Anomalies of development of a uterus
Anomalies of development of a uterus – the change of location, a form, the size, or proportions of body resulting from violations of development in the pre-natal period. Often is followed by functional frustration of reproductive system, it can be combined with malformations of other genitals. Infertility, not incubation and complications of pregnancy are possible. In some cases anomalies of development of a uterus proceed asymptomatically. The diagnosis is exposed taking into account complaints, the anamnesis, results of gynecologic survey and these additional researches. Medical tactics is defined depending on type and expressiveness of defect.
Anomalies of development of a uterus
Anomalies of development of a uterus – change of anatomical structure of body owing to violations of pre-natal development. Make 1-2% of total of congenital anomalies of female genitals. Significantly differ on manifestations and extent of functional violations. Are often combined with malformations of a vagina and fallopian pipes. Anomalies of development of a uterus quite often proceed asymptomatically and are found only when performing ultrasonography or gynecologic survey. Can provoke violations of a menstrual cycle, become the reason of infertility and not incubation. Increase probability of complications of pregnancy and childbirth. Treatment of anomalies of development of a uterus is performed by experts in the field of gynecology.
Reasons of anomalies of development of a uterus
The uterus is formed of a middle part of the pair myullerovy channels which merged among themselves. Channels are formed on the first month of pregnancy, their merge happens within the second month of pregnancy. At the same time the lower parts of channels also merge, forming a vagina, and top remain disconnected and subsequently are transformed to pipe fallopiyeva. Violation of process of merge involves various options of anomalies of development of a uterus in the form of partial or full duplication. Perhaps also an underdevelopment of one of channels with the corresponding asymmetry of body. Rather widespread pathology is the general underdevelopment of a uterus caused by later impacts on process of mutual regulation of the ripening endocrine and reproductive systems of a fruit.
Anomalies of development of a uterus arise under the influence of adverse factors during various periods of pregnancy. The type and expressiveness of congenital defect depends on influence time. Carry bacterial and viral infections of the pregnant woman, endocrine and somatic diseases, exchange violations, genetic anomalies to number of the adverse factors provoking anomalies of development of a uterus in a female fruit, professional harm, reception of some medicines, drug addiction, alcoholism, heavy psychological stresses, defective food and a bad ecological situation.
Types and symptoms of anomalies of development of a uterus
The agenesia (total absence of a uterus) is rare pathology and, is generally diagnosed when opening impractical fruits with multiple congenital defects.
The Odnorogy uterus is formed at a stop or delay of growth of one myullerov of a channel and normal development of another. Makes about 13% of total of the anomalies of development of a uterus caused by violation of development of myullerovy channels. Almost in half of cases it is combined with congenital defects of an urinary system. Allocate four main options of this anomaly of development of a uterus: without rudimentary horn; with a horn without cavity; with a horn which cavity is reported with a uterus cavity; with the horn having the isolated cavity.
Usually is followed by primary algomenorey. Are possible or uterine bleedings. Some patients with this anomaly of development of a uterus show complaints to morbidity during sexual intercourse. At a part of patients infertility is observed. At other women pregnancy is possible, but the outcome of a gestation depends on the uterus sizes. Statistically, in half of cases pregnancy comes to an end with spontaneous abortion.
Premature birth is observed at 15% of patients with this anomaly of development of a uterus. Survival of a fruit makes about 40%. The delay of pre-natal development and the wrong prelying is often diagnosed. The emergency states at an odnorogy uterus can arise at a blood congestion in the horn which is not reported with a uterus cavity. One more danger of this anomaly of development of a uterus is pregnancy in a rudimentary horn. Because of the small size of a horn such pregnancy comes to an end with a rupture of a uterus and massive bleeding.
For specification of features of anomaly of development of a uterus use invasive researches – simultaneous hysteroscopy and a laparoscopy which allow to estimate a form, the volume and a condition of an internal cavity of a uterus, to define existence of not reported horn, to reveal the accompanying pathology of fallopian pipes and other violations. Nontraumatic MRT and ultrasonography with high resolution become a modern alternative to an invasive research at this anomaly of development of a uterus.
The two-horned uterus is formed at incomplete merge of a middle part of myullerovy channels. Has two cavities and one neck, is more rare – two necks connecting to one normal vagina or to the vagina divided by a partial partition. In 20% of cases of anomalies of development of a uterus the full two-horned uterus – body with two separate cavities comes to light. The incomplete two-horned uterus reminds the symbolical image of heart, has the general cavity and the changed bottom divided by more or less expressed ledge.
