Bicornen uterus - Causes, symptoms and treatment. MF.
The uterus bicornis( uterus bicornis) is a malformation of the uterus, in which the uterus divides into two or more horns, in the presence of a fusion in the cervix. This pathology refers to the abnormalities of the development of the uterus and the vagina, quite often occurs and can both cause problems and cause infertility, miscarriage, cycle disorders, etc.
The total incidence of all malformations of the uterus is not high, about 0.5-1% in the population. Among them, the most common is the two-horned uterus, 62%.
Causes of development of the uterus of the uterus
The appearance of developmental defects, apparently, depends on the violation of the conditions of nutrition, gas exchange and other environmental conditions in which the fetus develops. The conditions of the environment of the intrauterine fetus are determined by the state of the mother's organism. Therefore, diseases, especially infectious, intoxications, endocrine disorders and other abnormalities in the mother's body that cause abrupt changes in the environment of the embryo, can cause developmental anomalies. It should also be added that genetic factors can play a minor role in the formation of developmental defects.
To understand the issue, one should refer to embryology. The formation of the duodenal uterus takes place on the 10th-14th week of intrauterine development of the embryo, at the time of the formation of the uterus( due to the fusion of the parameconephral ducts).After the fusion of the ducts, two utero-vaginal cavities are formed, which are first separated by a middle septum, and then, after the disappearance of the septum, merge and the uterus becomes unicellular. If in the process of embryogenesis incomplete fusion of meso-neural ducts occurs, then variants of the duodenal uterus are formed. It must be remembered that the embryo genital germs are anatomically closely related to the buds of the kidneys and urinary tracts. Therefore, the anomalies in the development of these two systems are often found together. So, for example, a frequent combination is a bicornic uterus and a doubling of the kidney or CHLK of the kidney.
There are the following variants of the two-horny uterus:
1. Incomplete form - thus, division into two horns is expressed only in the upper third of the body of the uterus. Earlier, the term bicornular uterus with one neck( uterus bicornis unicollis) was circulated.
2. Full shape - thus there is a complete division of the uterus into two horns, extending from each other at one or another angle. The name bicornate uterus with different cervical spines( uterus bicornis bicollis) was also common. In this situation, the vagina can be of the usual shape, or with a septum and even with a full doubling.
3. Saddle uterus - thus in the field of a bottom of a uterus the saddle deepening is formed. The rest of the two-partedness is not expressed. To date, the saddle uterus is most common among all types of duodenal uterus.
Often, especially with incomplete doubling and the saddle uterus, serious symptoms may not be present. However, the following main pathological conditions can be distinguished:
1. Menstrual cycle disorder - due to the pathology of the structure and the formation of the endometrium. It is rare.
2. Miscarriage of pregnancy - most often associated with a violation of the formation of the placenta and, as a consequence, a violation of nutrition of the fetus.
3. Infertility is a rare condition, as doubling the uterus by itself can not cause infertility. Pregnancy occurs even with a full doubling, and in this case develops more often in one of the horns of the uterus( less often in both horns).As a rule, the cause of infertility is the combination with other developmental malformations.
All these symptoms are typical for a complete doubling of the uterus. In this case, pregnancy planning is necessary after consulting a doctor, as preliminary surgical intervention may be necessary. A pregnant woman with a full doubling of the uterus should always be under the supervision of an obstetrician-gynecologist. The saddle-uterus and the incomplete form of doubling, as a rule, do not lead to such pathological conditions that would require medical intervention.
Diagnosis of the two-legged uterus
1. Conventional gynecological examination - as a rule, palpation can establish an abnormality in the structure of the uterus. However, it is difficult to establish the nature of the change precisely.
2. Ultrasound is the most informative method, in which the nature of the change can most often be established quite accurately.
3. Hysteroscopy and hysterosalpingography - you can not only visually inspect the uterine cavity and assess its condition, but also introduce an X-ray contrast substance, and use an X-ray image to establish doubling and its shape.
Metrosalpingogram with the bicornic uterus
4. MRI is a rather expensive method. Its use is permissible in extreme cases, when besides establishing anomalies of development there are other purposes.
Treatment methods for the bipedal uterus
As mentioned above, treatment requires only extreme forms that have clinical manifestations. The only effective method of treatment is surgical, in which there is restoration of the integrity of the uterus and the creation of a normal cavity. It is possible to perform a laparoscopic operation, which will be less traumatic and easier to tolerate by the patient, with sufficient qualification of the surgeon.
It is also important to note that in the case of beremnnostyu with the two-horned uterus, it is necessary to observe all the pregnancy symptoms in the doctor, preferably the same one who will deliver. The method of choice during delivery can be an operation by caesarean section, which the patient should know about and what it should be ready for.
Doctor obstetrician-gynecologist Kupatadze D.D.