In the process of ontogenesis, various morphological disorders occur in the reproductive system of a girl. One of them is the septum in the uterus. This is a very serious pathology that can lead to infertility or miscarriage.
Medical certificate
Laparoscopy and hysteroscopy are diagnostic procedures that are indicated when there is a strong indication. At the stage of planning a child, they are not mandatory. Getting good results of ultrasound and gynecological examinations annually, a woman may not even be aware of future problems with bearing a fetus. Spontaneous miscarriages can recur many times until advanced diagnosis using invasive techniques.
One of the most common problems associated with the clinical picture described above is an incomplete septum in the uterus. This is a congenital pathology found in 2-3% of cases. It is defined as the division of the reproductive organ into 2 parts of different lengths. Sometimes the septum reaches the cervical canal. In this case, it is called complete. Get pregnant and subsequently successfullycarrying a baby is possible only after the corresponding operation.
Pathogeny of pathology
Approximately at 3-4 gestational weeks, the fetus, regardless of its gender, forms the primary gonad. In a boy at week 7, it transforms into 2 testicles and begins to produce testosterone. In girls, the ovaries form a little later - at about 8-10 weeks.
By the fifth gestational week, the embryo has 2 pairs of genital ducts: Wolffian and Müllerian. If by the 8th week they do not begin to experience the influence of testosterone, the wolffian ducts partially die off. The rest of their site takes part in the development of the kidney.
Müllerian ducts gradually converge and grow together, forming the uterine cavity. The common wall, with which they adhere to each other, resolves by the 20th gestational week. This is necessary to form a single cavity. If this does not happen, a developmental anomaly appears - the intrauterine septum.
Main reasons
The development of an anomaly is not related to genetic characteristics. Doctors associate its occurrence with the influence of external factors on the body of a pregnant woman. The period from 10 to 20 weeks is especially dangerous.
The following can act as unfavorable agents:
- bad habits of a future woman in labor;
- severe toxicosis during pregnancy;
- mother-borne infections related to the TORCH group (rubella, toxoplasmosis, herpes, etc.);
- diabetes, as alreadypre-conception and acquired;
- taking toxic drugs;
- violations in the formation and attachment of the placenta;
- poor maternal nutrition;
- exposure to ionizing radiation.
Most often, the septum in the uterus does not manifest itself for a long time. That is why women learn about the pathology by chance, for example, during a diagnostic examination.
Clinical picture
Pathology has non-specific symptoms, which in each case appear individually. First of all, it should be noted that young girls have very painful periods. However, this is not a reason to see a doctor as they do not know how a normal period works.
The second obvious symptom is heavy uterine bleeding. They usually occur in the middle of the cycle and resemble very painful periods. The third and most rare manifestation of the disease is primary amenorrhea. This is the state when menstruation does not occur at all.
Pathology, as a rule, is detected only during an in-depth examination of the impossibility of conception or recurrent miscarriage. Also, an abnormal structure of the kidneys detected on ultrasound is considered a cause for concern. In this case, the doctor recommends carefully checking the functioning of the organs of the reproductive system.
Varieties of anomaly
As noted above, inDepending on the degree of division of the reproductive organ, two variants of the pathology are distinguished:
- Full partition. It stretches from the bottom of the uterus and reaches the cervix. In some cases, it goes to the vagina. It is not possible to bear a child.
- Incomplete partition. It partially covers the volume of the uterus. This is the most favorable variant of the course of the disease, but also does not exclude problems with conception.
The partition can be of various thicknesses. It can be located both longitudinally and transversely.
In some cases, the anomaly is combined with other pathologies of the reproductive system. We are talking about a bicornuate and saddle uterus. They do not interfere with natural conception, but pregnancy can be complicated.
Diagnostic Methods
A septum in the uterus is very difficult to diagnose. A standard examination on a gynecological chair does not allow it to be detected. Ultrasound of the pelvic organs with this problem also turns out to be uninformative. Hysterosalpingography, which involves an x-ray of the uterine cavity and fallopian tubes, is useful in only 50% of cases. Even CT and MRI with this anomaly almost completely lose their diagnostic significance.
The combination of hysteroscopy and laparoscopy is recognized as the gold standard in pathology detection. In the first case, an optical device is inserted into the uterine cavity, and then it is filled with gas or liquid. The procedure is performed under anesthesia. The study allows you to examine the connective tissue membrane, evaluate its length and thickness, as well as evaluate the shape of the uterus. It is recommended to carry it out in the first half of the cycle.