The saddle uterus makes 23% of total of anomalies of development of a uterus, represents body with saddle deepening in the field of a bottom. It can be divided by a full or partial intrauterine partition. Quite often proceeds asymptomatically. At some patients the normal course of pregnancy and a safe rodorazresheniye is noted. In other cases at this anomaly of development of a uterus pregnancy not incubation, pelvic prelying of a fruit, placenta pathology, premature birth, the weak or dicoordinated patrimonial activity is observed. The diagnosis anomaly of development of a uterus is established on the basis of ultrasonography, hysteroscopy, MRT and other tool researches.
Doubling of a uterus and vagina – a case of the brightest duplication of female genitals. More widespread option of this anomaly of development of a uterus is simultaneous doubling of a uterus and vagina, two uterus come to light at the general vagina less often. Bodies usually more or less closely adjoin among themselves or partially grow together, however cases of the uterus divided by a bladder are described. Degree of a maturity of bodies at this anomaly of development of a uterus can significantly differ – from two equally mature uterus and vaginas on both sides before extremely uneven development (full-fledged couple of bodies on the one hand and rudimentary with another). At sufficient development of both couples of bodies of periods and pregnancy can come both in one, and in other uterus. In the presence of two vaginas pathology is diagnosed previously at a stage of gynecologic survey. For specification of the diagnosis appoint ultrasonography, hysteroscopy and other researches.
Uterus hypoplasia – rather widespread anomaly of development of a uterus. The hypoplasia of a uterus can be combined with other manifestations of infantility or to be the isolated pathology. Perhaps proportional reduction of the sizes of a body and neck of a uterus or reduction of a body in combination with lengthening of a neck of a uterus. Often is followed by violation of position of a uterus (a pathological bend of a kpereda or a kzada). Patients with this anomaly of development of a uterus can show complaints on and .
Allocate three forms of this anomaly of development of a uterus: a small or hypoplastic uterus (length of body makes about 8 cm, the ratio of a body and neck is not broken), an infantile uterus (length of body more than 3 cm, the neck extended) and a rudimentary uterus (length of body less than 3 cm, neck length – more than a half from the total length of a uterus). The rudimentary uterus can be functioning or nonfunctioning. Sometimes at this anomaly of development of a uterus lack of a neck or the tservikalny channel is observed. The diagnosis is established on the basis of gynecologic survey and these additional researches.
Treatment of anomalies of development of a uterus
Tactics of treatment of anomalies of development of a uterus is defined by the gynecologist individually with type and expressiveness of anomaly, age and a condition of an organism of the patient, her desire to have children and other factors. Indications to the emergency surgery are pregnancy in a rudimentary horn of a uterus, a congestion of menstrual blood in an atrezirovanny vagina or in the isolated uterus horn cavity.
Violations of genital function (not incubation, infertility) become indications to planned operation at anomalies of development of a uterus usually. At an odnorogy uterus make removal of a rudimentary horn with the subsequent fixing of a uterine tube to a uterus corner. At a double and two-horned uterus of a wall of body cut on an internal edge, and then connect, forming a uniform cavity. Surgical intervention is usually made through open access (Shtrassman's operation), is more rare – with use of hysteroscopy. At a saddle uterus metroplasticity is usually carried out in natural ways during hysteroscopy.
The forecast at anomalies of development of a uterus
The forecast is defined by a type of pathology, degree of a maturity of a uterus and volume of a cavity of body. There is an increased threat of spontaneous abortion, not incubation and premature birth. Conducting pregnancy at anomalies of development of a uterus includes prevention of an abortion, development of bleedings and istmiko-tservikalny insufficiency. At emergence of threat of termination of pregnancy after the 26th week Cesarean section is shown.
In other cases obstetric aid tactics at anomalies of development of a uterus is defined with situation and a condition of a fruit, presence of endocrine and somatic diseases at mother and other factors. Performing surgeries allows to increase probability of successful incubation of pregnancy from 30-40 to 90 and more percent. The women with anomalies of development of a uterus who were earlier showing complaints to painful periods and violation of the general state during monthly note disappearance of pains and improvement of health.
At rough anomalies of development of a uterus and not incubation of pregnancy the woman can resort to surrogacy use. Artificial insemination by IKSI, IMSI or PIKSI method is performed with participation of own ovum of the patient and the husband's spermatozoa (or donor sperm). Then there is a cultivation of embryos. After selection and full inspection of substitute mother replanting of embryos in her uterus is made.