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Diagnosis and Management of Mullerian Anomalies Across Differing Resource Settings: Worldwide Adaptations
Journal of Pediatric and Adolescent Gynecology ( IF 1.8 ) Pub Date : 2022-04-27 , DOI: 10.1016/j.jpag.2022.04.007
Jennifer E Dietrich 1
Affiliation  

Background

Mullerian anomalies affect 7% of reproductive age women. It is important to have a basic understanding of these conditions, given they can affect women at any stage of life and have potential impacts on fertility and pregnancy. This article seeks to review these anomalies as well as specific diagnostic pitfalls and strategies to approach these conditions in both high- and low-resource environments.

Methods

This review was undertaken with a PubMed focused search, using terms related to the diagnosis and management of Mullerian anomalies in many worldwide settings. Consideration was made to assess the medical resources available in low- and middle-income countries (LMICs), which could impact diagnostic and management decisions, compared with high-income countries (HICs). Concurrent medical conditions and both gynecologic and obstetric outcomes were also searched. Practice recommendations from international societies were also reviewed and compared. Finally, 4 conditions were evaluated more closely to assess management differences based on geographic locations and whether the countries were LMICs or HICs; specifically, those evaluated were lower vaginal atresia, uterovaginal agenesis, bicornuate uterus, and septate uterus.

Discussion

Mullerian anomalies encompass a wide variety of conditions, ranging from subtle anatomic changes without concurrent anomalies to complex conditions, associated with anomalies of the kidney or spine, which could impact the ability to manage certain conditions based on medical resources available geographically. A systematic approach and provider expertise is important for appropriate diagnosis and management, independent of geographic location. Counseling is critical for medical and surgical decision-making and might be limited or guided by the resources available in certain settings or even by existing laws.

Conclusions

Limited outcomes are available among patients with Mullerian anomalies in LMICs; however, the management varies based on the basic tools available to address acute needs, as well as long-term fertility and obstetric concerns. More research is needed in this population, which could help drive the importance of early diagnosis and management not only in HICs but also in LMICs, where individualization strategies are key.



中文翻译:

跨不同资源设置的苗勒异常的诊断和管理:全球适应

背景

苗勒氏管异常影响 7% 的育龄妇女。对这些疾病有一个基本的了解很重要,因为它们会影响生命的任何阶段的女性,并对生育和怀孕产生潜在影响。本文旨在回顾这些异常情况以及在高资源和低资源环境中处理这些情况的具体诊断陷阱和策略。

方法

这篇综述是在 PubMed 的重点搜索中进行的,使用了与世界范围内许多环境中穆勒氏异常的诊断和管理相关的术语。与高收入国家 (HIC) 相比,考虑评估低收入和中等收入国家 (LMIC) 的可用医疗资源,这可能会影响诊断和管理决策。还搜索了并发的医疗条件以及妇科和产科结果。还审查和比较了来自国际社会的实践建议。最后,更密切地评估了 4 个条件,以评估基于地理位置以及这些国家是 LMIC 还是 HIC 的管理差异;具体来说,评估的是下阴道闭锁、子宫阴道发育不全、双角子宫和纵隔子宫。

讨论

苗勒氏异常包括各种各样的情况,从没有并发异常的细微解剖变化到与肾脏或脊柱异常相关的复杂情况,这可能会影响根据地理上可用的医疗资源管理某些情况的能力。系统的方法和提供者的专业知识对于适当的诊断和管理很重要,与地理位置无关。咨询对于医疗和手术决策至关重要,并且可能会受到某些环境中可用资源甚至现有法律的限制或指导。

结论

LMICs 苗勒管异常患者的结局有限;然而,管理因可用于解决紧急需求以及长期生育和产科问题的基本工具而异。需要对这一人群进行更多研究,这有助于推动早期诊断和管理的重要性,不仅在 HIC 中,而且在 LMIC 中,个性化策略是关键。

更新日期:2022-04-27
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