Uterine malformation
A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Müllerian duct during embryogenesis. Symptoms range from amenorrhea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect.
Types
The American Fertility Society Classification distinguishes:; Class I—Müllerian agenesis.
; Class II—Unicornuate uterus.
; Class III—Uterus didelphys, also uterus didelphis.
; Class IV—Bicornuate uterus.
; Class V—Septated uterus.
; Class VI—DES uterus.
An additional variation is the arcuate uterus where there is a concave dimple in the uterine fundus within the cavity. The distinction between an arcuate uterus and a septate uterus is not standardized.
A rudimentary uterus is a uterine remnant not connected to cervix and vagina and may be found on the other side of a unicornuate uterus.
Patients with uterine abnormalities may have associated renal abnormalities including unilateral renal agenesis.
"Double vagina"
As the vagina is largely derived from the Müllerian ducts, lack of fusion of the two ducts can lead to the formation of a vaginal duplication and lack of absorption of the wall between the two ducts will leave a residual septum, leading to a "double vagina". This condition may be associated with a uterus didelphys or a uterine septum.Diagnosis
Besides a physical examination, the physician will need imaging techniques to determine the character of the malformation: gynecologic ultrasonography, pelvic MRI, or hysterosalpingography. A hysterosalpingogram is not considered as useful due to the inability of the technique to evaluate the exterior contour of the uterus and distinguish between a bicornuate and septate uterus.In addition, laparoscopy and/or hysteroscopy may be indicated.
In some patients the vaginal development may be affected.
Treatment
Surgical intervention depends on the extent of the individual problem. With a didelphic uterus surgery is not usually recommended.A uterine septum can be resected in a simple out-patient procedure that combines laparoscopy and hysteroscopy. This procedure greatly decreases the rate of miscarriage for women with this anomaly.