and for women with congenital anomalies of the uterus.
Written by the members
of the Yahoo
Groups Müllerian Anomalies e-mail list.
Compiled and maintained by Lizbeth Ager (firstname.lastname@example.org).
FAQ contains individual experience and opinion, and is meant as a learning
aid, not a substitute for professional medical advice and care.
What does müllerian mean?
2. What are the different types of müllerian anomalies?
3. What causes a müllerian anomaly?
4. Müllerian anomaly myths
5. What are some of the pregnancy complications?
6. Should I see a regular OB-GYN or a high-risk specialist
7. Is an HSG alone good enough for a diagnosis?
8. Should I have my uterus surgically repaired?
9. How long to wait to TTC after surgery?
10. What is surgery like?
11. What are non-surgical diagnostic procedures like?
12. Does anyone have any success stories?
13. What do the abbreviations mean?
14. How do I change my group settings or unsubscribe?
What does müllerian mean?
The uterus, fallopian tubes and upper vagina are made up of two partially
fused tubes, which, in the embryo, are known as müllerian ducts,
named for physiologist Johannes Peter Müller, who first described them
in 1830. They are also known as the paramesonephric ducts, and
are at first present in embryos of both sexes.
Normally, these ducts run down
vertically from flank to pelvic floor in the young embryo and eventually
fuse into a double-barreled tube with two loose ends, known as the uterovaginal
primordium, or UVP. The double UVP will eventually merge into a single-barreled
uterus, cervix and upper vagina, while the loose ends develop into the fallopian
tubes. In adulthood, these organs are referred to as the müllerian
tract and congenital malformations of this tract are called müllerian
anomalies, or MAs, as we call them on this list.
In the male embryo, in the presence
of anti-müllerian hormone (AMH), the müllerian structures
disintegrate during early development. They persist in the female because
she does not produce AMH.
In the embryo, the müllerian
ducts act as scaffolding for the mesonephric ducts, which give
rise to the kidneys. Because of this parallel structural relationship, it
is common for a kidney or other urinary anomaly to be present with a müllerian
What are the different types of müllerian anomalies?
Agenesis & hypoplasia: Mayer-Rokitansky-Kuster-Hauser
syndrome is most common. All or part of the müllerian tract
fails to form, or is extremely underdeveloped. For example, a cervix may
be a tissue-thin membrane rather than a tough, fibrous "donut"
several centimeters thick. Most women suffering from agenesis or extreme
hypoplasia have severe fertility problems, simply by lacking sufficient
tissue to support a growing pregnancy. A common diagnosis used to be "infantile
uterus," but it simply means a smaller-than-average uterus and does
not refer to the MA described above. The old "infantile uterus"
is typically capable of supporting a pregnancy very well, since a uterus
easily grows during pregnancy. The "infantile" term has fallen
by the wayside in recent years..
uterus (UU): When one müllerian duct is underdeveloped or
fails to develop, a banana-shaped half-uterus is formed. It may or may
not be accompanied by a rudimentary horn, and that other horn may or may
not have an endometrial cavity or communicate with the main uterine cavity.
A missing kidney or other kidney problems accompany this asymmetric anomaly
more than they do other MAs. Frequently, the ovary on the rudimentary
side is found in an odd place, further up by the ribs. Adverse pregnancy
outcomes are common with UU.
didelphys (UD): The müllerian tract fails to fuse along
all or most of its length. There may be complete duplication of the vagina,
cervix and uterus, and the two halves may be divided by a ligament of
connective tissue. UD is reported to have the best pregnancy outcomes
of all the MAs.
uterus (BU): The uterine fundus fails to fuse and a myometrial
division extends down to the cervix in a complete bicornuate uterus, or
part way to the cervix in a partial bicornuate uterus. The division is
visible on the outside of the uterus, evidenced by a groove or cleft in
the uterine dome exceeding 1.5 centimeters. Cervix and vagina are usually
single but may be septate or duplicate. BU has relatively few pregnancy
complications when compared to SU or UU, with breech presentation being
one of the most common.
uterus (SU): The müllerian tract has fused properly and
the uterus looks single from the outside, but the inner duct wall (i.e.
the median septum) has failed to dissolve around 20 weeks of gestation,
and the uterus retains a double cavity. There may or may not be a shallow
groove of 1.5 centimeters or less on the outer uterine dome, and sometimes
even a whitish triangle of tissue, the septum itself, is visible. The
somewhat fibrous inner septum extends to the internal cervical opening
or beyond in a complete septate uterus, and extends only part of the way
down in a partial septate or subseptate uterus. The inadequate blood supply
and progesterone receptors of the median septum may cause problems in
pregnancy, giving the SU the worst pregnancy outcomes of all the MAs.
uterus (AU): The fundus of the uterus may be indented slightly
both inside and outside. This shape has been variously defined as slightly
bicornuate and slightly septate (and may be either one), and is so slight
that it is considered a variation of normal. However, a few studies suggest
that increased incidence of adverse pregnancy outcomes are associated
with an arcuate uterus.
uterus: A T-shaped uterine cavity, dilated horns and malformed
cervix and upper vagina may characterize this anomaly. Unlike the other
anomalies, a T-shaped uterus is sometimes caused by maternal ingestion
of DES, although sometimes the cause is unknown. When caused by DES, there
are often other problems, such as incompetent cervix, infertility and
abnormal tissue in the cervix and vagina. DES use is associated with high
rates of female cancers, including cancer of the vagina.
What causes a müllerian anomaly?
To date, there is no singular cause for müllerian anomalies. Some may
be hereditary (a small number of women on this board have relatives with
MAs), others result from an insult to the fetus while in the womb (the T-shaped
uterus of fetuses exposed to DES, for example), and still others may be
attributed to random mutation. It is important to remember that in our grandmothers’
and mothers’ generations, many women with this problem were not diagnosed;
while up to 4% of women may have a müllerian anomaly, it may be far
more common than physicians realize. Only as diagnostic technology improves
and women become more aware of their reproductive health will science get
a better understanding as to how common these differences really are. In
future years, our honest communication with our children will help build
a larger base for understanding the causes of this uniqueness.
Müllerian anomaly myths
This section deals with misinformation. Many women on this board have been
horrified by the predictions of doctors who have not had a lot of exposure
to women with müllerian anomalies. Some have been told they will only
have miscarriages and preemies. A few have even been told to consider adoption
or surrogacy, and that trying to conceive would be foolish. If you have
experienced this, request a referral to a Reproductive Endocrinologist (RE),
who can better assess your prognosis. Please read on.
