Des-related uterine malformation

Diethylstilbesterol (DES) is an orally active synthetic nonsteroidal oestrogenic compound, first synthesized in 1938. It was widely used in the 1940s to prevent pregnancy complications such as threatened abortion and prematurity. In 1971 it was realized that women who had been exposed to DES in utero were at increased risk of clear cell adenocarcinoma of the vagina (see clear cell adenocarcinoma vaginal). Soon after this association was established, the use of DES was banned by the Food and Drug Administration. Subsequent research showed additional risks of in utero DES exposure, including non-neoplastic lower genital tract abnormalities and clear cell adenocarcinoma of the cervix. Lower genital tract abnormalities include vaginal adenosis. (see adenosis vaginal), cervical extropion, and uterine malformation. These may result in abnormal findings at hysterosalpingography, and are therefore of radiological significance (Fig.1). A variety of irregularities in the size and shape of the endometrial cavity may be observed, including a T-shaped uterine cavity, constriction rings at the entrance of the Fallopian tubes into the uterus, an irregular contour of the endometrial cavity, and a below normal endometrial cavity size. Over 50% of DES-exposed women have detectable abnormalities at hysterosalpingography. Uterine changes due to DES exposure can also be identified by MRI (Fig.2). Uterine hypoplasia is recognized when the endometrial cavity is less than 3.3 cm in length. Cervical hypoplasia is present when the cervix is under 2.5 cm in length. Uterine constrictions are manifested as focal increases in junction zone thickness. Studies examining fertility in DES-exposed women have produced conflicting results, but it appears that fertility is reduced and that the rate of unfavourable pregnancy outcome is higher.

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