The document discusses uterine abnormalities and displacements, highlighting the importance of normal reproductive anatomy for pregnancy and labor. It provides definitions, symptoms, classifications, and management options for various types of uterine malformations resulting from abnormal development of the mullerian ducts. Additionally, it covers displacement issues of the uterus, potential complications, and recommended therapies.

1. UTERINE
ABNORMALITY AND
DISPLACEMENT
NAME: VASAVA KINJAL VECHANBHAI
ROLL NO: 11
2nd
YEAR MSC NURSING

2. INTRODUCTION
For pregnancy and labour to be achieved
with minimal difficult, a woman must
have normal reproductive anatomy.
When structural abnormality of the
pelvic organ exists, problems arise that
can place an extra burden on mother &
fetus.

3. DEFINITION
An uterine malformation is the result of
an abnormal development of the
mullerian ducts during embryogenesis.
Symptoms ranges from amenorrhea,
infertility, recurrent pregnancy loss, pain
to normal functioning depending on the
nature of the defect.

6. EMBRYOLOGICAL DEVELOPMENT OF UTERUS
 The female genital tract is formed in early
embryonic life when a pair of ducts develops.
These mullerian ducts comes together in the
midline and fuse into a Y – shaped canal. The
open upper ends of this structure lead into the
peritoneal cavity and the unfused portion
become the uterine tube. The fused lower
portion form the uterovaginal area, which
further develops into the uterus and vagina.

7. INCIDENCE
The prevalence of uterine malformation
is estimated to be 6.7% in general
population.
Slightly higher (7.3%) in the infertility
population
Significantly higher in a population of
woman with a history of recurrent
miscarriages (16%)

8. CLASSIFICATION
According to American fertility society
classification of mullerian anomalies is:
Class I: Agenesis or hypoplasia
segmental or complete absent uterus
Class II: Unicornute uterus (one sided
uterus)
Class III: Didelphys uterus also uterus
didelphis (double uterus)

9. CLASSIFICATION
 Class IV: Bicornuate uterus complete or
partial (uterus with two horns)
 Class V: Septate uterus complete or partial
(uterine septum or partition)
 Class VI: Arcuate uterus there is a concave
dimple in the uterine fundus within the
cavity.
 Class VII: DES- related abnormalities. The
uterine cavity has a “T-shaped” as a result of
fetal exposure to diethylstilbestrol

11. CAUSES
 Failure of development of one or both
mullerian ducts: the absence of both ducts
leads to absence of uterus
 Failure of recanalization of mullerian ducts:
agenesis of the upper vagina or the cervix
 Failure of fusion of mullerian ducts: in majority
the presence of deformity escapes attention.
In some, the detection is made accidently
during investigation of infertility or repeated
pregnancy wastages. In other the D & E
operation, manual removal of placenta during
cesarean section.

12. TYPES OF FUSION ANOMALIES:
 ARCUATE (18%)
 The cornual parts of the uterus remains separated. The
uterine fundus looks concave with heart shaped cavity
outline.
 UTERINE DIDELYSH (8%)
 There is complete lack of fusion of the mullerian ducts with
a double uterus, double cervix and double vagina.
 UTERUS BICORNIS (26%)
 Uterus bicornis bicollis: There are two uterine
cavities with double cervix with or without vaginal
septum
 Uterus bicornis unicollis: there are two uterine
cavities with one cervix

13. TYPES OF FUSION ANOMALIES:
 SEPTATE UTERUS (35%)
 The two mullerian ducts are fused together but there is
persistence of septum in between the two partially or
completely.
 UNICORNUATE UTERUS OR UTERUS UNICORNIS
(10%)
 There is a failure of development of one mullerian duct.
Only one side of the mullerian ducts forms and there is a
single uterine cavity with cervix and one fallopian tube
coming out of the uterus.
 ABSENT UTERUS OR UTERINE AGENSIS
 This is most severe kind of uterine malformation. Failure of
uterus, cervix and vagina to develop.