Cannot Have Children
will not be able to get pregnant because of your MA — FALSE
In most women, having a müllerian anomaly alone does not affect
their fertility. If there are other fertility concerns (e.g. damage
to the single connecting fallopian tube in a Unicornuate uterus) an
MA is one more factor to consider during fertility treatment.
2. You will never carry a baby safely — FALSE
Many women find this web site after one or more devastating losses.
The thing to remember is that with proper medical supervision, most
women can carry their pregnancies to a safe, live birth. After conception,
a woman with a müllerian anomaly should consult a high-risk OB/GYN
(also called Perinatal Specialists or Maternal-Fetal Specialists)
to discuss how their pregnancies will be monitored. A high-risk OB
will monitor your cervix for signs of incompetence and preterm labor,
your baby for signs of stress and your amniotic fluid for lower levels.
These sound scary but can be managed, and if someone is watching you
from the start, often prevented. Some of our mothers went overdue.
Others have had twins. In fact, a number of mothers on this board
have been discharged from their high-risk OBs because they were doing
mother took DES (or was otherwise responsible) — Not always
It is true that some mothers who were given a drug called DES while
they were pregnant gave birth to daughters who had distinctive T-shaped
uteri. However these young women make up just a fraction of women who
are diagnosed with müllerian anomalies. The fact is, the cause
of MAs is simply not completely understood.
From time to time an ignorant person may assume that a müllerian
anomaly is the result of venereal disease or abortion. The answer is
always false; MAs are always a birth defect.
can not have a vaginal birth— Not always
Studies and anecdotal evidence support the notion that the uteri of
women with müllerian anomalies may be prone to stretching differently
than a normal uterus while a baby grows. This can result in a breech
or transverse fetal lie towards the end of pregnancy. In these cases,
a cesarean birth may be scheduled in advance. This is just a tendency,
however, and a number of our members have had uncomplicated vaginal
births. Many women on this board feel cheated and mourn the loss of
the vaginal birth experience. If you feel this way, you aren’t
surgery can remove your septum— Sadly, this is not always true
While many of our posters have had one surgery “do the trick”,
quite a few have been shaken to find out a second, and perhaps even
a third surgery may be necessary to remove as much septum as possible.
In any case, most postoperative HSGs do reveal an arcuate-looking uterus,
and a residual septum of less than 1 cm. apparently does not affect
pregnancy outcomes. Some researchers even recommend leaving a residual
"stump," to guard against rupture. Please read on:
“A surgeon could
leave too much septum behind if he only cut the septum at the cervix
end of the uterus, but stopped too soon, before he got anywhere near
the fundus. If a surgeon does this, only some part of the septum snaps
back, but some of it is left intact… This can happen if the surgeon
is not experienced, or, if there is poor visibility in the scope due
to too much blood or endometrial tissue.”
"tipped" or "tilted" uterus is causing your infertility—No
A tipped uterus refers to the very common condition of the uterine fundus'
pointing somewhere besides slightly forward, toward the navel. Instead,
it may be pointing straight up, backward, or may be flexed forward more
than usual. This is almost never a problem, beyond the potential for
causing painful intercourse. In short, the tipped uterus is not
a müllerian anomaly, does not cause infertility, and usually
"cures" itself by the 10th week of pregnancy.
What are some of the pregnancy complications?
Before reading this list of possible complications, it is important to remember
that most babies born to women suffering from MAs encounter none of
these problems. These are simply possibilities to keep in mind, and
most of them come from the potential poor attachment/blood supply of the
placenta, or the lack of space.
Miscarriage: Spontaneous abortion is very common, especially
with the septate uterus, because of blood flow disruptions and possibly
hormonal receptor abnormalities. The normal miscarriage rate for a woman
with no fertility or anatomical problems is 20%, or 1 out of 5 pregnancies
lost. In the septate uterus, which has the worst pregnancy outcomes,
some studies show a miscarriage rate approaching 90%.
b. Incompetent cervix: As many as 20% of anomalous
uteri may have additional problems, such as incompetent or weak cervix.
Such cervices tend to give way between 16 and 22 weeks’ gestation.
A woman with a known MA should ask her OB to check for this possibility.
Cerclage—sewing a purse stitch around the cervix to keep it closed—is
the most common remedy.
c. Placenta previa: Because of the tight quarters in
an abnormal uterus, it is a little more common for the placenta to ride
low and cover the inner cervical os. This condition poses a bleeding
risk, but may correct itself as the pregnancy advances and the uterus
d. Abruptio placenta: Because of the abnormal configuration,
contractions and vasculature within an abnormal uterus, problems with
its attachment to the uterine wall may arise.
e. Premature labor: Although no one knows all the causes
of premature labor, expansion restrictions may be one reason why an
anomalous uterus is more prone to it. Another may be disorganized contractions
of the abnormal muscle in a septum.
f. Abnormal fetal lie: Breech position is very common
in an abnormally shaped uterus, possibly because there is more room
for limbs at the bottom, or because the fetus loses its ability to roll
180° earlier than a fetus in a normal uterus.
g. Intrauterine growth restriction (IUGR): Again, because
of the possible placental vascular insufficiency, the fetus may not
get all the nutrients it needs, and may be small for dates. One form
of IUGR tends to spare the brain, and the fetus, if born prematurely,
does quite well despite the small size.
Should I see a regular OB-GYN during pregnancy?
While it should be remembered that many women with uterine anomalies have
no trouble at all during pregnancy, one can never go wrong erring on the
side of caution. If the MA is a severe one (a deep SU or BU, or any UU),
it might be wise to at least consult with a high-risk specialist (perinatologist)
early in the pregnancy, or have one co-manage your case along with your
OB-GYN. Or you might simply interview your OB-GYN and find out how much
MA experience he or she has, what his or her philosophy of care is, and
whether or not you feel comfortable with it.
Expect to have your cervix length
evaluated (sometimes a cervix weakens when the baby is crowded) and possibly
treated with a purse stitch (cerclage) if it begins to open up in the second
trimester. You may also expect to be monitored for premature labor, intrauterine
growth retardation and abnormal fetal lie during your pregnancy; these pregnancy
complications are more common with müllerian anomalies.
