This document defines and classifies uterine abnormalities, or mullerian duct anomalies. It describes 7 classes of anomalies resulting from abnormal development of the mullerian ducts during embryogenesis. Class 1 involves complete or partial mullerian agenesis. Classes 2 through 5 involve various degrees of failure of the mullerian ducts to fully fuse, resulting in anomalies like a unicornuate, didelphys, bicornuate, or septate uterus. Class 6 is an arcuate uterus and Class 7 involves DES exposure in utero causing a T-shaped uterus. Symptoms may include pain or infertility. Diagnosis involves imaging tests. Treatment depends on symptoms but may involve surgery to correct the anomaly

1. Uterine abnormalities
Ms. Agnes Mahima David
Asst.Prof

2. DEFINITION
• Uterine abnormalities is a type of female
genital malformation resulting from an
abnormal development of the mullerian duct

3. CLASSIFICATION
ASRM CLASSIFICATION OF MULLERIAN ANOMALIES
 class 1: segmental or complete mullerian agenesis or
aplasia
• Vaginal
• Cervical
• Fundal
• Tubal
• Combined

4. • Class 2:unicornuate uterus with or without
the rudimentary horn
• With the rudimentary horn
• With the communicating endometrium cavity
• Non communicating cavity
• With no cavity
• Without the rudimentary horn

5.  Class 3:uterus didelphys
 Class 4:uterus bicornuate
• Complete
• Partial
 Class 5 :septate uterus
• Complete
• Partial
 Class 6:arcuate uterus
 Class 7:DES (diethylstilbestrol )related
abnormalities
• T shaped uterus with or without horns

7. CLASS -1 COMPLETE OR TOTAL AGENESIS
• Failure of canalization of the vagina results in
vaginal agenesis
• In partial vaginal agenesis there is a failure of
canalization of the lower part of the vagina, distal
to the normal uterus ,cervix and upper vagina

8. • CLASS -2 Unicornuate uterus
• It is uterus with one horn and results when
the tissue that forms uterus does not develop
• Uterus is just the half the size of the normal
uterus and the woman has only one fallopian
tube

9. • CLASS -3 Uterus didelphys
• Uterus didelphys (sometimes also uterus didelphis)
represents a uterine malformation where the uterus is
present as a paired organ when the embryogenetic
fusion of the Müllerian ducts fails to occur. As a result,
there is a double uterus with two separate cervices,
and possibly a double vagina as well

10. • CLASS -4 Bicornuate Uterus
• this uterine abnormality is also a result of the
müllerian duct not fusing properly to form a unified
uterus. This anomaly is further classified as bicollis –
two cervices, or unicollis – one cervix.

11. • While it is a uterine anomaly, the bicornuate uterus
does not pose fertility-related issues. Women with
this anomaly, however, commonly have breech
babies. Also, there is an increased risk of miscarriage
in women who conceive with the bicornuate uterus.

12. • CLASS- 5 Septate Uterus
• The inner partition that separates the two
müllerian tracts does not dissolve either partially
or wholly. This midline septum lacks protein Bcl-2
that protects the other parts of the uterus.
Whether the septum exists partially or entirely, the
septate uterus poses maximum pregnancy-related
issues, with completely septate uteri showing
about 90% pregnancy wastage. Treatment,
however, is possible by a simple endoscopic lysis of
the septum.

13. • CLASS -6 Arcuate Uterus:
• Known as uterus arcuatus or arcuate uterus, this type of
uterine anomaly is typically nothing to be too worried
about. In fact, an arcuate uterus is simply a slight variation
of a normal uterus. The uterus has a slight heart-shaped
appearance, and this happens when the müllerian tracts fail
to fuse or have a dysfunctional septum, but to a small
degree.

14. • CLASS -7 T-Shaped Uterus
• The T-shaped uterus in female infants is a result
of the mother consuming diethylstilbestrol (DES)
to do away with a risk of miscarriage. Studies
indicate that about 69% of female offspring of
women who consumed DES during their
pregnancy developed abnormal uterine cavities
have a T-shape with or without dilated cornua.

15. • The uterus in these cases tends to be hypoplastic and
prone to cervical incompetence. This results in
midterm loss of the fetus. These female infants are
also susceptible to other histological abnormalities
and are more prone to cervical or vaginal cancer at
an early age.

16. Symptoms
• Congenital uterine anomalies are present at
birth, but they rarely exhibit any sign or
symptom. Some women may experience pain
during their menstrual period, but that is not
always indicative of a congenital defect in the
uterus. Most of these abnormalities come to
the forefront only after recurrent pregnancy
loss or infertility problems

17. Diagnostic evaluation
• Vaginal Ultrasound
• Hysterosalpingogram
• Magnetic Resonance Imaging (MRI)
• Sonohysterogram
• Laparoscopy
• hysteroscopy.

18. Management
• Many women with uterine anomalies do not require
treatment. If pain, miscarriage, or infertility is an issue, a
physician may recommend correcting the anomaly
surgically. Most cases of uterine anomalies can be
corrected through minimally invasive techniques, such as
laparoscopy or hysteroscopy.
• In the instance of a unicornuate uterus, an obstructed
hemi-uterus can be removed if the other side of the uterus
is intact and functional. A dividing uterine septum can
usually be removed as well to open up the uterus.
• Women who are at risk for preterm delivery or late
pregnancy loss due to a uterine anomaly may need a stitch
to be placed in the cervix (called a cervical cerclage) to
prevent premature dilation.