Saddle uterus – a kind of a two-horned uterus; a malformation at which the bottom of a uterus is split in the form of a saddle. Extent of splitting of a bottom of a uterus on two horns happens various, but in all cases the shape of a uterus in a section reminds a saddle. Existence of a saddle uterus can not be shown by any violations or be followed by the increased threat of not incubation of pregnancy, premature birth, weaknesses and diskoordination of patrimonial activity, postnatal bleedings. The saddle uterus is often combined with other malformations. The saddle uterus, as a rule, incidentally – comes to light during ultrasonography, hysteroscopy, YaMRT. Surgical correction of a saddle uterus is shown in case of pregnancy incubation violation.
The saddle uterus is private manifestation of a two-horned uterus. At a saddle uterus on an external surface of a bottom of body small concave deepening in the form of a saddle is formed. In gynecology from total number of anomalies of development of a uterus about 23% of cases fall to the share of a saddle uterus. Extent of splitting of a bottom of a uterus on two horns happens various: expansion of the cross size, flattening of a bottom, a weak divergence of a bottom on two horns. In all cases the shape of a uterus in a section reminds a saddle.
The saddle uterus is quite often combined with defects of an urinary system, an intrauterine partition, a narrow basin. Therefore existence of a saddle uterus can be dangerous by development of primary infertility, various pathology of pregnancy, patrimonial injuries, postnatal complications, pre-natal death of a fruit.
Reasons of formation of a saddle uterus
Saddle deformation of a uterus is formed during the period between the 10-14th weeks of an embryogenesis in the course of merge of mezonefralny channels. At a stage of an embryonal development the cavity of a uterus is originally presented by two uterine and vaginal cavities divided by a median sagittalny partition. By the time of the birth of a female fruit the partition gradually resolves, i.e. initially two-horned uterus takes at first the saddle form, and then – normal, pear-shaped odnopolostny. In cases of incompleteness of processes of formation of a uterus by the time of the birth of the girl concavity in the field of a bottom remains, as results in congenital defect – a saddle uterus. Except splitting of a bottom at a saddle uterus there is always its expansion in the diameter.
Various damaging factors breaking the correct formation of bodies during pregnancy can serve as the reasons of a disembriogenez and formation of a saddle uterus: intoxications of mother (alcoholic, nicotinic, narcotic, medicinal, chemical), avitaminosis, stresses, endokrinopatiya (thyrotoxicosis, diabetes), heart diseases. Extremely adversely infectious diseases of the pregnant woman – measles, flu, a rubella, syphilis, toxoplasmosis, etc. affect an organogenesis. Course of pregnancy in the conditions of toxicosis, a chronic hypoxia of a fruit can promote formation of a saddle uterus.
Symptoms of a saddle uterus
Out of pregnancy the woman can not guess existence of a saddle uterus. Insignificant saddle deformation of a bottom of a uterus does not interfere with pregnancy approach, does not complicate incubation of a fruit and childbirth. At more expressed changes there can be a threat of spontaneous termination of pregnancy, placenta pathology (a side or low arrangement, prelying of a placenta, a premature otsloyka), the cross provision of a fruit, pelvic prelying of a fruit, premature birth.
In the course of childbirth the saddle uterus can be a factor of development of abnormal patrimonial activity – weaknesses or diskoordination. Quite often at a saddle uterus in obstetrics it is necessary to resort to Cesarean section. Anatomic and functional inferiority of a uterus can provoke postnatal bleedings. In lack of due observation of the woman in the course of conducting pregnancy the risk of perinatal mortality increases. In cases of the expressed deformation of a bottom of a uterus primary infertility can be observed.
Diagnostics of a saddle uterus
In diagnostics of a saddle uterus the crucial role is assigned to tool researches – ultrasonography, UZGSS, hysteroscopies, gisterosalpingografiya, a magnetic resonance tomography. A standard gynecologic research at a saddle uterus not informatively.
In the course of an ekhografiya of a small pelvis (ultrasonography) the saddle uterus comes to light not always. At considerable deformation cross scanning allows to reveal increase in width of a bottom of a uterus up to 68 mm, a thickening a bottom wall miometriya to 10-14 mm and its vybukhaniye in a cavity of body. For detection of a saddle uterus of ultrasonography it is more preferable to carry out by the vaginal sensor to the second phase of a cycle at rather expressed endometrium thickness.
The most authentically characteristic signs of a saddle uterus are found when carrying out a gisterosalpingografiya: on roentgenograms 2 mouths of fallopian pipes are defined, in the field of a bottom the small deepening in the form of a saddle pressing in a uterus cavity is distinctly read. Similar signs come to light when carrying out YaMRT. Hysteroscopy is used for direct visual inspection of a cavity of a uterus. In the course of conducting pregnancy at patients with a saddle uterus monitoring of doppler sonography of a uterine and placentary blood-groove is carried out, the kardiotokografiya, a fruit phonocardiography is carried out.
Treatment of a saddle uterus
Surgical tactics at a saddle uterus is applied only on condition of impossibility of conception (in the absence of other reasons) or habitual not incubation of a fruit. Reconstruction of a cavity of a uterus is more often made in the course of hysteroscopy in natural ways, without cuts. After defect correction chances of a normal course of pregnancy increase in tens of times.
Patients with a saddle uterus have to be under a fixed nablyuyodeniye of the obstetrician-gynecologist from early terms of pregnancy, accurately observe all rekomendayotion, and at emergence of the slightest violations to be hospitalized in establishment of obstetric aid. In case of the complicated course of pregnancy at patients with a saddle uterus the bed rest, spazmolitichesky means, vegetable sedative medicines, gestagena, a deproteinizirovanny haemo derivative of blood of calfs, essentsialny phospholipids is appointed. Tactics concerning the forthcoming childbirth at pregnant women with a saddle uterus is solved beforehand.