Uterine malformations occur due to abnormalities in the development of the Müllerian ducts during embryo formation. There are several types of uterine malformations that can occur including unicornuate uterus, bicornuate uterus, septate uterus, and arcuate uterus. Women with uterine malformations may experience issues with infertility, recurrent pregnancy loss, or other complications. Diagnosis is often made through ultrasound, MRI, or hysterosalpingography. Treatment options depend on the type of malformation but may include surgery to reconstruct the uterus or assisted reproduction techniques.

1. UTERINE
MALFORMATION
Vaishali rana
Final year M.Sc. Nursing student
Saraswati Nursing institue, kurali, Punjab

2. INTRODUCTION
The shape of the uterus has a direct impact on the
reproductive function, as it is the place where the
embryo grows during the 9 months of pregnancy.
Uterine or Müllerian duct anomalies (MDAs) are
caused by alterations in the development of the
uterus, causing implantation failure and recurrent
pregnancy loss. As a consequence, some women
with uterine anomalies have no alternative but to use
a gestational surrogate to have a baby.

3.  The female reproductive system develops from the
fusion of the Müllerian ducts during embryo
development. The septum that separates them disappears
eventually as well.
The differentiation of the female reproductive tract occurs
in three stages:
 Formation of the Müllerian ducts
 Fusion of the ducts
 Resorption or elimination of the septum that divided
them
DEVELOPMENT OF FEMALE SEX ORGANS

4. Any abnormality or alteration that occurs during
embryo development may lead to developing a
congenital uterine anomaly. As a result, the woman
grows with an abnormally shaped uterus due to an
incomplete Müllerian duct development.
CONGENITAL UTERINE ANOMALIES

5. Uterine
Anomalies
Absence of Uterus Fusion anomalies

6. Müllerian agenesis:- Congenital malformation
characterized by a failure of the müllerian duct to
develop, which leads to a condition called Mayer-
Rokitansky-Küster-Hauser (MRKH) syndrome, which
causes the woman to be born without a womb or
uterus. The fallopian tubes, cervix and vagina are
underdeveloped or absent, too. These women have
functional ovaries, which translates into ovulation and
production of egg cells. However, they won't have
normal menstrual periods (amenorrhea), as they lack
the necessary organs for the menstrual cycle to
happen monthly.
TYPES OF UTERINE MALFORMATION

8. Non-surgical treatment:- Non-surgical treatment of
Müllerian agenesis involves a technique known
as vaginal dilation. Vaginal dilators work by stretching
the skin of the vaginal area slowly over time. The
pressure applied causes the skin to stretch and the
vaginal canal to form eventually.
 The most widely used dilators are known as Frank
dilators, which are strongly recommendable at the
beginning of the treatment in an attempt to create a
vagina that measures around 8-10 cm. The effectiveness
rate reaches 90% and it can take as little as 6 months, or
as long as several months, depending on each woman.
TREATMENT

9. Surgical treatment:-
 The Mclndoe vaginoplasty is a technique used to create
a canal that resembles a normal vagina in appearance
between the recto-vesical pouch. The neovagina is
created with a split-thickness skin graft harvested from
the patient and a synthetic mold resembling a penis. The
mold is with the skin graft is placed into the vaginal
canal. After removing the synthetic mold, the patient has
to use vaginal dilators for around 3 months to have a
satisfactory vagina.

10.  Unicornuate uterus:- In this case, one only of the paired
Müllerian ducts develops. As a result, the uterus is
smaller than normal, with a curved and elongated shape,
and a unique Fallopian tube. Visually, the external
uterine contour resembles a banana. It is diagnosed in 20
percent of the cases.
A unicornuate uterus can be classified into four subtypes:
 Without rudimentary uterine horn (35% of the cases)
 With communicating uterine horn containing a functional
endometrium (10%)
 With non-communicating uterine horn containing a
functional endometrium (22%): it can cause
endometriosis and adenomyosis.
 With rudimentary horn that is non-functional (33%)

11. Types of unicornuate uterus

12.  Cervical stitch or cerclage – this is often suggested in
unicornuate uterus cases that report a history of
miscarriages, premature delivery and incompetent
cervix. In this, the cerix is stitched and closed during
pregnancy.
 Laparoscopic surgery – this is conducted to remove
an isolated hemi-uterus because it causes abdominal
due to the accumulation of menstrual blood that cannot
flow out.
 Emergency delivery under special care
 Assisted reproduction – this is one of the most
accepted treatments is unicornuate uterus IVF with
embryo transfer.
TREATMENT

13.  Uterus didelphys:- This abnormality counts for 5% of
the cases of uterine malformations. It is diagnosed when
both ducts develop but fail to fuse, resulting in two
separate cervices.
Two types of uterus didelphys:
 Uterus didelphys bicollis :Each uterine cavity has an
independent cervix and a vagina. It occurs in two-thirds
of the cases.
 Uterus didelphys unicollis:There are two uterine cavities
that communicate between each other through the
cervix, and there is only one vagina.

