3. INTRODUCTION
A Uterine abnormalities are malformations of the uterus that develop
during embryogenic life. Uterine abnormalities occur in less then 5%
of all women, but have been noted in upto 25% of women who have
had miscarriages and/or deliveries of premature babies.
When a women is in her mother’s womb, her uterus develops as to
separate halves that fuse together before she is born. When a
womens uterus develops differently from most women, it is called
uterine anomaly.
4. DEFINITION
A uterine abnormalities is a type of female genital malformation
resulting from an abnormal development of Mullerian ducts during
embryogenesis.
Symptoms range from amenorrhoea, infertility, recurrent pregnancy
loss, and pain, to normal functioning depending on the nature of the
defect.
5. INCIDENCE
The prevalence of 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 the history of
recurrent miscarriages ( 16%).
Prevalence in general
population 1 in 201 (0.5%)
Distribution : 7% arcuate, 34%
septate, 39% bicornuate, 11%
didelphic, 5% unicornuate, 4%
hypoplastic and other forms.
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7. TYPES
AMERICAN FERTILITY SOCIETY
CLASSIFICATION----
Class 1: Hypoplasia uterus or Agenesis:
Segmental or complete (absent uterus).
Class2: Unicornuate uterus with or
without rudimentary horn (a one-
sided uterus).
Class3: Didelphus uterus also uterus
didelphis (double uterus) .
Class4: Bicornuate uterus: Complete or
partial ( uterus with two horns).
Class5: Septate uterus: Complete or partial
(uterine septum or partition).
Class6: Arcuate uterus: There is a concave
dimple in the uterus fundus within the cavity.
Class7: Des related uterus: The uterine
cavity has a “t-shaped” as a result of fetal
exposure to diethylstilbestrol.
8. o CLASS 1: VAGINAL AGENESIS/
HYPOPLASIA--
It is characterised by an absence or
hypoplasia of the uterus, proximal
vagina and sometimes the fallopian
tube.
Diagnosed at the age of 15-18 yr
Assessment and physical
examination
Treatment : Surgical correction-
Plastic surgery
9. • o CLASS 2: UNICORNUATE
UTERUS--
• The unicornuate uterus forms
when one mullerian duct fail to
elongated but the another one
develops normally.
• TREATMENT:
• No surgical intervention 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.
10. o CLASS 3: DIDELPHUS UTERUS--
It is a rare congenital anomaly and is a
consequence of unilateral or bilateral
mullerian duct duplication.
It’s exact cause is unknown but it is
generally present from birth, though
often becomes noticeable after
puberty .
Diagnosis is carried out using a
physical examination alongside USG
and 3D USG more recently.
There is no treatment as such for the
condition, but it must be managed
especially during pregnancy.
11. o CLASS 4: BICORNUATE
UTERUS—
When the mullerians duct fuse
incompletely at the level of the
fundus then bicornuate formed.
The lower uterus and cervix are
completely fused resulting in 2
separate but communicating
endometrial cavities with a single
cervix and vagina.
Pre-term birth: The rate of
preterm delivery is 15 to 25%.
A pregnancy may not be
reach full term in a
bicornuate uterus when the
baby begins to grow in either
12. o CLASS 5: SEPTATE
UTERUS—
Most common form of
mullerian duct defect .
From incomplete
resorption of the medial
septum after the
complete fusion of the
mullerian duct has
occurred.
It is not considered
necessary to remove a
septum that has not
caused problems,
especially in women
who are not considering
pregnancy.
13. ARCUATE UTERUS
Characterised by a small septate indentation
the superior aspect of the uterine cavity in the
fundus.
Many patient with 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.
14. O CLASS 7: DES RELATED
ANOMALIES—
DES is a synthetic
estrogen that was
prescribed to women for
recurrent miscarriage and
premature delivery
during the year 1940-
early 1970.
The uterine cavity has a “T-
shape” as a result of fetal
exposure to
diethylstilbestrol.
15. CLINICAL FEATURES
No any symptoms
Difficulty in getting pregnant
Pelvic pain
Dysmenorrhea
Uterine rupture during pregnancy
Recurrent pregnancy loss
Concurrent renal abnormalities
Imperforated hymen
21. COMPLICATION
I. Infertility
II. Early pregnancy loss
III. Uterine rupture due to its poor development
IV. Malpresentations
V. Prolonged obstructed labor
VI. Abortion
VII. Weak uterine action
22. MANAGEMENT
1. No non-surgical treatment is present only symptomatic
treatment is done.
2. Surgical intervention is considered when a septate uterus is found.
3. Bicornuate, unicornuate and didelphic uteri rarely require surgical
management.
