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Uterine abnormalities
- 1. Uterine abnormalities Ms. Agnes Mahima David Asst.Prof
- 2. DEFINITION • Uterine abnormalities is a type of female genital malformation resulting from an abnormal development of the mullerian duct
- 3. CLASSIFICATION ASRM CLASSIFICATION OF MULLERIAN ANOMALIES class 1: segmental or complete mullerian agenesis or aplasia • Vaginal • Cervical • Fundal • Tubal • Combined
- 4. • Class 2:unicornuate uterus with or without the rudimentary horn • With the rudimentary horn • With the communicating endometrium cavity • Non communicating cavity • With no cavity • Without the rudimentary horn
- 5. Class 3:uterus didelphys Class 4:uterus bicornuate • Complete • Partial Class 5 :septate uterus • Complete • Partial Class 6:arcuate uterus Class 7:DES (diethylstilbestrol )related abnormalities • T shaped uterus with or without horns
- 7. CLASS -1 COMPLETE OR TOTAL AGENESIS • Failure of canalization of the vagina results in vaginal agenesis • In partial vaginal agenesis there is a failure of canalization of the lower part of the vagina, distal to the normal uterus ,cervix and upper vagina
- 8. • CLASS -2 Unicornuate uterus • It is uterus with one horn and results when the tissue that forms uterus does not develop • Uterus is just the half the size of the normal uterus and the woman has only one fallopian tube
- 9. • CLASS -3 Uterus didelphys • Uterus didelphys (sometimes also uterus didelphis) represents a uterine malformation where the uterus is present as a paired organ when the embryogenetic fusion of the Müllerian ducts fails to occur. As a result, there is a double uterus with two separate cervices, and possibly a double vagina as well
- 10. • CLASS -4 Bicornuate Uterus • this uterine abnormality is also a result of the müllerian duct not fusing properly to form a unified uterus. This anomaly is further classified as bicollis – two cervices, or unicollis – one cervix.
- 11. • While it is a uterine anomaly, the bicornuate uterus does not pose fertility-related issues. Women with this anomaly, however, commonly have breech babies. Also, there is an increased risk of miscarriage in women who conceive with the bicornuate uterus.
- 12. • CLASS- 5 Septate Uterus • The inner partition that separates the two müllerian tracts does not dissolve either partially or wholly. This midline septum lacks protein Bcl-2 that protects the other parts of the uterus. Whether the septum exists partially or entirely, the septate uterus poses maximum pregnancy-related issues, with completely septate uteri showing about 90% pregnancy wastage. Treatment, however, is possible by a simple endoscopic lysis of the septum.
- 13. • CLASS -6 Arcuate Uterus: • Known as uterus arcuatus or arcuate uterus, this type of uterine anomaly is typically nothing to be too worried about. In fact, an arcuate uterus is simply a slight variation of a normal uterus. The uterus has a slight heart-shaped appearance, and this happens when the müllerian tracts fail to fuse or have a dysfunctional septum, but to a small degree.
- 14. • CLASS -7 T-Shaped Uterus • The T-shaped uterus in female infants is a result of the mother consuming diethylstilbestrol (DES) to do away with a risk of miscarriage. Studies indicate that about 69% of female offspring of women who consumed DES during their pregnancy developed abnormal uterine cavities have a T-shape with or without dilated cornua.
- 15. • The uterus in these cases tends to be hypoplastic and prone to cervical incompetence. This results in midterm loss of the fetus. These female infants are also susceptible to other histological abnormalities and are more prone to cervical or vaginal cancer at an early age.
- 16. Symptoms • Congenital uterine anomalies are present at birth, but they rarely exhibit any sign or symptom. Some women may experience pain during their menstrual period, but that is not always indicative of a congenital defect in the uterus. Most of these abnormalities come to the forefront only after recurrent pregnancy loss or infertility problems
- 17. Diagnostic evaluation • Vaginal Ultrasound • Hysterosalpingogram • Magnetic Resonance Imaging (MRI) • Sonohysterogram • Laparoscopy • hysteroscopy.
- 18. Management • Many women with uterine anomalies do not require treatment. If pain, miscarriage, or infertility is an issue, a physician may recommend correcting the anomaly surgically. Most cases of uterine anomalies can be corrected through minimally invasive techniques, such as laparoscopy or hysteroscopy. • In the instance of a unicornuate uterus, an obstructed hemi-uterus can be removed if the other side of the uterus is intact and functional. A dividing uterine septum can usually be removed as well to open up the uterus. • Women who are at risk for preterm delivery or late pregnancy loss due to a uterine anomaly may need a stitch to be placed in the cervix (called a cervical cerclage) to prevent premature dilation.