Description
Uterine anomalies are congenital malformations of the uterus that can affect a woman's reproductive health. These anomalies can be classified into different types based on their anatomical location and severity. The management of uterine anomalies depends on the type and severity of the anomaly, as well as the woman's reproductive goals. Treatment options include surgical correction of the anomaly, assisted reproductive technologies, and close monitoring during pregnancy to prevent complications such as preterm labor and fetal growth restriction. It is important for women with uterine anomalies to receive specialized care from a healthcare provider with expertise in this area to optimize their reproductive outcomes.
Summary Listen
- Congenital uterine anomalies (CUA) result from abnormal formation, fusion, or resorption of the Mullerian ducts during fetal life. They affect a significant portion of the population, particularly women with infertility issues or a history of miscarriage. These anomalies can occur in isolation or as part of a complex syndrome, sometimes involving renal and vertebral abnormalities. Proper diagnosis is crucial as it impacts management and prognosis, especially considering the importance women place on motherhood.
- Associated anomalies often involve the renal system, with renal agenesis being the most common. Vertebral anomalies are also frequent. Normal uterine development occurs during the sixth week of fetal life, with the formation of primitive gonads and the development of mesonephric and paramesonephric ducts. The absence of the SRI gene in female embryos allows the gonads to develop into ovaries, while the lack of AMH causes the regression of the Wolffian ducts and the development of the Mullerian ducts into the fallopian tubes, uterus, and upper vagina.
- Abnormal uterine development can manifest in several ways, including failure of duct formation, canalization, migration, fusion, or resorption. This can result in conditions like uterine agenesis, unicornuate uterus, didelphys uterus, bicornuate uterus, septate uterus, or arcuate uterus. While some anomalies, like arcuate uterus, may not require intervention, others, such as septate uterus, often necessitate surgical correction.
- Diagnosis involves taking a thorough medical history and performing various imaging studies. Ultrasound, particularly 3D transvaginal ultrasound (TVS), is a common initial modality. MRI is considered the gold standard for definitive diagnosis. Hysterosalpingography (HSG), hysteroscopy, and laparoscopy can also be useful in defining the anatomy. The American Fertility Society (AFS) and American Society for Reproductive Medicine (ASRM) classifications, along with the ESHRE/ESGE classification, help categorize these anomalies.
- Management strategies vary depending on the type and severity of the anomaly. Obstructive anomalies often require surgical intervention to relieve the obstruction and restore normal menstrual flow. Non-obstructive anomalies, particularly those associated with infertility or recurrent pregnancy loss, may require surgical correction to improve reproductive outcomes. In some cases, such as with complex anomalies or severe uterine agenesis, surrogacy may be the only option for achieving pregnancy.
Sample Certificate
About the Speakers
Dr Richika Sahay
Director at India IVF Clinic Head Fertility specialist and Gynec-Laparoscopic surgeon at Fortis Hospital
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