This presentation of Uterine malformation is easy to understand read and very precise.

2. Congenital malformations are anomalies,
which may be either hereditary or occuring
during gestation and evident at the time of
birth. Development of the female genital tract
is a complex process depend upon a series of
event involving cellular differentiation ,
migration, fusion and canalization. Failure of
any one these processes result in a congenital
anomaly.

3. A Uterine malformation is the result
of an abnormal development of the Mullerian
ducts during embryogenesis.
 The most common types of uterine
abnormalities are caused by incomplete fusion
of mullerian ducts.
 Uterine anomalies are often associated with
vaginal maldevelopment.

6. American Fertility society (AFS) classification
of mullerian anomalies are :
 Class 1: Mullerian agenesis / hypoplasia-
segmental ( a. vaginal, b. cervical, c. uterine, d.
tubal, e. combined).
 Class 2 : Unicornuate with or without a
rudimentary horn.
 Class 3 : Uterus didelphys.
 Class 4 : Bicornuate utrerus (a.complete to
internal os, b.partial).

8.  Class 5: Septate uterus (complete incomplete )
 Class 6: Arcuate uterus.
 Class 7: Diethylstilbesterol (DES) –related
anomalies.
INCIDENCE
It varies between 3 and 4%.The
incidence is found to be high in women suffering
from recurrent miscarriage or pre term deliveries (5-
20%).

9.  Failure of development of one or both mullerian
ducts : The absence of both ducts leads to absence of
uterus , including oviducts . There is absence of
vagina as well . Primary amenorrhea is the chief
complaint.
 Failure of recanalization of the Mullerian ducts :
Agenesis of the upper vagina or of the cervix – this
may lead to hematometra as the uterus is
functioning.

10.  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 wastage . In others,
the diagnosis is made during D & E operation ,
manual removal of placenta or during cesarean
section.

11.  ARCUATE (18%):
The cornual parts of the uterus remains
separated . The uterine fundus looks concave with
heart shaped cavity outline .
 UTERINE DIDELHYS (8%):
There is complete lack of fusion
of the mullerian ducts with a double uterus, double
cervix and a double vagina.

12.  UTERUS BICORNIS (26%):
There is varying degree of fusion
of the muscle walls of the two ducts .
I. Uterus bicornis bicollis – There are two uterine
cavities with double cervix with or without
vaginal septum.
II. Uterus bicornis unicollis – There are two uterine
cavities with one cervix . The horns may be equal
or one horn may be rudimentary and have no
communication with the developed horns

13.  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 a cervix and one fallopian tube coming out of
the uterus.

14.  ABSENT UTERUS OR UTERINE AGENESIS:
This is the most severe kind of uterine
malformation . There is failure of uterus , cervix
and vagina to develop. A girl with this
malformation will experience puberty with the
absence of menstruation . The women will have a
small dimple in the place where the vagina should
be at.
 DES – RELATED ABNORMALITY:
It is due to DES exposure during
intrauterine life . Varieties of malformation are
included . Eg: Vagina –adenocarcinoma , adenosis.
Cervix – cockscomb cervix , cervical collar.
Uterus- hypoplasia , T-shaped cavity.
Fallopian tube – cornual budding , abnormal fimbrae.

18.  The condition may not produce
any clinical manifestation.
 Gynecological:
 Infertility and dyspareunia are often related in
association with vaginal septum.
 Dysmenorrhea in Bicornuate uterus or due to
cryptomenorrhea.
 Menstrual disorders (menorrhagia ,
cryptomenorrhea) are seen. Menorrhagia is due to
increased surface area in Bicornuate uterus.

19.  Obstetrical:
 Midtrimister miscarriage which may be recurrent .
 Rudimentary horn pregnancy may occur due to
transperitoneal migration of sperm or ovum from the
opposite side.
 Cervical incompetence.
 Increased incidence of malpresentation : tansverse lie in
arcuate or subseptate, breech in bicornuate,unicornuate
or complete septate uterus.
 Preterm labor,IUGR,IUD.
 Prolonged labor – Due to incordinate uterine action.
 Obstructed labor – obstruction by the non-gravid horn of
the bicornuate uterus or rudimentary horn.
 Retained placenta and postpartum hemorrhage where
the placenta is implanted over the uterine septum.

20.  Ultrasonography.
 Hysterosalpingography which allows
evaluation of the uterine cavity and tubal
pregnancy.
 MRI Scan.
 Hysteroscopy.

22.  Dysmenorrhea.
 Hematometra.
 Complications during pregnancy and labor –
late miscarriage, preterm labor, ssuterine
rupture, malpresentation, obstructed labor.
 Fertility is uneffected except for uterine
agenesis.

23.  Surgical intervention depending on the type of
abnormality or enabling a viable pregnancy.
 Rudimentary horn should be excised to reduce the
risk of ectopic pregnancy.
 Unification operation (bicornuate or septate uterus)
is,therefore,indicated in unexplained cases with
uterine malformation. Abdominal metroplasty could
be done either by excising or incising the septum.
 Hysteroscopic metroplasty is more commonly
done.Resection of the septum can be done either by
resectoscope or by laser.

24. contd…..
Advantages are-
i. High success rate(80-89%)
ii. Short hospital stay.
iii. Reduced postoperative morbidity.
iv. Subsequent chance of vaginal delivery is high
compared to abdominal metroplasty where C-
section is mandatory.
v. Unicornuate uterus has very poor outcome for
pregnancy (40%).No treatment is generally effective.
vi. Uterus didelphys has best possibility of successful
pregnancy(64%).

25.  Assess the condition of the women by collecting
health history , menstrual history and obstetrical
history .
 Based on the severity of the condition plan for
interventions.
 Educate the couple about the best possible treatment
of uterine malformation.
 Assure the couple about chances of fertility or
pregnancy except for the case of uterine agenesis.

26.  Allow the client exploring all possible options for
family.
 Help the couples in overcoming delimmas , deciding
the right fertility treatment.
 Counsel and encourage the couple for child adoption
in case of infertility.
 Help the couple to deal with emotional stress.
 Advice the mother to avoid fertility impairing
medication.
 To relieve dysmenorrhea , provide hot application.
 Administer analgesics to relieve pain.
 Educate the woman to practice light exercise and
maintain nutritious diet such as fibre diet after
surgical treatment.