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Uterine Anomalies

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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%.


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