14. Uterus didelphys bicollis vs. unicollis

15.  Bicornuate uterus:- It is caused by an incomplete
lateral fusion of the Müllerian ducts. These women have
two symmetric uteri, but the horns are underdeveloped
and smaller than in cases of uterus didelphys.
• The horns are separated by a central septum, which
reduces the space available for fetal development.
• Depending on the extension of the dividing septum, we
can differentiate between two subtypes:
 Complete bicornuate uterus It has a complete
transverse vaginal septum that extends to the internal
cervical orifice of the uterus (unicornuate bicollis) or
the external cervical orifice of the uterus (bicornuate
bicollis).
 Partial bicornuate uterus It just extends to the internal
orifice of the uterus.

16. Partial vs. complete
bicornuate uterus

17.  Increased risk of miscarriages
 Congenital anomalies in fetus
 Intra uterine growth retardation
 Difficulty in completing the pregnancy term
 High-risk pregnancy
 Preterm delivery
 Abnormal presentations of fetus
 Dystocia
 Adherent placenta
 Post-Partum Hemorrhage (PPH)
COMPLICATIONS OF
BICORNUATE
UTERUS

18.  Laparoscopic metroplasty:- It is the reconstructive
surgery for Bicornuate Uterus. This surgery for
Bicornuate Uterus is associated with fewer
complications including bleeding, adhesion formation
and duration of hospitalization.
 Hysteroscopic metroplasty:- Hysteroscopic
metroplasty can also be performed to treat Bicornuate
Uterus. This surgery avoids uterine scar and need for
elective C-section. The septum is resected with
resectoscope or scissors
TREATMENT

19.  Septate uterus:- It diagnosed in 55% of the patients
that have an abnormality of the uterus. In this case, the
septum that divided the Müllerian ducts doesn't
disappear, resulting in a partitioned uterine cavity. The
longitudinal septum may involve the endometrial canal
but not the cervix (partial septate uterus), or extend to
the internal or external cervical orifice of the uterus
(complete septate uterus).

20.  Transabdominal metroplasty
 Hysteroscopic metroplasty
TREATMENT

21.  Arcuate uterus:- Some consider it a variation of the
septate uterus, while others see it as just a mildly variant
shape of the normal uterus. The main difference with the
former is that the septum is less acute. This is precisely
the reason why, in the mildest cases, the morphology of
an arcuate uterus is similar to a normal uterus.
 This uterine anomaly is rather common. It rarely causes
infertility, although it may take longer for the woman to
get pregnant (subfertility). If it leads to recurrent
miscarriages, it can be treated with surgery.

22. The possible causes of uterine malformations are not
known exactly, but the most frequent are :
 exposure of the embryos to radiation.
 Intrauterine infections during pregnancy.
 Administration or exposure to teratogenic toxins.
 genetic problems can also lead to the appearance of
uterine malformations in women.
CAUSES, SYMPTOMS

23.  A large number of patients with anomalies of the
uterus have no symptoms. As a consequence, they
do not realize that they have an anomaly until they
get a routine transvaginal ultrasound done or visit a
fertility specialist due to trouble getting pregnant.
The symptoms may vary based on the type of
abnormality and its severity, though.
 Other uterine malformations symptoms range from
amenorrhea, infertility, hematometra, recurrent
pregnancy loss, discomfort sex and pelvic pain.

24.  Müllerian anomalies are often recognized at the onset
of puberty, when a young woman fails to get her
menstrual period.
 It may also be diagnosed when a woman has trouble
getting pregnant, or maintaining a pregnancy.
 Ultrasound
 MRI
 Hysterosalpingography
DIAGNOSIS OF UTERINE MALFORMATIONS

25.  The only treatment option for a uterine malformation is
surgery. Uterine malformations may contribute to fertility
problems, but many women with the condition have
healthy, successful pregnancies, with or without surgery.
Pregnancy options with uterine abnormalities
TREATMENT OF UTERINE MALFORMATIONS