“My OB was kind of cynical about me seeing the peri. He feels
they do a lot of ultrasounds and keep making you come back. He said to
call in a few days after he's reviewed the perinatologist's report. Then,
he said that if all they're doing is monitoring cervical length, well,
he'll do that. So, then if that's all, then I shouldn't need to see them.
But, if they're doing something in addition that he can't do, then I should
“A peri here not only monitors the cervix but later on in the pregnancy
will do tests on the baby, better quality US, like a Level 2, and they
are also more experienced in finding problems. My OB consults with a peri,
but I have never seen them. That was my decision. I think you should do
what will make you feel comfortable, if your insurance is paying and you
feel like it gives you peace of mind, then do it.”
“My next appt. is for an U/S in 2 weeks, so I will see how my cervix
is holding up and decide if I want a referral to a peri. When I was with
[my RE's office] they always said I would get a referral to [a perinatologist]
at 12 weeks when I was released from their care, but my pregnancies never
made it that far.”
“I started seeing my perinatologist at 16 weeks. Interestingly,
the reason I was referred to him
initially had nothing to do with my uterine anomaly. I was referred to
the perinatologist because I tested high on the AFP blood test, which
is a marker for some birth defects. (As if I needed something else to
be scared about!) Anyway, we went to the perinatologist for a Level II
ultrasound (which found no defects) and amniocentesis (which we declined).
But after discussing my uterine anomaly with the perinatologist, he recommended
that I come back to him for monthly ultrasounds for the rest of the pregnancy.
I do feel quite a bit better, psychologically, now that I'm seeing a high-risk
specialist. I will insist on it for the whole time in future pregnancies.
I'm not sure yet who will actually deliver my baby - the peri or the OB.
I guess I need to find out soon.”
“I kept finding [a contradiction]
in medical literature about septoplasty: risk assessment in subsequent
pregnancies. Most studies suggest that there is no reason to treat a patient
pregnant after septoplasty as high risk, but about a third of studies
suggest that a woman who has had a premature baby or a second trimester
miscarriage is still at high risk of premature labor and birth, and should
be treated as high risk. Just a heads up.”
Is HSG alone good enough for diagnosis?
First of all, in an infertility work-up, a hysterosalpingogram (HSG) should
be done to either rule out or assess the presence of a two-chambered uterus,
the depth of the division, as well as tubal patency. But an HSG alone cannot
differentiate between septate and bicornuate uterus. Misdiagnoses of BU
by HSG are very common.
methods have better levels of reliability:
ultrasound is nearly 100% successful in detecting a bifid uterus,
but only 80% successful in differentiating between SU and BU. It can
be a helpful tool in the diagnostic process, but should not be relied
• Three-dimensional ultrasound (3DUS), is 92%
accurate in differentiation of BU from SU, according to one 1997 study,
but not widely available at the time of this writing. It should not
be relied upon alone, with an 8% margin of error.
• According to two studies done in 1994 and 1995, MRI
can reliably differentiate between BU from SU, with an accuracy of 100%
in comparison with laparoscopy/hysteroscopy. More recent studies cast
some doubt on this. Proceed with caution after an MRI.
• Concurrent laparoscopy and hysteroscopy are
considered the "gold standard” of BU/SU differentiation.
This test is invasive, but if needed, corrective hysteroscopic metroplasty
can be done at the same time.
“The bottom line still seems to be that with a simultaneous
laparoscopy/hysteroscopy, the diagnosis is the most accurate. The doctors
were not sure if I had a septate or bicornuate uterus after a HSG and
also a hysterosonogram. However, after the MRI they felt very confident
that I have a septate uterus. I brought my films with me to my high-risk
ob and he also felt that based on the MRI I have a septate uterus. Anyway,
I guess I can't know for sure but it seems the MRI is more accurate than
“HSG is arguably the best way to show what's inside the uterus,
shows the exact contour of the cavity, and determines tubal patency, but
absolutely does not differentiate between BU and SU. (Some say that if
the angle between the horns is > 75°, then it is a likely BU, but
this is also not reliable, as many septa can be very, very wide.)”
“After an HSG 8 years ago I was give the mistaken diagnosis of BU;
only after 2 miscarriages this year do I know now that I have a septum.
(I had a hysteroscopy that showed a large septum combined with US that
showed the top of my uterus does not have the characteristic dip associated
with BU) Septums are associated with high miscarriage rates and 2nd/3rd
trimester losses. Septums can be surgically removed. Surgery dramatically
increases the outcome for a live pregnancy.”
“HSG and hysteroscopy
alone [ . . .] cannot really differentiate between BU & SU. An MRI
or very, very careful US might be able to tell. I had a US diagnose me
as SU where the HSG was inconclusive. However, the surgeon wanted to do
a laparoscopy on me, too, before he would cut. I agree with his rationale.”
“I was diagnosed with MRI after an ultrasound showed a possible
uterine anomaly. I also had a HSG, which showed UU, but the MRI confirmed
“I was told that it was impossible to tell from my HSG whether my
uterus was BU or septate, so an MRI was proposed. Then the doc learned
that MRI is frequently inconclusive with this sort of thing, and ordered
an abdominal and transvaginal ultrasound. The diagnosis of septate was
made, then, on evidence that there wasn't even a dimple on the outside
of the fundus, much less a division. Scanning the longitudinal cross section
showed that. My other option would have been to have a simultaneous
laparoscopy/hysteroscopy. As it turned out, that is what I did have, just
to back up the diagnosis and monitor the septoplasty surgery.”
“I had an HSG, which was a horrible experience for me and was diagnosed
with a UU. I was devastated. I did a bunch of research, found a group
of women with UUs and just pretty much fell apart at the information I
found. [ . . . ] The doctor decided to do an MRI to confirm the diagnosis.
Turns out I have a BU.”
“They told me I am BU based on the HSG alone, but I don't feel like
they have enough info to give an accurate dx. She said she will call me
after the radiologist reads the US films. I tried to talk to the US tech,
but I know they aren't supposed to tell you too much while they are scanning
you. I asked some questions while she was working on me and she showed
me the 2 horns. I was asking her if she could really tell how the fundus
was shaped (smooth or indented), and she said that it looked indented,
but said that the HSG would show more. I know that HSG cannot show the
outside contour of the uterus, but the medical community seems misinformed
Should I have my uterus surgically repaired?
metroplasty, abdominal metroplasty, hemihysterectomy, vaginoplasty
The quick, reflexive party line
here is that if you have a septate uterus, yes, you should
have it fixed. Studies tend to show a poor pregnancy outcome in the uncorrected
SU, but a near-normal pregnancy outcome in the surgically corrected SU.
