uterine abnormality

nursing

1. UTERINE ABNORMALITIES SUBMITTED BY Ms. Ashima Singh Bsc . Nursing 4 th year

2. CONTENT INTRODUCTION DEFINITION INCIDENCE ETIOLOGY CLASSIFICATION OF UTERINE ABNORMALITIES DIAGNOSTIC MEASURES COMPLICATION MANAGEMENT

3. INTRODUCTION A Uterine abnormalities are malformations of the uterus that develop during embryogenic life. Uterine abnormalities occur in less then 5% of all women, but have been noted in upto 25% of women who have had miscarriages and /or deliveries of premature babies. When a women is in her mother’s womb, her uterus develops as to separate halves that fuse together before she is born. When a womens uterus develops differently from most women, it is called uterine anomaly.

4. DEFINITION A uterine abnormalities is a type of female genital malformation resulting from an abnormal development of Mullerian ducts during embryogenesis. Symptoms range from amenorrhoea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect.

5. INCIDENCE The prevalence of uterine malformation is estimated to be 6.7% in the general population, slightly higher 7.3% in the infertility population, and significantly higher in a population of women with the history of recurrent miscarriages ( 16%). Prevalence in general population 1 in 201 (0.5%) Distribution : 7% arcuate, 34% septate, 39% bicornuate, 11% didelphic, 5% unicornuate, 4% hypoplastic and other forms. hypoplastic u n i c o r n ua t e arcuate didelphic septate bicornuate

6. ETIOLOGY Genetic cause No any other causes at this time is present

7. TYPES AMERICAN FERTILITY SOCIETY CLASSIFICATION---- Class 1: Hypoplasia uterus or Agenesis: Segmental or complete (absent uterus). Class2: Unicornuate uterus with or without rudimentary horn (a one-sided uterus). Class3: Didelphus uterus also uterus didelphis (double uterus) . Class4: Bicornuate uterus: Complete or partial ( uterus with two horns). Class5: Septate uterus: Complete or partial (uterine septum or partition). Class6: Arcuate uterus: There is a concave dimple in the uterus fundus within the cavity. Class7: Des related uterus: The uterine cavity has a “t-shaped” as a result of fetal exposure to diethylstilbestrol.

8. o CLASS 1: VAGINAL AGENESIS/ HYPOPLASIA-- It is characterised by an absence or hypoplasia of the uterus, proximal vagina and sometimes the fallopian tube. Diagnosed at the age of 15-18 yr Assessment and physical examination Treatment : Surgical correction- Plastic surgery

9. o CLASS 2: UNICORNUATE UTERUS-- The unicornuate uterus forms when one mullerian duct fail to elongated but the another one develops normally. TREATMENT: No surgical intervention is required unless endometrial tissue in a rudimentary horn results in pain or a pelvic mass or unless an incompetent cervix is suspected during pregnancy.

10. o CLASS 3: DIDELPHUS UTERUS-- It is a rare congenital anomaly and is a consequence of unilateral or bilateral mullerian duct duplication. It’s exact cause is unknown but it is generally present from birth, though often becomes noticeable after puberty . Diagnosis is carried out using a physical examination alongside USG and 3D USG more recently. There is no treatment as such for the condition, but it must be managed especially during pregnancy.

11. o CLASS 4: BICORNUATE UTERUS— When the mullerians duct fuse incompletely at the level of the fundus then bicornuate formed. The lower uterus and cervix are completely fused resulting in 2 separate but communicating endometrial cavities with a single cervix and vagina. Pre-term birth: The rate of preterm delivery is 15 to 25%. A pregnancy may not be reach full term in a bicornuate uterus when the baby begins to grow in either of the uterine horns.

12. CLASS 5: SEPTATE UTERUS— Most common form of mullerian duct defect . From incomplete resorption of the medial septum after the complete fusion of the mullerian duct has occurred. It is not considered necessary to remove a septum that has not caused problems, especially in women who are not considering pregnancy.

13. ARCUATE UTERUS Characterised by a small septate indentation the superior aspect of the uterine cavity in the fundus. Many patient with an arcuate uterus will not experience any reproductive problems and do not require any surgery. In patients with recurrent pregnancy loss thought to be caused by an arcuate uterus hysteroscopic resection can be performed.

14. O CLASS 7: DES RELATED ANOMALIES— DES is a synthetic estrogen that was prescribed to women for recurrent miscarriage and premature delivery during the year 1940- early 1970. The uterine cavity has a “T-shape” as a result of fetal exposure to diethylstilbestrol.

15. CLINICAL FEATURES No any symptoms Difficulty in getting pregnant Pelvic pain Dysmenorrhea Uterine rupture during pregnancy Recurrent pregnancy loss Concurrent renal abnormalities Imperforated hymen

16. DIAGNOSTIC MEASURES

17. COMPLICATION Infertility Early pregnancy loss Uterine rupture due to its poor development Malpresentations Prolonged obstructed labor Abortion Weak uterine action

18. MANAGEMENT No non-surgical treatment is present only symptomatic treatment is done. Surgical intervention is considered when a septate uterus is found. Bicornuate, unicornuate and didelphic uteri rarely require surgical management.

19. BIBLIOGRAPHY WWW.WIKIPEDIA.NET WWW.SLIDESHARE.COM