Uterine Anomalies

Description

Uterine anomalies occur in 0.1 to 0.5% of women, depending on the population. Uterine anomalies that are large enough to decrease the size of the uterine cavity (womb) are a major cause of recurring abortions, premature labor and/or abnormal presentation of the fetus during labor. Uterine anomalies are detected in 15% to 25% of women with recurrent pregnancy loss. Unfortunately, uterine anomalies are usually not diagnosed until a woman becomes pregnant.

Causes

# The cause of most congenital uterine anomalies is unknown.
# In the past, pregnant women were sometimes given diethylstilbestrol (DES) to prevent miscarriage. Female offspring of these women had a higher frequency than usual of uterine anomalies, as well as an increase in cancers of the female reproductive tract.
# A genetic cause has not been found.
# Environmental factors, as yet undetermined, may affect uterine development.



Symptoms

# Recurrent miscarriages (spontaneous abortions)
# Premature delivery
# Intrauterine fetal growth retardation
# Abnormal fetal presentation (defined as any part of the fetus that presents other than the top (vertex) of the fetal head facing the cervix towards the floor)
# Pelvic examination reveals two vaginas and/or two cervix (associated with uterine anomalies) or sometimes two horns are felt on the uterus.
# Usually there is no sign of a uterine anomaly on a routine pelvic examination.



Diagnosis

# History of pregnancy losses or prenatal exposure to DES
# Pelvic examination
# Ultrasound
# Magnetic resonance imaging (MRI)
# Hysterosalpingogram
# Hysteroscopy
# Laparoscopy



Treatment

# Aggressive obstetrical, nonsurgical management of patients with prior reproductive failure.
# Surgery to redesign the uterus is a highly successful procedure. Postoperative success rates (i.e., term pregnancy) generally range from 70% to 80%, with premature delivery rates less than 10%.