Abstract
Double uterus with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) is a well-described syndrome that most commonly involves a triad of associated anomalies. However, given the rarity of this syndrome in the general population, patients with this syndrome are commonly misdiagnosed and incorrectly managed. It is important for providers to be familiar with the features of this syndrome in order to decrease the time to diagnosis and to ensure that patients receive appropriate counseling regarding management options and long-term outcomes. Once a patient is diagnosed with OHVIRA syndrome, a physician with experience treating this syndrome should be involved in the development of a management plan which should ultimately include surgical correction. In this chapter, we will cover the development and classification of this anomaly, the diagnostic considerations, and the management goals and strategies that providers should understand in order to provide optimal care to patients with OHVIRA syndrome.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Herlyn U, Werner H. Simultaneous occurrence of an open Gartner-duct cyst, a homolateral aplasia of the kidney and a double uterus as a typical syndrome of abnormalities. Geburtshilfe Frauenheilkd. 1971;31:340–7.
Wunderlich M. Unusual form of genital malformation with aplasia of the right kidney. Zentralbl Gynakol. 1976;98:559–62.
Acién P. Embryological observations on the female genital tract. Hum Reprod. 1992;7:437–45.
Aswani Y, Varma R, Choudhary P, Gupta RB. Wolffian origin of vagina unfolds the embryopathogenesis of OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly) syndrome and places OHVIRA as a female counterpart of Zinner syndrome in males. Pol J Radiol. 2016;81:549–56.
The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–55.
Smith NA, Laufer MR. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome: management and follow-up. Fertil Steril. 2007;87:918–22.
Fedele L, Motta F, Frontino G, Restelli E, Bianchi S. Double uterus with obstructed hemivagina and ipsilateral renal agenesis: pelvic anatomic variants in 87 cases. Hum Reprod. 2013;28:1580–3.
Candiani GB, Fedele L, Candiani M. Double uterus, blind hemivagina, and ipsilateral renal agenesis: 36 cases and long-term follow-up. Obstet Gynecol. 1997;90:26–32.
Mandava A, Prabhakar RR, Smitha S. OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) with uterus didelphys, an unusual presentation. J Pediatr Adolesc Gynecol. 2012;25:e23–5.
Kueppers J, Wehrli L, Zundel S, Shavit S, Stahr N, Szavay PO. OHVIRA-syndrome in a newborn. J Pediatr Surg Case Rep. 2021;69:101859.
Dhar H, Razek YA, Hamdi I. Uterus didelphys with obstructed right hemivagina, ipsilateral renal agenesis and right pyocolpos: a case report. Oman Med J. 2011;26:447–50.
Zurawin RK, Dietrich JE, Heard MJ, Edwards CL. Didelphic uterus and obstructed hemivagina with renal agenesis: case report and review of the literature. J Pediatr Adolesc Gynecol. 2004;17:137–41.
Rivas AG, Epelman M, Ellsworth PI, Podberesky DJ, Gould SW. Magnetic resonance imaging of Müllerian anomalies in girls: concepts and controversies. Pediatr Radiol. 2021. https://doi.org/10.1007/s00247-021-05089-6.
Romanski PA, Aluko A, Bortoletto P, Troiano RN, Pfeifer SM. Aqueous vaginal contrast and scheduled hematocolpos with magnetic resonance imaging to delineate complex Müllerian anomalies. Fertil Steril. 2022;117(1):221–3.
Unlu E, Virarkar M, Rao S, Sun J, Bhosale P. Assessment of the effectiveness of the vaginal contrast media in magnetic resonance imaging for detection of pelvic pathologies: a meta-analysis. J Comput Assist Tomogr. 2020;44:436–42.
Mishra N, Ng S. Sonographic diagnosis of obstructed hemivagina and ipsilateral renal anomaly syndrome: a report of two cases. Australas J Ultrasound Med. 2014;17:153–8.
Deutch TD, Abuhamad AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of Müllerian duct anomalies. J Ultrasound Med. 2008;27:413–23.
Kamio M, Nagata C, Sameshima H, Togami S, Kobayashi H. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome with septic shock: a case report. J Obstet Gynaecol Res. 2018;44:1326–9.
Ludwin A, Lindheim SR, Bhagavath B, Martins WP, Ludwin I. Longitudinal vaginal septum: a proposed classification and surgical management. Fertil Steril. 2020. https://doi.org/10.1016/j.fertnstert.2020.06.014.
Romanski PA, Bortoletto P, Pfeifer SM. Unilateral obstructed Müllerian anomalies: a series of unusual variants of known anomalies. J Pediatr Adolesc Gynecol. 2021. https://doi.org/10.1016/j.jpag.2021.04.005.
Ludwin A, Pfeifer SM. Reproductive surgery for Müllerian anomalies: a review of progress in the last decade. Fertil Steril. 2019;112:408–16.
Cosgrove P, Kahlden K, Barr L, Sanchez J. Obstructed hemivagina with ipsilateral renal agenesis (OHVIRA) syndrome with imperforate anus. J Pediatr Surg Case Rep. 2016;12:34–7.
Ludwin A, Ludwin I, Bhagavath B, Martins WP, Lindheim SR. Virginity-sparing management of blind hemivagina in obstructed hemivagina and ipsilateral renal anomaly syndrome. Fertil Steril. 2018;110:976–8.
Xu B, Xue M, Xu D. Hysteroscopic management of an oblique vaginal septum in a virgin girl with a rare variant of Herlyn-Werner-Wunderlich syndrome. J Minim Invasive Gynecol. 2015;22:7.
Gungor Ugurlucan F, Dural O, Yasa C, Kirpinar G, Akhan SE. Diagnosis, management, and outcome of obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome): is there a correlation between MRI findings and outcome? Clin Imaging. 2020;59:172–8.
Tong J, Zhu L, Lang J. Clinical characteristics of 70 patients with Herlyn–Werner–Wunderlich syndrome. Int J Gynecol Obstet. 2013;121:173–5.
Haddad B, Barranger E, Paniel BJ. Blind hemivagina: long-term follow-up and reproductive performance in 42 cases. Hum Reprod. 1999;14:1962–4.
Heinonen PK. Pregnancies in women with uterine malformation, treated obstruction of hemivagina and ipsilateral renal agenesis. Arch Gynecol Obstet. 2013;287:975–8.
Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol. 2011;38:371–82.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Romanski, P.A., Bortoletto, P., Pfeifer, S.M. (2022). Double Uterus with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA). In: Lindheim, S.R., Petrozza, J.C. (eds) Reproductive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-05240-8_1
Download citation
DOI: https://doi.org/10.1007/978-3-031-05240-8_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-05239-2
Online ISBN: 978-3-031-05240-8
eBook Packages: MedicineMedicine (R0)