Diagnosis of Congenital Uterine Anomalies
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
It is truly said that women are a masterpiece made by god, for a woman nurtures a life inside her body in the womb and brings it to this world. But have you ever wondered how a baby grows inside the body of a woman?
A woman bears an organ called a ‘Uterus’ where the fetus grows until it is born. It is a hollow muscular organ that is pear-shaped. It is located in the lower belly, i.e., the pelvic region in between the rectum and the bladder. A uterus is the size of a fist but grows a baby that generally weighs around 3 kilograms during birth. The muscles of the uterus are so strong that they extend hard to accommodate a baby inside it. Isn’t it amazing? The diagnosis of congenital uterine abnormalities is typically confirmed through imaging techniques like ultrasound or MRI, along with clinical evaluation by a healthcare provider.
Structure of a normal uterus
It is divided into three regions:
- Fundus - Top part of the uterus
- Body - Middle part of the uterus
- Cervix - Opening or lower part of the uterus that connects to the vagina
A uterus has two fallopian tubes connected on both sides that open externally with finger-like projections called ‘fimbriae’ that serve as a path for an egg to travel to the uterus from the ovaries. A sperm fertilizes the egg inside the fallopian tube, and then the embryo travels to the
uterus for implantation in the endometrium.
But there are instances when this normal structure of the uterus is disturbed, resulting in malformations known as ‘Uterine anomalies’ that are present right from birth and are termed as ‘Congenital uterine anomalies.’ Patients suffering from congenital anomalies of the uterus do not generally present any symptoms unless they have conceived or are unable to conceive. Hence, the diagnosis of congenital uterine malformations can be accidental. However, the diagnosis of congenital uterine abnormalities is essential. These anomalies may occur due to various reasons like the formation, fusion, and dissolution of Mullerian ducts. Hence, these are also known as congenital mullerian anomalies.
Let us go into the details of the formation of female reproductive organs to study the role of Mullerian ducts in causing congenital uterine malformations.
Know How A Female Reproductive System Is Formed
- Formation of ducts In this stage, the ducts are formed and play a crucial role in the formation of the uterus.
- Fusion of ducts The formed ducts should be fused properly so that a normal uterus is formed.
- Dissolution of the septum Once the ducts are fused and the uterus is formed, the septum must dissolve so that the uterus gets a normal structure.
Types Of Uterine Abnormalities
Let us discuss all the uterine abnormality types in detail:
Formation
- Mullerian agenesis - Ducts are either not formed at all, or they are formed but are non- functional.
- Unicornuate uterus - This has only a single fallopian tube and is referred to as a single- horned uterus. In some cases, a rudimentary structure may be formed but is non- functional.
Fusion
- Didelphys uterus - Commonly referred to as twin uterus, and may have one or two cervices. But it has two vaginas separated by a thin wall.
- Bicornuate uterus - It has two uterine bodies, and hence, the fundus looks heart-shaped. This can either be partial or complete. It has a single cervix and a vagina.
Dissolution
- Septate uterus - Two ducts fuse to form a single uterus, but as the septum fails dissolution, two uterine bodies are formed. It has a normal fundus, though.
- Arcuate uterus - The ducts fail dissolution, and hence, the remnant of the septum forms a dimple on the cranium of the uterus.
Symptoms Of Congenital Uterine Abnormalities
Many women don’t realize that they have an abnormal uterus until they present any gynecological issues and they undergo a diagnosis of congenital uterine abnormalities.
Some of the common symptoms of uterine anomalies include;
- Irregular or no periods
- Recurrent miscarriage
- Infertility
- Problems delivering baby due to abnormal positioning of the baby
- Blocked menstrual blood
- Abdominal pain with or without external bleeding
It is essential to see a gynecologist if you have any of the above-mentioned symptoms. The doctor will rule out the problem and give you the proper treatment.
Diagnosis Of Congenital Uterine Abnormalities
2D or 3D ultrasound is the most commonly used technique for the diagnosis of congenital uterine abnormalities. Other than these, MRI, hysterosalpingo-contrast-sonography, X-ray hysterosalpingography, hysteroscopy, and laparoscopy are some of the other methods used to rule out a uterine anomaly.
Let us discuss in detail the diagnostic methods
2 Dimensional ultrasound
- A simple and non-invasive method
- Low cost
- Provides good information
3 Dimensional ultrasound
- Provides reliable results
- Allows evaluation of the cervix and vagina
- Requires expertise to perform the test
Magnetic Resonance Imaging
- Provides reliable tridimensional information about the genitals
- Fails to examine the fallopian tubes
- Useful to diagnose obstructive malformations i.e., issues related to the menstruation
Hysterosalpingo-Contrast-Sonography
- Minimal invasive method
- Low cost, hence affordable
- Provides good information but may sometimes give false negative images.
X-ray Hysterosalpingography
- Gives data only about the uterine cavity and tubes
- Used for infertility examination
- Invasive hence painful
- Fails to differentiate a septate uterus from a bicornuate uterus
- Fails to diagnose uterine horn
- It cannot be used in vaginal and cervical obstructions
Hysteroscopy
- Minimally invasive
- Provides reliable information
- Works well to visualize the vagina, cervical canal, and uterine cavity
- Fails to differentiate a septate uterus from a bicornuate uterus
Laparoscopy
- Evaluate the external and peritoneal structure of the uterus
- Invasive method
A diagnostic method is chosen based on the symptoms the patient presents and the opinion of the gynecologist.
Treatment of congenital uterine abnormalities
Surgery is the only way to treat congenital uterine anomalies. Laparoscopies are performed to minimize the risk of infections. In the case of a septate uterus, the septum is surgically removed to let the uterus retain its normal shape.
Conclusion
The uterus is a childbearing organ in the female reproductive system. In some cases, the normal uterine structure is disturbed as the Mullerian ducts do not work well, forming malformations at birth referred to as congenital uterine malformations. These can be medically
termed Congenital Mullerian anomalies.
There are a lot of women facing infertility and wish to experience the joy of being a mother. Congenital uterine malformations can be a hindrance to motherhood for many women, and it is necessary to see a gynecologist to rule out the cause. Additionally, many women face issues with carrying the fetus for the whole nine months. Even though they conceive, they cannot deliver a full-term baby. The most commonly faced problem is preterm labor, wherein there is no space for the fetus to grow inside the womb, resulting in delivering the baby before the estimated due date.
With the advancements in medical technology, diagnosis of congenital uterine abnormalities has become easier. Your gynecologist rules out the reason behind your bad obstetrics history or the infertility issues that you are facing. Your doctor gives you the best available treatment to give you the joy of parenthood.
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