Plastic enlargement

Diethylstilbestrol (DES) is a synthetic estrogen which was prescribedfrom 1941 onwards for the prevention of miscarriage. Besides apossible risk of cancer, another side effect of this treatment was thepossible abnormality of the genitalia in women exposed in utero.The idea of the plastic enlargement operation is to widen the cavityby making careful incisions on the excess muscle tissue located onthe uterus wall.The objective is to obtain a triangular shaped cavity taking care notto weaken the walls themselves. Fifty one patients were treated. Weobserved 31 pregnancies (49%) after 16 months, with 25 ongoingpregnancies. Anatomic results are generally excellent but functionalresults or success rate in future pregnancies are difficult to assess.Main risks are : placenta percreta, a possible rupture of the uterus,though this can happen at any time with DES patients .This operation can only be recommended once a thorough examinationof the patient has been made.It is not advisable for patients with a hypoplasic cavity in a hypoplasicuterus (hysterometry <4 cm).This operation should never be done as a first course of action but itcan be recommended above all if the patient has a constriction ringas a sole reason for infertility, - when infertility has been diagnosedand unsuccessfully treated, after an unexplained failure of ART,and when the patient has unexplained repeated miscarriages.