Of course there are exceptions, and we should not forget that most women
with a septate uterus are never diagnosed, and may indeed have no trouble
In deciding whether or not to have it repaired, take into account your own
pregnancy history, your complications, your age, and, possibly, your investment.
Are you spending thousands per cycle on IVF treatments? Then you may want
to get the septum out of the way. If you have no trouble getting pregnant
and have had only one miscarriage, some doctors recommend a more conservative
approach, treating with surgery only if another miscarriage happens. Resecting
a septum, although not without risks, is a relatively minor surgery compared
to the open, abdominal metroplasty once performed.
If you have a septate uterus
and suffer from painful menstrual periods, there is a good chance that having
your septum resected will cure the painful periods.
Bicornuate, arcuate and
didelphic uteri are generally thought to do well in pregnancy,
but some studies show correlation to miscarriage and other problems. Again,
take your history into account, first and foremost, and weigh the benefits
versus the risks. Surgical correction of a bicornuate uterus involves an
open (laparotomy) procedure in which the surgeon cuts through the uterine
wall of each horn and then sews them together. Unlike most septum surgeries,
abdominal metroplasty is a major procedure and carries greater risks of
bleeding, infection, adhesions, infertility and rupture during pregnancy.
Recuperation takes at least twice as long, and greater pain control is required.
Sometimes a well developed unicornuate
uterus has a rudimentary bud (anlage) that is capable of supporting
a pregnancy for time, but then ruptures, because of its tiny size. This
tiny half-uterus may need to be removed in what is known as a “hemihysterectomy.”
The surgery eliminates the possibily of an ectopic pregnancy in the rudimenary
horn, lessens pain during menses and reduces the possiility of endometroisis
caused by retrograde menstruation. The surgery is not common, but a few
members have had it done.
Women with UD or with a completely
septate uterus may also have a vaginal septum, sometimes
expending to the perineum, creating two vaginal openings. This may make
intercourse difficult or painful, or using tampons impractical, and surgery
to lyse the vaginal septum is fairly simple. There is some controversy about
severing the septum within a septate cervix, since there is a possibility
of creating an incompetent cervix. Some surgeons prefer to spare the cervical
segment of a septum.
How long to wait to TTC following surgery?
The standard advice is to wait either two cycles or 8–10 weeks following
hysteroscopic metroplasty surgery, to allow time for the
inflammatory response at the wound site to go away. Local inflammation is
a normal response to an injury, but may increase miscarriage or hinder conception—opinions
and studies vary. Sometimes, the hormones prescribed before or after surgery
can interfere with conception as well.
Sometimes a surgeon will shorten
the recuperation time to one cycle, depending in part on the scale of the
surgery. Some list members have become pregnant even without an intervening
menstrual period and the pregnancies have gone well.
Recuperation time for an abdominal
metroplasty will be longer; 3–6 months' waiting is a common
recommendation, because of the full-thickness wound in the uterine wall.
It is prudent to have a follow-up
HSG to confirm the results of surgery before trying to conceive. An HSG
can be done after the first menstruation, ideally before the next ovulation,
while the lining is thin and compact. It will show not only the changed
configuration of the uterine cavity, but may reveal perforations.
What is surgery like?
Hysteroscopic metroplasty (uterine septum resection via the vagina) ; a.k.a.
During this procedure, a uterine (and also a vaginal septum, if applicable)
can be incised to open the uterus up for a better pregnancy result.
This surgery is usually done at the same time as a laparoscopy (see
below) and is often referred to on the board as a “lap/hyst.”
It can be done with scissors, an electrocautery tool or a laser tool,
depending on what the surgeon is most experienced with.
not an accurate term for what happens, since no tissue is removed from
the uterus; instead, the surgeon parts the septum, like cutting a swatch
of material in half. On parting, the septum retracts close to the normal
uterine wall on each side, where it is covered with endometrium within
days or weeks.
It is a day surgery in most
cases. Recovery is different from woman to woman, but most agree that
3–5 days are required. It is important to know that some women
require more than one surgery to adequately resect a septum.
For more, please refer to part d., the hysteroscopy section.
And please read the list members' analogies below to help you understand
what’s really going on during a resection!
“They do not take anything out of you in a resection. You
could think of it like this. Picture your uterus as a blown-up balloon,
lying on its side. The fundus is the rounded part opposite the opening
of the balloon (the cervix). If you have a septum, the balloon has a
wall of rubber that runs in the inside from the fundus to the cervix.
When the surgeon goes in, he goes in through the cervix. Then he takes
scissors and cuts the rubber wall septum in the middle, starting at
the part near the cervix and moving up toward the fundus. The top part
of the cut septum snaps back into the top wall of the balloon. The bottom
part of the cut septum snaps back into the bottom wall of the balloon.
Then endometrium grows over these ridges of septum tissue, and the uterus
is nearly normal shaped on the inside. Septum tissue is actually a lot
like a very firm rubber. It does not act like normal skin or muscle.
It literally does snap back when cut.
”A surgeon could leave too much septum behind if he only cut the
septum at the cervix end of the uterus, but stopped too soon, before
he got anywhere near the fundus. If a surgeon does this, only some part
of the septum snaps back, but some of it is left intact… This
can happen if the surgeon is not experienced, or, if there is poor visibility
in the scope due to too much blood or endometrial tissue, or, I guess
simple bad judgment. The best bet for visibility is to have the surgery
right after [your period] is gone. Or, take birth control pills to keep
the lining very thin.”
You prepare for laparoscopy by fasting and discontinuing meds as ordered
(aspirin or metformin, for example). You may or may not be ordered to
do a bowel prep (laxative, enema, clear liquids), and wash your abdomen
with special soap such as Phisoderm for a period of time preceding the
surgery, as well as trim back or shave the pubic hair.
When you are under anesthesia
(usually general), you’ll be put in the lithotomy position (a
lot like a Pap smear), draped and prepped. The surgeon will make two
to four puncture wounds in your abdominal wall—one inside the
navel (for the laparoscope) and one to three in the bikini line fold
just above the pubic hair, for other implements. Sometimes a minilaparotomy
incision, about an inch wide, is made on the bikini line at the midline,
though this is not usually the case. The surgeon will then inflate your
abdominal cavity with carbon dioxide to improve visibility, and have
a look with the lighted scope at your pelvic organs.