14. TYPES CONTI…
 DES- RELATED ABNORMALITY:
 It is due to DES exposure during intrauterine
life. Varites of malformation are included
 VAGINA: adenosis ( red granular patches)
 FALLOPIAN TUBE: abnormal fimbrae
 UTERUS: hypoplasia

17. CLINICAL FEATURES
 GYNECOLOGICAL:
 Infertility
 Dysmenorrhoea
 Menorrhagia due to increase surface area in bicornuate
uterus
 OBSTETRICAL
 Midtrimester abortion
 Increase incidence of malperentation
 Preterm labour
 Prolonged labour
 Obstruct labour
 PPH

18. DIAGNOSIS
 Physical examination
 Ultrasonography
 Pelvic MRI
 Hysterosalphinography
 Laparoscopy or hysteroscopy may be indicate

19. MANAGEMENT
 TREATMENT
 Uterine malformations like absence are not amenable
to treatment.
 Hypoplastic uterus in young age girls may gradually
develop with advance of age.
 Oestrogen theraphy may be temporarily given for
amenorrhea, oligomenorrhea: dilation and curettage
may be helpful in some cases with dysmenorrhoea.
 Surgery of double uterus
 Chances of pregnancy develop in the Hypoplastic
uterus.
 Hysteroscopic metroplasty is more commonly done.
 Surgical intervention

20. COMPLICATION
 Abortion
 Weak uterine action
 PPH
 Adhesion of placenta
 Malperesentations
 Prolonged or obstructed labour
 Uterine rapture due to its poor development

21. DISPLACEMENT OF
THE UTERUS

22. DISPLACEMENT OF THE UTERUS
 The uterus has central position in the pelvic. The
ternal os is at the level of the ischial spine.
 Retroversion of the uterus: it mean that the axis of
the cervix become behind the vertical axis of
female body.
 Retoflexion: axis of the uterine body behind the ais
of female body.

23. DEGREE:
 1st
DEGREE: axis of the cervix is behind the
vertical axis of female but the fundus is above
the promontory.
 2nd
DEGREE: the fundus is below the
promontory but still above the external os
 3rd
DEGREE: the fundus is below the external
os

24. SYMPTOMS
 PAIN
 Low backache
 Dysmenorrheal
 Dysparunia
 Mid cyclic pain
 Menstrual disturbance
 SIGNS
 Cervix is displaced
 Fundus in dougls pouch
 Absent of the uterus interiorly
 A soft, smooth, nontender mass filling the cul-de-sac
 Uterine malformation


25. INVESTIGATION
PV examination
Hystrography for find out the position of
uterus
Double pessary test

26. COMPLICATION
 Kinking of the uterus vessels, congestion of
uterus- dysmenorrhea, abortion
 Congestion of the ovary: polymenorrhra, mid
cyclic pain
 Infertility
 Uterine prolapsed
 Prolepses of tube ovaries

27. MANAGEMENT
 PROPHYLACTIC
 During labor, avoid bearing down, breach
extraction before full dilation of the cervix
 During puerperium, sleeping in semis position
empty of bladder

28. MANAGEMENT
 Possible therapies for retroversion
 Bladder drainage by indwelling catheter
 Patient positioning exercises (intermittent knee
chest or all fours positioning, sleeping prone)
 Manipulation of the uterus in to its usual anatomic
position, with or without tocolysis or anesthesia
 Colonoscopic manipulation of uterine fundus
under

29. BIBLIOGRAPHY
1. Basvanthappa B.T: “TEXT BOOK OF
MIDWIFERY AND REPRODUCTIVE
HEALTH NURSING” first edition 2006,
jaypee brother publication, new delhi. Page no:
200 to 208
2. Dutta D.C: “TEXT BOOK OF
OBSTETRICS” 6th
edition 2004: page no: 199-
192
3. Kumari neelam 2010; 1st
edition “MIDWIFERY
AND GYNECOLOGICAL NURSING”
s.vikas and company: page no: 160-170