Guide. Springer Science+Business Media. pp. 312–314. ISBN 9781461468370.
- ↑ 2.0 2.1 2.2 2.3 Sokol, Andrew I.; Sokol, Eric R. (2013). General Gynecology: The Requisites in Obstetrics and Gynecology. Elsevier. p. 217. ISBN 9780323032476.
- ↑ 3.0 3.1 3.2 3.3 Drutz, Harold P.; Herschorn, Sender; Diamant, Nicholas E. (2007). Female Pelvic Medicine and Reconstructive Pelvic Surgery. Springer Science+Business Media. p. 54. ISBN 9781846282386.
- ↑ 4.0 4.1 Arulkumaran, Sabaratnam, ed. (2011). Oxford Desk Reference: Obstetrics and Gynaecology. Oxford University Press. p. 533. ISBN 9780199552214.
External links
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