The main purpose of a laparoscopy
is to monitor the outside of the uterus for imminent or actual perforations
as the surgery goes on inside the uterus, but other fertility-related
surgery may be done as needed: lysing adhesions, removing fibroids or
endometriosis, or ovarian laser drilling.
After the surgery, you can
expect to feel sleepy, forgetful and possibly nauseated from the anesthesia
and the pain medication, and that may last over 24 hours. You may feel
pain in your abdomen, under the ribcage and even referred to your shoulders
from remaining carbon dioxide within your abdomen. Expect to have a
sore abdomen for the next week or so. Many women compare the feeling
to that of having done too many sit-ups.
A hysteroscopy involves distending
the uterus with a fluid or gas, inserting a scope and then doing one
of two things: either operating (e.g. removing a polyp or fibroid, resecting
a septum) or just documenting any abnormality and then withdrawing the
instrument. You prepare for laparoscopy by fasting and discontinuing
meds as ordered (aspirin or metformin, for example). You may or may
not be ordered to do a bowel prep (laxative, enema, clear liquids),
and you may be on progestins, danazol or GnRH analogs in order to thin
the uterine lining prior to surgery. Surgeons' preferences vary widely.
It seems to be most useful in improving visibility with a wide septum
or a complete septum (one that extends to the cervical os or beyond).
While it is a minor surgery, any instrumentation of the uterus creates
the risk of injury or infection, and HSC carries with it about a 1%
risk of perforating the uterine wall. Most perforations are minor in
nature, but if the wound is large or bloody, or injures other abdominal
structures, such as the intestines, complications can be serious. Perforation
also increases the likelihood of rupture during pregnancy or childbirth.
HSC also creates a risk of fluid overload and serious electrolyte imbalance
as the distending medium enters the bloodstream, although fluid status
is continually monitored during surgery. There is also the risk that
the surgery will not accomplish its purpose and may need to be repeated.
The advantage of HSC, of
course, is avoiding abdominal metroplasty, a major surgery with all
the attendant risks.
Hysteroscopy itself does
not seem to cause pain during recuperation, although the accompanying
laparoscopy tends to give a sore abdomen. Expect to bleed for a day
or two, then to see the flow lighten to a watery pink. After a few days,
the flow should change to a watery, slightly yellowish serous fluid,
and disappear at roughly two weeks post surgery. Foul-smelling discharge
or a fever warrants an immediate call to the surgeon because of possible
Some surgeons like to leave
an inflated Foley catheter in place to hold the sides of the uterus
apart, or to leave some other adhesion barrier in there. Barriers tend
to increase bleeding and cramping beyond a few days, and some surgeons
believe that barriers increase the risk for intrauterine adhesions and
An experienced surgeon may
choose to waive the laparoscopy during HSC, but this is the exception,
not the rule.
As often as not, an operative
HSC is followed up with a course of conjugated estrogens to help promote
regrowth and proper healing of the endometrium, especially if the patient
has taken premedication to thin the uterine lining. Studies increasingly
show postoperative estrogen to make little difference in re-epithelialization
of the cut septum.
Antibiotics during or after
surgery are also commonly given, although risk of endometritis is low.
An exploratory (rather than
operative) hysteroscopy is an office procedure, frequently done while
the patient is awake. Since the uterus needs to be expanded with saline,
glycine or carbon dioxide, this can be quite painful, similar to having
a hysterosalpingogram (HSG).
is a stitch placed around the opening of the uterus, usually the cervix,
to hold the uterus closed as pregnancy advances, and is done in cases
where there has been a loss due to painless prolapse of the membranes
in the second trimester of pregnancy. The McDonald stitch is the most
common form of cerclage done. It is a suture done with mersilene or
proline suture material, under local anesthesia (usually a low, short-acting
spinal block). It takes only a few minutes to place, and recovery and
monitoring following the procedure take only a few hours. Bedrest for
48 hours after the procedure is recommended
The patient is placed in the
lithotomy position following the spinal or epidural anesthesia, and
the area is draped and swabbed with antiseptic. A kind of caliper called
a tenaculum is used to pull the cervix closer to the mouth of the vagina
and manipulate the cervix as the surgeon makes the sutures. The patient
may feel a painless tugging sensation as this is done. Sedation is optional;
some surgeons feel that tranquilizers or general anesthesia pose an
unnecessary risk to the developing fetus.
The patient is monitored
closely for signs of bleeding, contractions and ruptured membranes and
then usually discharged the same day, after she is able to void her
bladder into the toilet. Sometimes an overnight stay is needed. The
surgeon may or may not prescribe bed rest beyond 2–3 days, depending
on individual circumstances. "Pelvic rest," or refraining
from intercourse and orgasm, is also frequently advised, because of
the infection risk and tendency for a cerclaged uterus to be irritable.
At minimum, pelvic rest is advised for one wekk prior to and one week
Cerclages work well
(up to 90% success rate), but some do fail. In that case, a second stitch
can be placed, and the patient is put on strict bed rest, which involves
taking meals lying down and using a bedpan. One alternative to cerclage
is strict bed rest by itself, beginning in the early second trimester;
some studies show it to be just as effective as cerclage. The advantage
of cerclage is, of course, avoiding the health risks of lying in bed
for several months.
for having a cerclage is active labor, since this may cause the stitch
to tear through the cervix. Consequently, most cerclages are removed
around 37 weeks, to allow effacement and dilation to occur naturally.
Some women with very weak cervices experience labor and birth almost
immediately after cerclage removal, but not always. Sometimes the cervix
develops scar tissue from the cerclage and does not thin out or open
up easily (cervical dystocia), which may necessitate a c-section.
Opinions vary as
to when it is appropriate to place a cerclage. Current trends point
to earlier placement—at 10 weeks or as soon as the embryo looks
viable on ultrasound. Prior conventional wisdom indicated placement
at 12–14 weeks, after it becomes 97% certain that the pregnancy
will continue. However, ultrasound technology can predict a positive
outcome with 95% certainty at 10 weeks, LMP.
A cerclage done
to salvage a threatened pregnancy, after the membranes have begun to
prolapse, is called an emergent or rescue cerclage. A rescue cerclage
requires bed rest, and the prognosis is not as good as that of a cerclage
done well before cervical shortening begins.
For patients with
underdeveloped cervices or repeated cerclage failures, an abdominal
cerclage promises some success. Prior to conception, the suture is placed
around the lower segment of the uterus, deep to the uterine arteries,
and is done through a laparotomy. Delivery must be by c-section, and
the cerclage can be left in place for the next pregnancy.
