What Are Uterine Abnormalities?
The term "uterine abnormalities" describes issues with the uterus's structure. This may be the consequence of a congenital abnormality, an illness, or a previous surgical procedure. Many women are unaware that they have a uterine anomaly until they become ill, are examined, or get an imaging test (such as an ultrasound). The uterus may continue to operate normally despite the abnormality. A woman may experience irregular or missing menstruation, repeated miscarriages, fertility problems, difficulties giving birth, and other conditions related to uterine abnormalities. Certain defects can be treated without medical intervention, whereas symptomatic anomalies can be fixed with minimally invasive surgery.
What Are the Various Types of Uterine Abnormalities?
Uterine abnormalities are of various types. They are as follows:
1. Bicornuate Uterus
A bicornuate uterus features two "horns," or sections at the highest point of the uterus, and is a partly split uterus shaped like a heart. Preterm birth, recurrent miscarriages, or fetal growth impairment can result from the irregular shape, particularly when the fetus attaches to one of the horns where the lining is insufficient, or there is less space for the baby to develop.
Furthermore, by the time a pregnancy is almost over, most kids turn their head down; but, because of the form of the bicornuate uterus, it is possible for the baby to fit within the uterus easier head up, which can result in transverse or breech births. However, a lady with a bicornuate uterus can carry a typical pregnancy.
2. Unicornuate Uterus
It is uncommon to have a unicornuate womb. This indicates that a portion of the womb did not develop, making it half the size of a typical womb. Preterm delivery, late miscarriage, and ectopic pregnancy are all at higher risk. Later in pregnancy, the fetus may lie in an uncomfortable position, necessitating a cesarean section. Although unicornate wombs are more common in infertile women, unicornate wombs can nevertheless result in conception in healthy women. An additional hemi-uterus, or tiny second cavity that is closed off from the vagina can also be present in unicorniform uteruses. Pain because of retained blood during menstruation may be observed in women who have acquired a hemi-uterus. A laparoscopic technique, ultrasound, or other imaging method is typically used to diagnose hemi-uterus.
3. Septate and Subseptate Uterus
A septate womb has a muscular wall running along the center, dividing the space in half. At times, the wall descends entirely (septate), and at other times, it descends only partially (subseptate). Conception problems are more common in women whose wombs are septate or subseptate. Preterm delivery and early miscarriage are also at a higher probability. Menstrual blood can also get stuck in the upper vagina when the septum wall obstructs the vaginal septum.
4. Didelphic Uterus
An uncommon disorder known as uterine didelphys enables a person to acquire two uteruses. The combined size of the two uterine cavities is smaller than that of a normal uterus. The fallopian tube and ovary are unique to each uterus. There is a slight increase in the risk of premature birth, but this is the only disadvantage for women with didelphic wombs.
What Are the Ways to Diagnose Uterine Abnormalities?
Asymptomatic uterine abnormalities predominate. Because of this, a woman is typically only diagnosed when she experiences difficulty becoming pregnant or when pregnancy-related issues emerge. The following tests are used to validate a diagnosis of uterine abnormalities:
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Vaginal Ultrasound: An abdominal ultrasonography and a vaginal ultrasound are not the same. This type of internal ultrasonography takes pictures of the uterus and vagina by using sound waves.
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Hysterosalpingogram (HSG): This test involves obtaining an X-ray of the reproductive organs after a dye is inserted into the cervix.
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Magnetic Resonance Imaging (MRI): Uterine abnormalities can be detected with magnetic resonance imaging (MRI).
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Sonohysterogram: For this test, the uterus is imaged using ultrasound technology after being filled with salt water.
How to Manage Uterine Abnormalities?
Various treatment methods available to manage uterine abnormalities are as follows:
Bicornuate and Didelphic Uterus:
Abdominal metroplasty is still the only surgical treatment out there for women with unification disorders, such as bicornuate or didelphic uteri, and is traditionally performed to unite or reconstruct the form of the uterus. On the other hand, there is a larger chance of complications, such as an extended hospital stay, a more prolonged recuperation period, intraperitoneal adhesions following surgery, and uterine rupture with a subsequent pregnancy. In the unlikely event of a considerable undesirable reproductive history, this intervention is typically neither recommended nor considered. There is relatively little data on how abdominal metroplasty for unification deformities on the wombs of women who have experienced repeated miscarriages or preterm births can improve reproductive results.
Septate Uterus:
For patients with septate uteri, hysteroscopic metroplasty or hysteroscopic transcervical division of the uterine septum is now the preferred course of treatment. The treatment can be carried out under laparoscopic or transabdominal ultrasonography assistance to guarantee procedural appropriateness and lower the danger of uterine perforation. To guarantee surgical safety and effectiveness, it is best practice to assess the septal length before surgery using 3D ultrasound or MRI. Although it is not frequently utilized, preoperative endometrial suppression can enhance visibility and surgical accuracy. Preferably, the surgery occurs during the menstrual cycle's early follicular phase. The uterine septum, which runs from the fundus to the internal cervical os, can range from 1 to 5 cm. It is common for the cavities to be asymmetrical and the openings to have noticeably different dimensions. Resection begins at the septum's apex, regardless of its form or depth. The septum is divided evenly and gradually by carrying the incision laterally on both sides.
Post-operative care for endometrial repair following septum excision involves re-epithelialization of the incisional surface, both centripetally (by endometrial tissue proliferating) and centrifugally (derived from the base of the surviving glands to the incision border). IUAs could occur following the operation. After surgical hysteroscopy, a number of techniques have been employed to prevent IUAs, including treatment with hormones using estrogen, dual therapy with IUD (intrauterine device) and hormone treatment, and copper intrauterine device.
Unicornuate Uterus:
A working rudimentary uterine horn, which is often associated with a unicornuate uterus, needs to be surgically removed to reduce the possibility of hematometra or pregnancy developing in the horn. However, a unicornuate uterus does not require surgical intervention.
Conclusion
Uterine abnormalities are rare and are of various types. A physical examination, imaging test, or laparoscopy surgery can all be used to identify uterine abnormalities. Treatment is not necessary for many women who have uterine abnormalities. Infertility, pain, or miscarriage may prompt a doctor to suggest surgically resolving the abnormality. The majority of uterine abnormalities can be fixed using minimally invasive methods.
