How are they formed and what are they?
The uterus develops from two paired ducts that merge along the midline, and then the septum between them resolves. Violation of any of these stages leads to the formation of an anomaly.
- Saddle uterus - slight depression of the fundus; most common and least significant variant, usually does not affect pregnancy
- Uterine septum - the septum is preserved completely or partially; the most clinically significant form associated with an increased risk of miscarriage
- Bicornuate uterus - incomplete fusion of the ducts, the cavity is divided, the bottom has a notch on the outside
- Unicornuate uterus - only one duct has developed; the cavity is smaller than usual
- Duplication of the uterus - two uteruses and often two cervixes
- Uterine aplasia - its absence; manifested by primary amenorrhea
- Anomalies with impaired outflow of menstrual blood - manifested by pain on the days of menstruation
Принципиальное различие между перегородкой и двурогой маткой: при перегородке наружные контуры матки нормальные, а разделена только полость; при двурогой матке разделено и тело матки снаружи. Это важно, потому что перегородку можно устранить гистероскопически, изнутри, а коррекция двурогой матки требует значительно более сложной операции и выполняется редко.
How does it affect pregnancy?
- The uterine septum is the most significant: it increases the risk of early miscarriage, since the embryo can attach to a poorly supplied septum
- Also increases the risk of preterm birth and fetal malposition
- Bicornuate and unicornuate uterus - increase the risk of premature birth and abnormal fetal position due to the reduced volume of the cavity
- Saddle uterus - usually does not affect pregnancy
- Duplication of the uterus - pregnancy is possible, most often occurs in one of the cavities
- Anomalies may be combined with isthmic-cervical insufficiency
- Anomalies affect the possibility of conception less than pregnancy
Symptoms
- Most often there are no symptoms - the anomaly is discovered accidentally
- Repeated early miscarriages
- History of premature birth
- Incorrect fetal position in previous pregnancies
- Painful periods
- In case of anomalies with impaired outflow - severe pain on the days of menstruation, sometimes without discharge
- Lack of menstruation with uterine aplasia
- Infertility is less common than miscarriage
Diagnostics
- Ultrasound of the pelvic organs, especially three-dimensional, allows you to evaluate the shape of the cavity and the outer contour of the uterus
- MRI of the pelvis is the most accurate non-invasive method
- Hysterosalpingography - shows the shape of the cavity, but does not distinguish between the septum and bicornuate uterus
- Hysteroscopy - direct examination of the cavity; in combination with laparoscopy gives the final answer
- Laparoscopy - assessment of the external contour of the uterus
- Ultrasound of the kidneys is mandatory: uterine abnormalities are often combined with abnormalities of the urinary system
- Full examination for miscarriage - the anomaly may not be the only cause
A kidney exam is not a formality. The uterus and urinary system are formed from close buds, so when an abnormality of the uterus is detected, the absence or duplication of a kidney is often discovered, which the woman did not know about.
Treatment
- Observation - for a saddle uterus and for anomalies that do not affect reproductive function
- Hysteroscopic excision of the uterine septum is the main method of correction; performed without incisions, through the vagina
- Prevention of synechiae after surgery: intrauterine device, gel, estrogen therapy
- Control hysteroscopy after intervention
- Metroplasty during laparotomy - for complex forms; performed rarely and according to strict indications
- Surgical correction of anomalies with impaired outflow of menstrual blood
- Suture placement on the cervix for isthmic-cervical insufficiency during pregnancy
- Careful monitoring during pregnancy with monitoring of cervical length
- Discussion of the method of delivery taking into account the shape of the uterus
Коррекция перегородки показана прежде всего при повторных потерях беременности или бесплодии, а не просто по факту её обнаружения. Решение принимается индивидуально: у женщины без репродуктивных проблем перегородка может не требовать вмешательства.
Forecast
- After hysteroscopic excision of the septum, the frequency of miscarriages in most women is markedly reduced
- Pregnancy can usually be planned within the period set by the doctor after a control hysteroscopy
- With a bicornuate and unicornuate uterus, pregnancy often requires more careful monitoring
- Many women with uterine anomalies successfully carry and give birth without any correction
- The method of delivery is determined individually
- Uterine anomalies are not strictly inherited, but familial cases do occur
Where to get examined in Tashkent
Three-dimensional ultrasound or MRI, hysteroscopy and, in complex forms, laparoscopy are required to finalize the diagnosis.
In Tashkent, such an examination and hysteroscopic correction of the uterine septum are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have been diagnosed with a “bicornuate uterus” only by a regular ultrasound, it makes sense to clarify it with a more accurate method: the septum and the bicornuate uterus are often confused, and their treatment is fundamentally different. Clinic contacts are below.
