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Uterine malformations
This document discusses uterine malformations, which result from abnormal development of the Mullerian ducts in utero. It describes the 7 classes of uterine anomalies in the American Fertility Society classification system, including septate, bicornuate, and didelphys uteri. For each class, it covers defining features, incidence, diagnosis, associated reproductive risks like miscarriage and preterm birth, and potential treatment options like surgical resection. Complications from uterine anomalies can include abortion, placenta problems, and difficult labor.
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Uterine malformations
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- 2. INTRODUCTION: • For pregnancyand labour to be achieved with minimal difficult, a woman must have normal reproductive anatomy. When structural abnormality of the pelvic organs exists, problems arise that can place an extra burden on mother and fetus.
- 3. Definition • A uterinemalformation is the result of an abnormal development of the Mullerian ducts during embryogenesis. • Symptoms range from amenorrhoea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect.
- 4. Embryological development ofuterus • The female genital tract is formed in early embryonic life when a pair of ducts develops. These paramesonephric or mullerian ducts come together in the midline and fuse into a Y- shaped canal. The open upper ends of this structure lead into the peritoneal cavity and the unfused portions become the uterine tubes. The fused lower portion forms the uterovaginal area, which further develops into the uterus and vagina.
- 5. Incidence • The prevalenceof uterine malformation is estimated to be 6.7% in the general population, slightly higher (7.3%) in the infertility population, and Significantly higher in a population of women with a history of recurrent miscarriages (16%).
- 6. American Fertility SocietyClassification • Class I : Agenesis or hypoplasia: segmental or complete (absent uterus). • Class II : Unicornuate uterus with or without rudimentary horn (a one-sided uterus). • Class III : Didelphys uterus also uterus didelphis (double uterus) • Class IV : Bicornuate uterus: complete or partial (uterus with two horns)
- 7. Classification – Cont’d •Class V : Septate Uterus: complete or partial (uterine septum or partition). • Class VI : Arcuate uterus: There is a concave dimple in the uterine fundus within the cavity. • Class VII : DES-related abnormalities: The uterine cavity has a "T-shape" as a result of fetal exposure to diethylstilbesterol
- 8. Class I :Agenesis or hypoplasia: segmental or complete (absent uterus).
- 9. Cont..... • Diagnosed atthe age of 15 -18 • Assessment and physical examination • Treatment: Surgical correction-Plastic surgery • Sexuality and motherhood • Counselling
- 10. Class II :Unicornuate uterus with or without rudimentary horn (a one-sided uterus).
- 11. Types • Communicating contralateral rudimentaryhorn contains endometrium (10%) • Non-communicating contralateral rudimentary horn contains endometrium (22%) • Contralateral horn has no endometrial cavity (33%) • No horn (35%)
- 12. Treatment • No surgicalintervention is required unless endometrial tissue in a rudimentary horn results in pain or a pelvic mass or unless an incompetent cervix is suspected during pregnancy. • A rudimentary horn may be excised to treat endometriosis and prevent an ectopic pregnancy. • Cervical encerclage may be recommended during pregnancy in women with a history of miscarriage and/or premature birth or if an incompetent cervix is observed.
- 13. Class III :Didelphys uterus also uterus didelphis (double uterus) • Uterus Didelphys, more commonly knows as a double uterus, is a condition where a woman’s uterus forms differently, creating a double uterus, two separate cervices and sometimes two vaginas (though not always).
- 14. • It’s exactcause is unknown, but it is generally present from birth, though often only becomes noticeable after puberty. • Diagnosis is carried out using a physical examination alongside ultrasound scans and 3-D ultrasounds more recently. • There is no treatment as such for the condition, but it must be managed, especially during pregnancy. • Women with this condition will frequently have a slightly higher risk of late miscarriage, premature delivery and bleeding during pregnancy. • Often birth by Caesarean section is considered in these circumstances, to lessen the risk of complications.
- 15. Class IV :Bicornuate uterus: complete or partial (uterus with two horns)
- 16. Cont... • Pregnancies ina bicornuate uterus are usually considered high risk and require extra monitoring because of association with poor reproduction potential. • A bicornuate uterus is associated with increased adverse reproductive outcomes, such as: • Recurrent pregnancy loss
- 17. Cont..... • Preterm birth:The rate of preterm delivery is 15 to 25%. • A pregnancy may not reach full term in a bicornuate uterus when the baby begins to grow in either of the uterine horns. • A short cervical length seems to be a good predictor of preterm delivery in women with a bicornuate uterus
- 18. Cont..... • Malpresentation (breechbirth or transverse presentation): a breech presentation occurs in 40-50% of pregnancies with a partial bicornuate uterus and not at all in a complete bicornuate uterus. • Deformity: Offspring of mothers with a bicornuate uterus are at high risk for "deformities and disruptions" and "malformations." • Previously, a bicornuate uterus was thought to be associated with infertility, but recent studies have not confirmed such an association
- 19. Class V :Septate Uterus: complete or partial (uterine septum or partition).
- 20. Cont..... • A septumcan be resected with surgery. • Hysteroscopic removal of a uterine septum is generally the preferred method, as the intervention is relatively minor and safe in experienced hands. • A follow-up imaging study should demonstrate the removal of the septum.
- 21. Cont.... • It isnot considered necessary to remove a septum that has not caused problems, especially in women who are not considering pregnancy. • There is controversy over whether a septum should be removed prophylactically to reduce the risk of pregnancy loss prior to a pregnancy or infertility treatment.
- 22. Class VI :Arcuate uterus • An arcuate uterus is characterized by a mild indentation of the endometrium at the uterine fundus. It occurs as the result of near complete resorption of the uterovaginal septum
- 23. Cont.... • Many patientswith an arcuate uterus will not experience any reproductive problems and do not require any surgery. In patients with recurrent pregnancy loss thought to be caused by an arcuate uterus hysteroscopic resection can be performed.
- 24. Class VII :DES-related abnormalities: • The uterine cavity has a "T-shape" as a result of fetal exposure to diethylstilbesterol
- 25. Cont.... • Reproductive performance: • - Lower conception rates • - Increased incidence of abortion : due to structural anomalies and cervical incompetence • - Increased incidence of ectopic pregnancy : due to tubal and uterine anomalies • - Infertility : due to cervical hypoplasia and atresia
- 26. COMPLICATIONS : • Abortion •Weak uterine action • Post partum haemorrhage • Adhesion of the placenta • Malpresentations • Prolonged or obstructed labour • Uterine rupture due to its poor development. • The placenta, if it is formed on the septum, may be adherent and may cause post partum haemorrhage.