Congenital uterine anomalies are malformations of the womb that develop during fetal life. When a baby girl is in her mother’s womb, her womb develops as two separate halves from two tubular structures called mullerian ducts’, which fuse together before she is born. Abnormalities that occur during the baby’s development can be variable from complete absence of a womb through to more subtle anomalies, which are classified into specific categories.
Types
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- Uterus didelphys (double uterus),
- Arcuate uterus (uterus with a dent on the top part),
- Unicornuate uterus (one-sided uterus),
- Bicornuate uterus (heart-shaped uterus),
- Septate uterus (uterus with partition in the middle),
- Absent uterus.
Symptoms:
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- Asymptomatic
- Painful periods.
- Most cases of congenital uterine anomalies do not cause a woman to have difficulty in becoming pregnant and the outcome of pregnancy is good.
- These womb anomalies are often discovered during investigations for infertility or miscarriage.
- there may be increased risk of first and second trimester miscarriages,
- preterm birth,
- poor growth of the baby in the mother’s womb (fetal growth restriction),
- pre-eclampsia
- Difficult positioning of the baby for birth (fetal malpresentation).
Diagnosis:
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- Ultrasound is good in screening for congenital uterine anomalies, 3D ultrasound is used to confirm a diagnosis.
- If a complex womb abnormality is suspected, MRI scanning may also be used.
- laparoscopy in which a camera is inserted into the cavity of the abdomen
- Hysteroscopy, when the camera is placed in the womb cavity. As there can be a link between CUAs and abnormalities of the kidney and bladder, scans of these organs are also usually requested.
Treatment:
Surgical treatment is only recommended to a woman who has had recurrent miscarriages and has a septate uterus. In this case, surgery may improve her chances for a successful pregnancy, although the risks of surgery, especially scarring of the womb should be considered.
Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These women, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up.