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Uterus - Abnormalities


Discussions on "Uterus - Abnormalities" in "Gynaecology Problems" forum.


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    nlakshmi's Avatar
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    Uterus - Abnormalities

    What is the uterus?

    The womb or uterus is a pear-shaped organ, tucked away in your pelvis. It is 7.5cm long, 5cm wide and 2.5cm in depth. Inside, it is hollow with thick muscular walls. The lower third of the uterus hangs down into the vagina and is called the cervix. The upper portion is called the fundus and this is where the fertilised egg grows into a baby.

    Approximately 0.1-3.2% of women have a uterine abnormality. Many women will have an abnormality without ever knowing anything about it, because it has no effect on their fertility or on their ability to give birth.


    What are the main abnormalities of the uterus?

    There are quite a few different kinds of problems of the uterus:

    A bicornuate uterus (a womb with two "horns") is the most common. Instead of the womb being pear-shaped, it is shaped like a heart, with a deep indentation at the top. This means that the baby has less space to grow than in a normally shaped womb.

    A unicornuate uterus (a womb with one "horn") happens when the tissue that forms the womb does not develop properly. This is a very rare condition. A unicornuate uterus is just half the size of a normal womb and the woman has only one fallopian tube. However, she usually has two ovaries.

    A double uterus, technically called a "uterus didelphys", is when the uterus has two inner cavities. Each cavity may lead to its own cervix and vagina, so the woman has two cervixes and two vaginas. Again, this is very rare.

    A septate uterus is where the inside of the uterus is divided by a wall (septum). The septum may extend only part way into the uterus or it may reach as far as the cervix.

    Normally, the uterus leans forwards over the top of the bladder. Doctors call this position "anteverted" and "anteflexed". Some women have a tilted uterus (which may also be described as "backward", "retroflexed", "retroverted" or "tipped") which leans away from the bladder rather than over it.

    What are the treatments for uterine abnormalities?

    If you are having fertility problems, your doctor will refer you to a specialist for exploratory tests. An ultrasound examination of your womb will identify any abnormalities.

    Sometimes, a special x-ray using dye, called a hysterosalpingography, is carried out, although an ultrasound is better because it doesn't carry any risk of infection and is just as good at spotting abnormalities.

    You may be recommended to have a laparoscopy. This involves passing an instrument called an endoscope through the wall of your abdomen in order to look at the womb and the fallopian tubes.

    Some abnormalities can be treated, but the treatment itself can carry risks. For example, if you have surgery to cut open the womb and remove a septum, the lining of your uterus may be damaged and so your fertility might be reduced. However, it is possible to remove a septum using an instrument called a hysteroscope which does far less damage to the uterus and maximises your chances of having a successful pregnancy afterwards.



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    Re: Uterus - Abnormalities

    What effect do uterine abnormalities have?

    On fertility A tilted uterus does not make a woman less fertile, and a woman with a uterine septum only occasionally has infertility problems. Women with a unicornuate uterus may have difficulties conceiving, because they have only one fallopian tube. However, pregnancy in women with this condition is far from unknown. In general, uterine abnormalities do not prevent a woman from getting pregnant, but they may make it more difficult for her to carry a baby for the full nine months of pregnancy.

    On miscarriage Experts say that it's hard to tell whether there is a link between uterine abnormalities and miscarriage. However, a review of research into pregnancy outcomes of women with abnormal uteri found that miscarriage is higher in women with an abnormality than in women with normal uteri, but the rates vary according to the type of abnormality -- for example, women with a septate uterus are at a greater risk of miscarriage than women with other abnormalities.

    On pregnancy Women with uterine abnormalities, particularly unicornate uterus, are more likely to have complications during pregnancy or delivery, whether the baby was conceived naturally or by Assisted Reproductive Technology (ART), compared with women with normal shaped uteri.

    If the uterus is an unusual shape, many babies will settle into the breech positionrather than into the normal head-down position. If you are expecting a breech baby you will be offered a caesarean because this is currently considered the safest way for the baby to be born.

    If you have a unicornuate or bicornuate uterus you may go into premature labourbecause there comes a point where there simply isn't enough room for the baby to grow any more, and over-stretching of the womb triggers labour. Alternatively, the cervix (neck) of an abnormally shaped womb may not be strong enough to keep the baby inside and it opens too early and lets the baby out. This is called a weak cervix, sometimes called an "incompetent cervix" and it tends to be a problem for women with an abnormally shaped uterus who are expecting their first baby. The more pregnancies you have, the less of a problem it tends to be.


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    Re: Uterus - Abnormalities

    How will this affect me when I am pregnant?

    If you know that you have an abnormally shaped uterus, you may feel very anxious during your pregnancy, especially if you have had previous miscarriages. Go to all your antenatal appointments because your obstetrician will want to keep a very close eye on you. Try to stay as relaxed as possible and keep busy to distract yourself. Don’t hesitate to talk to your doctor about any fears or queries that you have and follow the medical advice that is recommended.

    Ask your doctor to explain clearly to you the signs of premature labour, so that if your baby starts coming too soon, you will know what is happening and can get to hospital quickly. Choose some good antenatal classes where you can talk about your worries, and learn about what happens if a baby is in the breech position or is born prematurely.

    If at any time you feel that something is wrong, contact your doctor immediately. Don't worry about raising a "false alarm". Your doctor will be only too pleased to check you over and reassure you.


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    Re: Uterus - Abnormalities

    Hi Lakshmi,

    Thanks for posting useful information. I am also having unicornuate uterus.
    First IVF was unsuccessfull and now I am pregnant without IVF.

    Do you have any idea or specialist who take care of this kind of cases.


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