Everything about Uterine Malformation totally explained
A
uterine malformation is the result of an abnormal development of the
Mullerian duct(s) during
embryogenesis. Symptoms range from
amenorrhea,
infertility and pain, to normal functioning depending on the nature of the defect. Uterine malformations affect about 1% of the female population.
Types
The American Fertility Society (now
American Society of Reproductive Medicine) Classification distinguishes:
- Class I: Mullerian agenesis (absent uterus).
- Uterus isn't present, vagina only rudimentary or absent. The condition is also called Mayer-Rokitansky-Kuster-Hauser syndrome. The patient with MRKH syndrome will have primary amenorrhea.
- Class II: Unicornuate uterus (a one-sided uterus).
- Only one side of the Mullerian duct forms. The uterus has a typical "penis shape" on imaging systems.
- Class III: Uterus didelphys, also uterus didelphis (double uterus).
- Both Mullerian ducts develop but fail to fuse, thus the patient has a "double uterus". This may be a condition with a double cervix and a vaginal partition (v.i.), or the lower Mullerian system fused into its unpaired condition. See Triplet-birth with Uterus didelphys
for a case of a woman having spontaneous birth in both wombs with twins.
- Class IV: Bicornuate uterus (uterus with two horns).
- Only the upper part of that part of the Mullerian system that forms the uterus fails to fuse, thus the caudal part of the uterus is normal, the cranial part is bifurcated. The uterus is "heart-shaped".
- Class V: Septated uterus (uterine septum or partition).
- The two Mullerian ducts have fused, but the partition between them is still present, splitting the system into two parts. With a complete septum the vagina, cervix and the uterus can be partitioned. Usually the septum affects only the cranial part of the uterus. A uterine septum is the most common uterine malformation and a cause for miscarriages. It is diagnosed by medical image techniques, ie ultrasound or an MRI. MRI is considered the preferred modality due to its multiplanar capabilities as well as its ability to evaluate the uterine contour, junctional zone, and other pelvic anatomy. A hysterosalpingogram isn't considered as useful due to the inability of the technique to evaluate the exterior contour of the uterus and distinguish between a bicornuate and septate uterus.
A uterine septum can be corrected by hysteroscopic surgery.
- Class VI: DES uterus.
An additional variation is the
arcuate uterus where there's a concave dimple in the uterine fundus within the cavity.
A
rudimentary uterus is a uterine remnant not connected to cervix and vagina and may be found on the other side of an unicornuate uterus.
Patients with uterine abnormalities may have associated renal abnormalities including unilateral renal agenesis.
"Double vagina"
Uterine Didelphys is a rare type of deformity (1 in 1000 women) in the female
reproductive organs in which some organs may be either split or duplicated. Typically, some of these "extra" organs are non-functional or semi-functional appendages, although on occasion that'll be completely functional in all normal respects, and often independently. As the
vagina is largely derived from the
Mullerian ducts, lack of fusion of the two ducts can lead to the formation of a vaginal septum, or "double vagina", a condition sometimes called with a
uterus didelphys or a uterine septum.
Diagnosis
Besides a physical examination, the physician will need imaging techniques to determine the character of the malformation:
gynecologic ultrasonography, pelvic
MRI, or
hysterosalpingography. A hysterosalpingogram isn't considered as useful due to the inability of the technique to evaluate the exterior contour of the uterus and distinguish between a bicornuate and septate uterus.
In addition,
laparoscopy and/or
hysteroscopy may be indicated.
In some patients the
vaginal development may be affected.
Treatment
Surgical intervention depends on the extent of the individual problem. With a didelphic uterus surgery isn't usually recommended.
A uterine septum can be resected in a simple out-patient procedure that combines laparoscopy and hysteroscopy. This procedure greatly decreases the rate of miscarriage for women with this anomaly.
Further Information
Get more info on 'Uterine Malformation'.
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