Two-horned uterus – the congenital anomaly of an anatomic structure of a uterus consisting in splitting of a uniform cavity on two horns merging in the lower departments. Existence of a two-horned uterus proves dismenorey, abnormal uterine bleedings, not incubation of pregnancy or infertility. Diagnostics of a two-horned uterus includes performing ultrasonography, a gisterosonografiya, hysteroscopy, laparoscopy. In need of correction endoscopic interventions on restoration of a cavity of a uterus, Shtrassmann's operation are carried out. Pregnancy and childbirth at a two-horned uterus are possible, though are accompanied by the increased risks.
Among anomalies of a uterus the dvurogost is the most met, but in general it is diagnosed only for 0,1-0,5% of women. Formation of a two-horned uterus is connected with violations of pre-natal development. Pathology develops owing to incomplete merge of myullerovy channels on 10-14 weeks of an embryogenesis that leads to division of a cavity of a uterus into two niches.
More often at a two-horned uterus there are one neck and one vagina, but also doubling of a neck and existence of an incomplete vaginal partition is possible. One horn in a two-horned uterus can be rudimentary (rudimentary). In case of an attachment of fetal egg in a rudimentary horn pregnancy proceeds as extra-uterine with a rupture of a horn and intra belly bleeding. In other cases both horns are developed correctly, and in each of them there can be full-fledged uterine cycles, come the pregnancy which is coming to the end with childbirth.
Reasons of formation of a two-horned uterus
Formation of a two-horned uterus at a female fruit can be promoted by action of various damaging factors in the first months of incubation of pregnancy when bodies of the child are put and develop. Different intoxications (alcohol, nicotine, drugs, drugs, chemical agents), avitaminosis, mental injuries during pregnancy, endocrine diseases (diabetes, a thyrotoxicosis) or heart diseases at mother belong to such teratogenny factors.
The damaging impact on an embryo infectious agents – causative agents of measles, rubella, flu, toxoplasmosis, syphilis, etc. diseases possess. Adversely the chronic hypoxia of a fruit, course of pregnancy with toxicosis affects process of an organogenesis. The two-horned uterus can be combined with some other anomalies, most often — with defects of an urinary system.
Anatomic options of a two-horned uterus
The two-horned uterus is characterized by division of a cavity into two parts which merge in the lower departments at various levels. Depending on the size of splitting of a cavity of a uterus the gynecology allocates a full, incomplete and saddle two-horned uterus.
At full option of a two-horned uterus division of a cavity and the otkhozhdeniye of horns in different directions begins at the level of uterine and sacral sheaves; at the same time the corner between two horns can be various. The expressed division of a cavity of a uterus leads to existence of the separate niches reminding two odnorogy uterus which is located very closely to each other. Pregnancy in this case can normally develop in a niche of one of the available horns.
The incomplete option of a two-horned uterus is characterized by splitting of a cavity in the top third and a superficial aperture between two horns. At the same time the form and the sizes of both uterine horns are usually identical. At a saddle two-horned uterus in the field of its bottom there is an insignificant deepening in a form reminding a saddle. Conception at a saddle uterus is not excluded, however with the accompanying defects there can be a spontaneous termination of pregnancy. The two-horned saddle uterus in combination with a narrow basin can cause the wrong provision of a fruit that excludes a possibility of independent childbirth.
Symptoms at a two-horned uterus
Existence of a two-horned uterus can not be followed by the expressed clinical manifestations. Sometimes at a two-horned uterus it is noted , uterine bleedings. Quite often at women with a two-horned uterus spontaneous abortions or infertility are observed. However it is not excluded that pregnancy and childbirth will proceed without complications.
At a two-horned uterus pregnancy usually develops in one of the available horns, in rare instances – at the same time in both horns. Pregnancy at a two-horned uterus is often accompanied by risks of interruption that demands careful medical observation. Spontaneous abortions at a two-horned uterus usually happen in the I trimester as growth of an embryo is interfered by insufficient blood supply and small volume of an internal cavity of a uterine horn.
Besides, at a two-horned uterus anomalies of an arrangement of a placenta (prelying or low placement) fraught with its premature otsloyka and bleedings often meet. Existence of a two-horned uterus increases probability of istmiko-tservikalny insufficiency, pelvic prelying of a fruit, premature birth and violation of sokratitelny activity of muscles of a uterus, postnatal bleeding. At the slanting or cross provision of a fruit performance of Cesarean section is shown.
Diagnostics of a two-horned uterus
Existence of a two-horned uterus can be suspected by the gynecologist at typical complaints – algodismenory, abnormal bleedings, habitual abortions, infertility. During the gynecologic research of the patient the specifying sounding of a cavity of a uterus allowing to define its form and existence of anatomical two-horned structure is carried out.
The two-horned uterus is found when performing ultrasonography of a small pelvis the vaginal or abdominal sensor; confirmation of the diagnosis is promoted by results OUSE-gisterosalpingoskopii, gisterosalpingografiya, MRT, hysteroscopies and laparoscopies. On gisterogramma or tomograms at a two-horned uterus existence of two mouths of uterine tubes comes to light; the uterus bottom in different degree in the form of a crest presses in a uterus cavity. At inspection of patients differential diagnostics between an intrauterine partition and a dvurogost is carried out.
Treatment of a two-horned uterus
Surgical tactics at a two-horned uterus is shown only in case of habitual not incubation of pregnancy (2-3 abortions in a row) or infertility. The operation purpose at a two-horned uterus is restoration of a uniform full-fledged uterine cavity. Most often in operational gynecology resort to an extirpation of a rudimentary horn or removal of a partition, the dividing cavity (Thompson's operations, Shtrassman).
As standard intervention at a two-horned uterus serves Shtrassmann's operation consisting in a laparotomy, a uterus bottom section a cross-section, excision of a median partition with the subsequent sewing together of covers of a uterus. In addition, surgical correction at a two-horned uterus can be carried out with use of a gisteroskopichesky technique. After expeditious restoration of a uniform cavity of a uterus for 6-8 months is established by Naval Forces.
The forecast at a two-horned uterus
At the sufficient capacity of a cavity of a uterus incubation of pregnancy can happen without complications. At the expressed extent of bifurcation of a cavity of a uterus the risk of spontaneous abortion or premature birth increases. Conducting pregnancy with a two-horned uterus demands prevention of an abortion, development of istmiko-tservikalny insufficiency, bleedings from patients.
At approach of threat of termination of pregnancy Cesarean section for preservation of a fruit is carried out to late terms (after 26-28 weeks of a gestation). At the full-term pregnancy the issue of a rodorazresheniye is resolved taking into account various factors (situation and prelying of a fruit, the accompanying pathology at the pregnant woman etc.). After surgical correction of a two-horned uterus the risk of not incubation of pregnancy decreases from 90% to 30%. Women with an insufficient volume have cavities of a uterus or with the pregnancy not incubation remaining after surgical treatment motherhood is possible, thanks to auxiliary reproductive technologies, namely EKO for the program of surrogacy. Artificial insemination of an ovum of the patient is made on IKSI or IMSI technology (if necessary with use of donor sperm), after a stage of cultivation replanting of embryos in a uterus of substitute mother is carried out.