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Structural changes of the genital tract associated with in utero exposure to diethylstilbestrol.


 Lower and upper genital tract abnormalities detected in a group of women exposed in utero to diethylstilbestrol (DES) are reported. Data are from the Baylor College of Medicine, which is 1 of 4 participating centers in a National Cancer Institute project studying the incidence of genital tract abnormalities and cancer in DES-exposed offspring. Patients were recruited through physician referral and record review or were walk-ins. Gross anatomic changes of the cervix were noted in 178 (33%) of the 537 women with documented DES exposure. The occurrence of these changes decreased significantly when DES exposure was after the 20th week of gestation. An earlier study by the author noted upper genital tract abnormalities in 185 (69%) of 267 DES-exposed women on whom hysterosalpingography (HSG) was performed. Abnormal x-ray findings included a T-shaped uterus with a small cavity in 57%, a T-shaped uterus alone in 19%, a small uterine cavity in 13%, a T-shaped uterus with a constriction ring in 13%, and constriction rings alone in 4%. Uterine changes were unrelated to age or the occurrence of prior pregnancy. An abnormal HSG was 4.5 times more likely in women with structural cervical changes, occurring most often in women with a small uterine cavity. 146 (82%) of 179 women with vaginal epithelial changes had abnormal x-ray findings. Women with vaginal changes were 5 times more likely to show abnormal x-ray results. A gradual decrease of abnormal x-ray findings was noted with increasing gestational week of beginning DES exposure. The poor pregnancy outcome noted in DES-exposed women is believed to be associated with structural, cervical, and uterine changes rather than with DES exposure per se. The author's analysis of 93 DES-exposed women revealed the following pregnancy outcome statistics for women with abnormal and normal x-rays respectively: term pregnancy, 29% and 50%; spontaneous abortion, 27% and 16%; ectopic pregnancy, 7% and 0; and never a term delivery, 54% and 34%. These figures underscore the need for careful observation of DES-exposed women during pregnancy.
