DES Related Uterine Anomalies
Copyright 2010
Definition
DES-related uterine structural abnormalities are a group of congenital uterine anomalies caused by fetal exposure to DES in-utero.
Diethylstilbestrol (DES) is a synthetic estrogen prescribed to women between 1938 and 1971 in order to prevent miscarriage. However, the result has proven to be increased risk of vaginal and cervical cancer, as well as uterine structural abnormalities in the female children of women taking DES during pregnancy.
The result of in-utero DES exposure includes these uterine structural anomalies, as well as clear cell adenocarcinoma of the vagina and cervix.
The structural changes may be characterized by a T-shaped uterus, cervical hypoplasia, or cervical polyps.
The functional changes may be minimal, but can include difficulty becoming pregnant or sustaining pregnancy due to uterine structural changes.
Women are often asymptomatic, but can present clinically with infertility, recurrent miscarriage, ectopic pregnancy or preterm labor and delivery.
Imaging modalities used to evaluate uterine abnormalities include sonohysterography, hysterosalpingography, and MRI.
Diagnosis is made based on these imaging modalities combined with a careful history of maternal exposures.
No treatment may be necessary, as many women can carry a pregnancy to term without complication. However, due to the increased risk of spontaneous abortion and preterm delivery, women with these structural abnormalities should be closely observed during pregnancy. Screening for vaginal and cervical clear cell adenocarcinoma should also be started in young adulthood. Colposcopy to visualize the cervix should be performed at the first pelvic exam and repeated if any abnormalities are seen. Cervical and vaginal cytology with careful palpation should be performed annually for further screening.