Can Classifications Adequately Represent Genital Malformations?
Kiblboeck S. Oppelt P. Oppelt P. Stein R. Ommer S. Pavlik R. Rall K. Kongrtay K. Wagner H. Hermann P. Trautner P.S.
3 July 2023Georg Thieme Verlag
Geburtshilfe und Frauenheilkunde
2023#83Issue 7827 - 834 pp.
Introduction Genital malformations are a common clinical occurrence that can be represented using different classifications. Reproducibility is an essential quality characteristic for a classification, and it plays an important role, especially in consultations and the treatment of infertile patients and in obstetric management. The aim of this study is to demonstrate the reproducibility and clinical practicality of three commonly used classifications: the ESHRE/ESGE (European Society of Human Reproduction and Embryology/ European Society for Gynecological Endoscopy), VCUAM (Vagina Cervix Uterus Adnex-associated Malformation), and AFS (American Fertility Society) classifications. Materials and Methods Sixty-five patients with female genital malformations were included in this prospective, multicenter, exploratory, observational study. All participants underwent a clinical examination and a medical interview. The investigators were instructed to classify the presenting malformations according to the ESHRE/ESGE, VCUAM, and AFS classifications using a structured questionnaire. Investigators were asked whether the malformation could be reproducibly classified (yes/no) and about the grade (grade 1-5 from very good to deficient) they would assign to each classification. Classification assessment was queried for vagina, cervix, uterus, adnexa, and associated malformations and was scored from 1 to 5. Results Reproducibility was rated as 80% (n = 52/65), 92.3% (n = 60/65), and 56.9% (n = 37/65) for the ESHRE/ESGE, VCUAM, and AFS classification, respectively. ESHRE/ESGE, VCUAM and AFS were rated as very good or good for 83.3%, 89.2%, and 10.8% of vaginal malformations; for 75.8%, 87.5%, and 24.2% of cervical malformations; and for 89.7%, 89.5%, and 86.2% of uterine malformations, respectively. VCUAM was rated as very good or good for 77.8% and 69.6% of adnexal malformations and associated malformations, respectively. ESHRE/ESGE and AFS were rated as sufficient or deficient for 100% and 75% of adnexal malformations and for 77.3% and 69.6% of associated malformations, respectively. Conclusion The prospective multicenter EVA (E SHRE/ESGE | V CUAM | A FS) study revealed that the organ-based ESHRE/ESGE and VCUAM classifications of female genital malformations perform better in terms of reproducibility as well as in the assessment of individual compartments than the non-organ-based AFS classification.
EVA study , female genital malformation , genital classification , uterine malformation
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Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Johannes Kepler Universität Linz, Linz, Austria
Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
Department of Pediatric Surgery, University Hospital Jena, Jena, Germany
TFP Fertility Wels, Thalheim bei Wels, Austria
Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
Clinical Academic Department of Womens Health, Corporate Fund University Medical Center, Astana, Kazakhstan
Department of Applied Statistics, Johannes Kepler University Linz, Linz, Austria
Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, Linz, Austria
Department of Gynecology
Department of Gynecology
Department of Pediatric
Department of Pediatric Surgery
TFP Fertility Wels
Department of Gynecology and Obstetrics
Clinical Academic Department of Womens Health
Department of Applied Statistics
Center for Clinical Studies (CCS Linz)
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