Paulina Gomez
National Autonomous University of Mexico (UNAM), MexicoPresentation Title:
Müllerian anomalies: Importance of timely prenatal diagnosis and their reproductive prognosis
Abstract
Müllerian anomalies present a diagnostic and therapeutic challenge due to their wide spectrum of presentations and the complexity of their classification. They can interfere with implantation, fetal growth, and mode of delivery, carrying an increased risk of infertility (8%), spontaneous abortion (13.3%), preterm birth (56%), among other obstetric complications.
A 26-year-old secundigravida with a history of neurofibromatosis type 1 and previous miscarriage presented in labor at 37 weeks of gestation. Physical examination revealed multiple neurofibromas and “café-au-lait” macules. A longitudinal vaginal septum and two cervices were noted; the right cervix was dilated 1 cm. Ultrasound showed a fetus at the percentile <1 for estimated fetal weight and anhydramnios. A C-section was performed, revealing two uteri: the right enlarged due to pregnancy, with ipsilateral fallopian tube and ovary, and the left with corresponding adnexa. A live female new born weighing 2,090 g was delivered, with Apgar scores of 8 and 9, and Capurro gestational age assessment of 37 weeks. Final diagnosis: uterus didelphys, bicollis, and longitudinal vaginal septum. The patient had a favorable postoperative course.
Accurate classification of these anomalies is essential to improve reproductive prognosis. They pose a significant risk during pregnancy, increasing the likelihood of adverse maternal and perinatal outcomes. Uterus didelphys carries the highest rate of preterm birth (14.7%), periviable births (5%), a fourfold increased risk of fetal growth restriction, and a cesarean delivery rate of 65.5%. The 2021 MAC classification by the American Society for Reproductive Medicine provides a clear and standardized tool for identification, description, and management. This case demonstrates that, despite a complex uterine malformation, a term pregnancy is possible with specialized monitoring. Demonstrating the importance of prompt recognition and appropriate management to optimize reproductive outcomes and reduce maternal and perinatal risks.
Biography
Paulina Gómez completed her medical degree at the Universidad de Guanajuato in Mexico. She is currently in her third year of residency in Obstetrics and Gynecology at the National Autonomous University of Mexico (UNAM). She also holds a postgraduate diploma in Gynecological Endocrinology and Andrology accredited by UNAM. She is an active member of the Association of Mexican Residents of Gynecology and Obstetrics (ARMGO), recognized by the World Association of Trainees in Obstetrics and Gynecology (WATOG), and serves as the ARMGO representative at her hospital. She has participated as a speaker in multiple conferences, including the Veracruz Regional Congress with the topic “Reducing Maternal Mortality in Our Country”, the Acapulco National Congress of Obstetrics and Gynecology with the topic “Technology, Information and Apps in Fetal Medicine and Reproductive Biology”, and the Tulum National Congress of Reproductive Medicine of Mexico (AMMR), where she presented a poster case report titled “Müllerian Anomalies: Importance of Timely Prenatal Diagnosis and Their Reproductive Prognosis”. In addition, together with other ARMGO members, she is currently working on a book addressing key topics in Obstetrics and Gynecology for residents, and she is conducting a research project in the field of gynecological endocrinology.
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