Successful pregnancy is not always guaranteed even for an absolutely he althy woman. What can we say about those who, by the will of fate, had to face any gynecological problem. Let's talk about an unpleasant pathology - a unicornuate uterus. We will analyze the causes of development, diagnosis and treatment of such a rather rare phenomenon. First, let's find out what a unicornuate uterus means, endosonography, whether pregnancy with such a pathology is possible, and how to bear a he althy baby.
Main reproductive organ
The uterus is a pear-shaped smooth muscle unpaired hollow organ in which the development of the embryo and gestation takes place. It consists of the bottom, body and neck. In a normal anatomical structure, the organ has the shape of a triangle. Its natural position is harmoniously created for the unhindered development of the fetus. During the 9 months of pregnancy, the uterus undergoes tremendous changes in size. Any defect can disrupt the proper development of the child. What's more, it could put the lives of mom and baby at risk.
Main pathologies
Along with the normal structure, it occursa number of pathologies:
- bicornuate uterus;
- uterus with septum;
- saddle uterus;
- complete doubling of uterus;
- unicornuate uterus (photo of which can be seen in the article).
Any of these non-standard manifestations can promise the patient the inability to give birth to a child. However, there are chances even in the rarest cases with a unicornuate uterus.
What is this pathology and how does it affect a woman's life?
In simple terms, a unicornuate uterus is half of a normal uterus. It has a rounded, elongated shape, it has no bottom when passing from the inside into the fallopian tube. It is worth saying that the body of the uterus of a unicornuate form is quite common. It is also important to mention that this species has several subspecies:
- With communicating cavities of the rudimentary and main horn.
- With non-communicating cavities of the rudimentary and main horn.
- With a cavityless vestigial horn.
- With missing vestigial horn.
These four options can only be identified with the help of complex diagnostics: laparoscopy and hysteroscopy. The most dangerous with such a diagnosis may be the occurrence of an ectopic pregnancy. The fetus, which began to develop in a rudimentary horn, simply does not have the conditions for a full-fledged existence. The outcome of pregnancy in this situation can be life-threatening. So what are the reasons for the appearance and development of such a defect?
Reasons
The real causes of this pathology are still unknown. She isaccounts for only 1 - 2% of the total number of abnormal, mutational formation of the female reproductive system. The only thing that scientists can say is that a failure in the system occurs even at the stage of embryonic development, that is, in the first trimester of pregnancy. It is in these first 12 weeks that the laying of all the vital organs of the girl takes place. The likelihood of developing anomalies increases if the mother has had any infection during this period of time. The hereditary factor is also considered as one of the reasons for the appearance of this anomaly.
Thus, during the formation of a unicornuate uterus, instead of two paramesonephric ducts, one is formed. Less often - two, but any of them turns out to be rudimentary, underdeveloped, unable to function normally. Most often, a unicornuate uterus is not the only anomaly in the genitourinary system. In combination with other structural disorders of the female organs, it is an aggravating factor in the development of infertility and miscarriage.
According to what symptoms can this disease be suspected and how to diagnose it? Can I do it myself or do I need to see a doctor?
Symptomatics
The appearance of the first clinical signs of the disease depends on the variant of the defect. With a functioning closed rudimentary horn, they appear shortly after menarche. Characterized by algomenorrhea.
Violation of the outflow of menstrual blood from the pathological organ leads to the formation of hematometers and hematosalpings in it with unilateral pain on 3-4 daysfemale cycle. Retrograde reflux of secretions may be accompanied by acute abdominal syndrome, the development of endometriosis and adhesions in the pelvis. In most cases, problems with the reproductive organs in women are similar in their symptoms. Summarizing them, we get the following clinical picture:
- painful and profuse periods or lack thereof;
- unilateral abdominal pain radiating all around;
- tumor formations;
- involuntary miscarriages;
- miscarriage.
The consequence of all this is infertility.
Diagnosis
It is almost impossible to identify and diagnose a unicornuate uterus during a routine gynecological examination. This can only be done by hardware methods. Primary diagnosis in case of suspected diagnosis of a unicornuate uterus - ultrasound examination. When it is carried out, you can clearly see the reduced thickness of the walls of the female organ, asymmetry, the absence of one of the ovaries.
For a more accurate vision of the picture, laparoscopy, hysteroscopy, MRI, ultrasound of the kidneys are prescribed. These methods determine the shape of the uterus, the presence or absence of a rudimentary horn, its size, the presence of additional abnormal formations in the uterine appendages, a single mouth of the fallopian tube.
When an accurate diagnosis is made, a woman may be offered a variety of therapies.
Treatment
The management of such patients does not have a single tactic. The doctors agreethat each case must be considered individually. According to the appointment of a specialist, depending on the condition of the patient, the following types of treatment are used:
- Indisputable indications for surgery are: pain syndrome, endometrial cavity in the rudimentary horn, ectopic pregnancy.
- In the absence of pain and copious discharge, the usual observation of a woman with the appointment of periodic examinations is shown. Although many experts believe that surgery is indicated for everyone. In any case, before conception, the patient must make a decision about how to get rid of the existing problem.
The operative method of removing the rudimentary horn can be carried out in two ways: laparoscopically and during abdominal excision.
Of course, a less traumatic method is currently being chosen. This is laparoscopy. It allows not only the removal of the rudimentary horn, but also the correction of other gynecological pathologies revealed during the surgical intervention. Also, this method can significantly minimize possible postoperative complications and reduce the length of the patient's stay in the hospital.
The operation is important
During corrective operations (regardless of the method), other related gynecological problems are also solved. These include:
- conservative myomectomy (removal of fibroids);
- removal of an ovary or fallopian tube;
- salpingolysis (restoration of patency of the fallopianpipes);
- resection or biopsy;
- salpingostomy (creating an opening in the fallopian tube to connect to the abdominal cavity);
- electrocoagulation of endometriosis foci (germination of uterine cells into other organs);
- disconnection of adhesions.
After this gentle laparoscopic surgery, patients can start walking in 2 to 3 hours and be discharged to outpatient care in 2 to 3 days.
Most of those operated on note an improvement in their general condition. Those who experienced unbearable pain during menstruation, accompanied by dizziness, nausea and vomiting, subsequently note the disappearance of these manifestations.
After 2-3 months, patients with a removed rudimentary horn are allowed to become pregnant. At the same time, nothing prevents a woman from giving birth to a child in a natural way, without resorting to the cesarean section method. This is due to the fact that when an underdeveloped rudiment is amputated, there is no scar left.
In every third case in women without correction of a congenital malformation of the uterus, a defect was detected during a caesarean section or manual removal of the placenta during childbirth. According to clinical data and ultrasound echography, no pathology was detected. This indicates the complexity of its diagnosis, especially in the absence of a violation of the outflow of menstrual blood.
One of the causes of hard-to-diagnose congenital anomalies of the genitals was the late visit to the doctor due to infertility and recurrent miscarriage.
Result
To all women,who are faced with this problem, doctors advise not to panic. Conception and pregnancy with a unicornuate uterus with a rudimentary horn is quite real. And if you follow all the recommendations, then the chance to endure and give birth to a he althy baby will be one hundred percent.
The right decision is to contact your doctor. He must appoint all the necessary studies. Then, together with the patient, find the best way out of a particular situation.
Modern medicine is capable of much. Don't be afraid of this diagnosis. Remember that there is a way out - laparoscopic surgery, after which it will be possible to conceive, endure and give birth to a he althy baby.