Some cerclage stats from Wikipedia:
The success rate for
cervical cerclage is approximately 80-90% for elective cerclages, and
40-60% for emergent cerclages. A cerclage is considered successful if
labor and delivery is delayed to at least 37 weeks (full term).
Morbidity and mortality rates:
Approximately 1-9% of women will experience premature labor after cerclage.
The risk of chorioamnionitis is 1-7%, but increases to 30% if the cervix
is dilated greater than 1.2 in (3 cm). The risks associated with premature
delivery, however, are far greater. Babies born between 22 and 25 weeks
of pregnancy are at significant risk of moderate to severe disabilities
(46-56%) or death (approximately 10-30% survive at 22 weeks, increasing
to 50% at 24 weeks, and 95% by 26 weeks).
If your c-section is planned, you will be asked to take nothing
by mouth for several hours prior to surgery. At the hospital, you will
be hooked up to a fetal monitor for a time and an IV of normal saline
or Ringer's lactate will be started in your non-dominant hand. You may
be shaved, prepped (enemas are passé!) and catheterized prior
to the spinal anesthesia. The nurses will put tight anti-embolic stockings
on your legs to reduce the risk of blood clotting while you are immobile.
is increasingly the method of choice for controlling pain. Shortly before
surgery, the nurse anesthetist or anesthesiologist will start a spinal
anesthetic of a fairly short-acting substance, such as lidocaine. You
will be asked to lean forward and "shove" your back towards
the anesthetist, to make room for the needle to enter the spinal space.
You will feel a small prick right about at kidney-level, slightly off-center.
When the anesthetic is introduced, you will lose a sense of having a
lower body from the nipple line on down, and a warm, not unpleasant
feeling may overtake you. Assistants help you lie back on the operating
table and one or both arms are strapped at 90° angles to your body.
Someone will apply a pulse oximeter, EKG leads and an oxygen mask or
nasal cannula. You may begin to feel tingling or numbness in your thumbs
and a difficulty swallowing, and while disconcerting, this is seldom
a problem. A medication may be introduced into your IV to help with
any feelings of anxiety.
expose your abdomen, scrub it with antiseptics and drape it with sterile
drapes. Your surgeon will probably make a 10-cm. horizontal incision
just superior to the pubic bone, above the hair line—a pfannensteil
incision. Working very quickly, the surgeon will part and retract the
underlying tissues, exposing the uterus. The uterus is opened with (usually)
a horizontal incision, and the amniotic sac incised. Amniotic fluid
is allowed to drain away. In many cases, the patient may not even have
realized that surgery has begun.
While an assistant
presses downward on the fundus, the surgeon reaches into the uterus
and delivers the fetus' head. Taking gentle traction on the head, he
or she delivers the baby rapidly. You may feel a pressure or rocking
as they work.
Then comes the joyful
part, as the baby is assessed and begins to cry. You may be able to
touch, kiss or hold the baby, or even nurse the baby immediately following
birth (this is something to work out beforehand in your birth plan with
Meanwhile, the uterus
itself is often delivered outside the laparotomy incision, inspected,
suctioned, massaged and sutured, then replaced into the pevlic/abdominal
cavity. This may be a good time to have a tubal ligation performed,
if you do not want any more children. And your surgeon may ask
if you want any septum present to be resected. One school of
thought holds that childbirth is a risky time for a metroplasty because
of increased vascularity and risk of infections and adhesions, but there
are two documented cases of septa being successfully resected during
Expect to spend
an hour or two in recovery, being assessed and reassessed, and having
your fundus massaged. With luck, you will be able to bond with your
baby during this time. You will remain in bed, catheterized, until the
anesthesia wears off, possibly with pneumatic sleeves on your feet or
lower legs that periodically inflate to stimulate circulation in your
legs. Once the catheter is out and you are able to void, you will be
encouraged to stand, sit and walk around as soon as possible.
The level of discomfort
following a c-section varies widely, and you may or may not require
much pain medication. If it is painful to nurse your baby, a pillow
over the incision may distribute pressure more comfortably. You will
have lochia (postpartum flow), but it tends to be lighter than that
of a vaginal birth. A typical hospital stay following a c-section is
2-5 days. Following hospital discharge, you will be asked not to lift
anything heavier than your baby, or to drive, to minimize the risk of
adhesion fomration immediately following the surgery. The stitches or
staples closing the incision usually come out within a few days following
surgery, and are replaced with steri-strips or other dressing. The scar
gradually thins and fades in color.
Vaginal birth following
a lower segment incision is definitely possible, with the right provider.
An emergency c-section
is done after the mother goes into labor and it becomes apparent that
she needs a section. A crash c-section is done when the fetus is at
risk of hypoxia or death. In both these cases, anesthesia may be by
epidural block or general.
What are non-surgical diagnostic procedures like?
b. Sonohysterogram (SHG)
c. Intravaginal and transabdominal ultrasound
d. Intravenous pyelogram (IVP)
What is an IVP?
An IVP is a special x-ray exam of your kidneys and other parts of your
urinary system. This includes your ureters (the tubes leading from the
kidneys) and your bladder. Another name for this test is "IV urogram."
If you’ve had an x-ray for a broken bone, it is a little similar
How do I prepare for this exam?
Your physician will give
you a set of instructions describing how you need to prepare for this
procedure. In order to see the kidneys well on X-ray, we need to "clean
out" the bowel. This involves drinking a fluid that will help clear
the bowel, as well as fasting the day of, and sometimes the evening
before your procedure
What else do I need to do to know?
have asthma or any allergies to foods or medications, be sure to tell
the people who are doing your exam. Also, be sure to tell them about
any reactions to x-ray dye you've had in the past. Tell them even if
you think the information is on your record, or you think they already
know about it. This is for your safety. You will be getting a dye for
this test, and some people who have allergies are also allergic to the
you have been scheduled for any other x-ray test on the same day as
your IVP, call the radiology department to make sure one test will not
interfere with the other.
happen during the test?
First, a technologist will
take a "test" x-ray to see if your bowel is empty enough for
the test. If there is a lot of gas or bowel contents over the kidneys,
you may have to reschedule your test. If not, the technician will start
an IV (intravenous) line in your arm.
We will give you a special
x-ray dye through the IV. This dye will outline the kidneys and urinary
system so we can see them on x-ray. This will show the radiologist (the
doctor who reads the x-rays) how well your kidneys are working, and
the structure of your urinary system.