In laparoscopy, manipulation instruments are inserted through small incisions in the abdomen. The procedure helps to assess the condition of the reproductive organ and its symmetry, the functionality of the fallopian tubes and ovaries.
Based on the results of the examination, the doctor prescribes therapy.
Features of treatment
Removal of the septum in the uterus is carried out surgically using therapeutic hysteroscopy under the control of a laparoscope. The main indications for the procedure are infertility and a history of several miscarriages. However, some doctors are against such an operation. Self conception and successful bearing is possible in 50% of cases.
Hysteroscopy begins with stretching the organ cavity with an isotonic solution. Then the doctor proceeds to the phased excision of the septum through the cervical canal. The main tool are special scissors. Their use helps to avoid internal bleeding.
In the case of a thick-walled septum in the uterus, hysteroresectoscopy is considered the best method for its removal. It is in many ways similar to standard hysteroscopy. However, the instruments for manipulation are electrodes in the form of a knife or a loop. During the procedure, tissue coagulation is also performed. Its main advantage is the low traumatism of the inner layer of the uterus. Full recovery of the mucous layer is observed 3 months after the intervention.
Justified and Sharinghysteroscopy and laparoscopy. Laparoscopic guidance helps:
- Assess the size and shape of the uterus, identify the nature of the anomaly.
- Determine the progress of the procedure. A special lighting system shines through the organ through the muscle layer. This approach avoids perforation.
- If necessary, move the intestinal loops to the side so as not to damage them during the operation.
- In case of damage to the reproductive organ, the perforation can be quickly sutured.
The choice of a specific method of intervention is up to the doctor. At the same time, he must necessarily take into account the presence of concomitant he alth problems in a woman.
Post-operative period
After the operation, all patients must be prescribed hormone therapy. It is a kind of prevention of synechia and helps to accelerate the epithelization of the wound surface. The course of treatment is 2-3 months. Antibiotics are also prescribed to prevent the onset of inflammatory processes.
Possible Complications
The operation is sometimes accompanied by a breakthrough of the wall of the reproductive organ. In addition, resection contributes to the thinning of the uterine fundus. This violation can cause organ rupture during pregnancy. Therefore, the entire gestation period should be under the supervision of a good gynecologist.
Planning a pregnancy is allowed no earlier than 13 months after surgery. For the entire period, a woman is recommended to use barrier products.contraception.
Course of pathology and pregnancy
Having a septum affects a woman's ability to have children.
First of all, it can be the main cause of infertility. In 21-28% of women with this defect, primary infertility is diagnosed. This means that pregnancy never occurred. In 12-19% of cases, this condition is secondary. The woman has already managed to give birth to one child, but after all attempts at conception end in failure.
On the other hand, during pregnancy with a uterine septum, there is a risk of miscarriage. The probability remains even in the second trimester and subject to the attachment of the fetus to the wall of the organ. One of the reasons for the interruption is the non-closure of the walls of the cervical canal. As a result, the cervix loses its ability to resist intrauterine pressure, which only increases as the fetus grows and develops. Without timely medical correction, a miscarriage can occur. In addition, the partition inside the reproductive organ does not allow the cavity to grow in proportion to the growing child.
However, the medical statistics are very reassuring. In 50% of cases, women with a similar anomaly manage to become pregnant on their own and subsequently bear the baby. Its presence increases the likelihood of a transverse location of the fetus. Therefore, in most cases, a caesarean section is required.
Influence of the septum on childbirth
The septum in the uterine cavity, even with successful conception, can negatively affect the process of the birth of a child onlight. Doctors warn of the following problems:
- Premature birth. They begin due to the pressure of the septum on the already large fetus.
- Deterioration of uterine contractility. If the fetus is in a transverse position, one part of the uterus and its muscles practically do not stretch during pregnancy. As a result, discoordination or weakness of labor activity develops. In rare cases, the intrauterine membrane causes a condition that is dangerous for a woman, when the uterus quickly relaxes after childbirth. This leads to profuse bleeding, which can only be stopped by resection of the entire reproductive organ.
Such complications are rare, but they are not excluded. That is why a woman during pregnancy and at the time of childbirth should be under the close attention of specialists.
Prognosis for recovery
As medical practice shows, hysteroscopy is the best option for eliminating pathology. This is a low-traumatic operation, after which no scars remain. In addition, it increases the possibility of natural childbirth by 70-85%.
In some cases, there are complications in the form of infertility. That is why the treatment of pathology should be handled by a qualified specialist. It is important for a gynecologist to take into account not only the clinical picture, but also the general he alth of the patient.