After the injection, the
technologist will take a number of x-rays. Each time, you will be asked
to hold your breath for a brief period. After the radiologist has seen
your bladder fill with dye, the technologist will ask you to go to the
bathroom to urinate. Then, they will look at your empty bladder on x-ray.
Some people experience a
mild feeling of warmth, tingling or coolness at the site the injection
or at their tailbone. Others experience a "metal" taste. And
that’s it–most people say the preparation is worse than
the test itself.
How long will the exam take?
The exam takes about one
hour. Occasionally, more time is necessary when we need to take delayed
If you experience nausea
or breathing difficulties, please inform the technologist immediately.
resonance imaging (MRI)
MRI uses a strong magnetic
field to produce extremely detailed images of the structures inside
the body. MRI can provide a clear picture of all bodily tissues, including
MRI is needed when HSG cannot
provide a good enough view of the uterine structure in question, or
when repeated scans are needed and there is concern over excessive exposure
I prepare for this exam?
While there are no special
preparations for this procedure, there are some cases in which MRI may
not be recommended: when there is metal hardware in the body (the magnet
may dislodge it); when there is a pacemaker; and when you are pregnant.
The effects of magnetic waves on an unborn child are as yet unknown.
Because of the uncertainty, you need to let your doctor know if you
are pregnant beforehand. Let your doctor know if you have allergies
to iodine, seafood, or contrast medium (some but not all MRIs use contrast),
and if you have anxiety in enclosed spaces.
Before the procedure begins,
you will need to remove all clothes, jewelry and accessories with metal
parts, and don a hospital gown. Small transmitters, which send and receive
radio waves, are placed on the area being studied.
An MRI machine is a large,
hollow tube with a padded table sticking out of it. As you lie on the
table, it moves slowly into the tube, and while pictures are taken,
you will need to lie extremely still. Technicians may place a few straps
on you as reminders to help you stay still, or towels under your bottom
to position your pelvis at the right angle for maximum viewing of the
uterus. The radiologist or technician will be in a neighboring room
and will talk to you via intercom.
An MRI machine is noisy,
although you will not be able to feel the magnetic and radio waves imaging
your body. If you are claustrophobic, your doctor may give you a mild
sedative before the test.
will it take?
The scan should
take from 30–90 minutes. Sometimes it is hard to get just the
right angle of the uterus.
Does anyone have any success stories?
The short answer is yes! From carrying twins in one horn of a complete BU
to having two children despite lacking a cervix, we have success stories
in the archives for every kind of uterus.
18 weeks, I began having some spotting and strange cramping that went
across the left side of my pelvis and toward my thigh. The monitor actually
showed uterine irritability which stopped after a shot of terbutaline.
At that point, I was put on bed rest and various meds (over the next
months, I was given: brethine, nifedipine, indocin, betamethasone steroids,
and several high doses of mag sulfate.)
"By 24 weeks,
I was having pretty frequent contractions (which are hard to feel early
in pregnancy, but I think particularly hard to feel with a UU. Only
half of your stomach gets
hard and it feels very much like the baby's movements.) My contractions
would start very easily, even when I was talking on the phone for extended
periods of time. By 26 weeks, we raced into the hospital with contractions
that were 2 minutes apart. This became our routine for the next several
months. It got to the point where all I had to do was call and tell
the L&D nurses my name, and they would ask "How close are they?"
I was fortunate that my cervix was pretty stubborn and I did not actually
start to dilate until I was 31 weeks. They also did FFN testing which
always came back negative.
"All in all, I spent 18 weeks on bed rest. During that time, I
made countless trips to L&D and was admitted several times. It was
difficult, but paid off. DS was not born until 36 weeks...I even had
a vaginal delivery. They used the vacuum (UU couldn't really push very
well) and needed pitocin b/c contractions basically got "stuck."
Otherwise, delivery was very easy. He was 6 lbs 7 ounces and other than
jaundice and reflux, his health was perfect.
" I'm still in awe when
I look at him!"
b. Uterus didelphys
a bicornuate uterus with a septum and 2 cervices. So
joke was that the baby could pick the exit when the time came.
But that never happened because my daughter was, of course, breech
The beginning of the pregnancy was really bumpy; first they thought
I was a tubal because I was having a lot of pain and just had my
first positive prego test. After many ultrasounds in the ER, they
saw no evidence of a tubal, but instead saw fluid (probably from a
ruptured ovarian cyst) and the smallest of gestational sacs...with
no fetal pole. So I was sent home and told to wait...and to see an
OB/GYN which I did. I did not know that I had a bicornuate uterus
until I got pregnant.
"I had bleeding (nothing major but definitely not normal)
first 20 weeks of my pregnancy along with intermittent cramping. I
had a lot of ultrasounds, including 2 level 2 ultrasounds, to make
sure she was growing normally (and she was even BIG, 8 pounds, 12
ounces at birth, which shocked everyone). She lived on my right
side throughout most of the pregnancy, practically in my rib cage.
We knew about the bicornuate uterus, but did not know about the
septum until they were performing my c-section...at 38 weeks!!!
"In the end I was so fortunate to have carried such a beautiful
daughter to term, fully knowing that things very well may not have
gone so well...and all the problems that might happen in the
"Inaccurately dx by HSG in 1995 (I think?) with BU. In 2001,
got pregnant twice, miscarried at 12 and then 8 weeks. Finally correctly
dx with SU bicollis. Found the MA group (my lifesaver!)
and decided the lap/hyst to resect the septum was the choice for me.
Had one surgery in January, 2002.
"It was very successful, and I am left with a slight residual
septum, making me somewhat BU — still have 2 cervices and vaginal
septum (and one kidney). Post surgery had long, wacky cycles. Got pregnant
on day 34 ovulation in July, 2002. Great pregnancy (although paranoid)
and I was able to keep active throughout. No bed rest, no preterm labour.
My son was breech from the start, and didn't turn despite lots of mellow
encouragement (didn't even attempt a version). Went into labour at 39
weeks, and he was born by c-section.
And hopefully I will have a second success story to share in
November, as I am currently 6 weeks pregnant and saw the HB today (despite
a few days of spotting last week). Still nursing my almost 2 year-old
son (who needs to be weaned otherwise he will BF until he is a teenager)."
"After 4 miscarriages, including one involving incompetent
cervix, I was diagnosed as having a complete SU in
2000. A resection was partially successful, although the surgeon perforated
my uterus high up on the fundus. Had a second resection 6 months later,
leaving me with segments of the septum intact, but a window between
the two horns.
"I miscarried once more and then conceived my DS. had a
cerclage at 11 weeks and had some slight trouble with bleeding and contractions
during the pregnancy. I was worried about possible rupture, so we planned
on a c-section at 37 weeks, before prodromal labor got vigorous. All
in all, I spent 23 weeks on modified bed rest and had a lot of cervical
monitoring. The cervix held up splendidly, although my uterus was irritable.
I took terbutaline for that up until about 21 or 22 weeks, and in retrospect,
I would have taken far less of it.
"The septum resurrected itself during the early part of
the pregnancy, and I was worried about that, but by 20 weeks, the fetus
had squashed it back into the uterine walls. He was still able to flip
from vertex to transverse and back again at 36 weeks, and was born by
planned c-section at 37 weeks on the dot, weighing 7 lbs., 3 oz., and
in perfect health."
What do the abbreviations mean?
is a short list of abbreviations and specialized terms used in the Müllerian
Anomalies e-mail list.
"Aunt Flow" or menstrual period.
The name for the undeveloped or rudimentary müllerian duct.
AU A variation of normal uterine development in which the top of the
uterus has a slight dip. Rarely a problem.
"Baby-dancing," or sex intended for conception.
"Big Fat Negative," on a home pregnancy test. "Fat"
may be substituted by the F-word of one's choice.
Meaning "2 cervices." Many septate, bicornuate and didelphys
uteri can have a double cervix. Eg. "uterus bicornis bicollis."
BU Meaning "two horns," it describes a uterus with a distinct
division (> 1 cm.) visible from the outside, caused by incomplete
fusion of the two müllerian ducts. A.k.a. "uterus bicornis."
See: Bicornuate uterus.
Brand name of "clomiphene citrate," an oral fertility drug.
Term for the two horns of a uterus, normally united to form a cavity
shaped like an upside-down triangle. The cornua are more separate and
pronounced in müllerian anomalies.
DES. Artificial hormone given to pregnant women in cases of threatened
abortion, especially during the 1960s and early 1970s. DES was found
to cause many reproductive abnormalities in the fetus, including a small
uterus with a T-shaped cavity in the female.
Painful menstrual cramps. Women with uterine anomalies frequently
have painful menstruation, typically from associated endometriosis,
outlet obstruction, retrograde menstruation and the disorganized muscle
contractions caused by an intrauterine septum.
"Human chorionic gonadotropin." This is the hormone made by
the embryo's placenta. The pregnancy hormone.
Removal of one uterine horn, commonly done for the tiny, undeveloped
horn opposite a unicornuate uterus.
Common term for the hemi-uterine cavities found in bicornuate
and septate uteri.
Abbreviation for "home pregnancy test."
Term meaning small, or underdeveloped. The small uterus of a DES daughter
is said to be hypoplastic.
The x-ray "dye test" good for showing the shape of the uterine
cavity and whether or not the oviducts are open.
A minimally invasive surgery in which a lighted scope is inserted
through the cervix of the uterus. It can be done just to check the uterine
cavity ("diagnostic hysteroscopy") or to correct polyps, septa,
adhesions, etc. ("operative hysteroscopy"). General anesthesia
is used for the latter.
See: incompetent cervix.
cervix: IC. A condition in which the cervix opens up under
the weight of a growing pregnancy, and and very common in women with
müllerian anomalies. Sometimes the lack of uterine volume forces
open an otherwise normal, competent cervix, but it is also the case
that a cervix can be malformed or congenitally weakened, as in the case
of DES daughters.
insemination: Placement of live, washed sperm inside the uterine
cavity with a catheter. A.k.a. IUI.
pyelogram: "IVP." This is an x-ray dye test of the
kidneys, done in women with müllerian defects, most especially
those with asymmetrical defects, such as uterus unicornis. Since the
urinary and reproductive tracts form at the same time, it is not unusual
for a woman with only one uterine horn to lack a kidney or ureter on
the opposing side. Likewise, it is sometimes possible to have a "horseshoe
kidney," that is a single large kidney extending from one side
to the other, caused, much as a septum is, by the failure of some embryonic
structure to deteriorate at the right time.
"Intrauterine growth retardation," a condition common when
uterine volume is diminished, in which the fetus does not obtain sufficient
nutrition from a rapidly aging placenta and is small for gestational
age. The placenta deteriorates more rapidly because it is overly compressed
as the pregnancy progresses. IUGR also has other causes, such as autoimmune
disorders and diabetes.
& Jones metroplasty: A type of alteration of the uterus
done through a laparotomy.
Abbreviation "Laparoscopy/hysteroscopy"—a combination
of two operations in which the uterus is inspected inside and out, to
determine the extent of the malformation. A lap/hyst is the `gold standard'
of diagnoses in differentiating between a septate or bicornuate uterus.
It is also commonly done during hysteroscopic septoplasty to monitor
the operation and verify whether or not a uterine perforation has occurred
in the course of the hysteroscopy.
The inflation of the abdomen with carbon dioxide gas and the insertion
of a lighted scope through the navel, through a half-inch incision.
Additional incisions for manipulating instruments may be made at the
pubic hairline. Laparoscopy may be done to diagnose a uterine anomaly,
to operate within the abdomen, or to monitor a hysteroscopic procedure.
A laparoscopy is classified as major surgery, but recovery time is considerably
shorter than that of a laparotomy. "Keyhole surgery."
a surgical incision in the wall of the abdomen large enough
to admit conventional surgical instruments.
Müllerian anomaly. A.k.a.: Müllerian duct anomaly.
resonance imaging: MRI A noninvasive test useful in seeing
the contours of the uterus and differentiating between a septate and
Common in women with decreased uterine volume, malpresentation is the
position of a fetus in the uterus such that some other part besides
the head will be coming out first. "Breech presentation,"
in which the feet or buttocks present first, is the most common malpresentation
in women with uterine anomalies, and a common reason for birth by c-section.
A general term for the surgical alteration of the uterus, be it surgery
to remove a septum or to unite the two horns of a bicornuate uterus.
A subset of metroplasty is septoplasty.
Abbreviation for müllerian duct anomaly. a.k.a. müllerian
Magnetic resonance imaging
anomaly: A developmental abnormality of the internal female
sex organs resulting from the failure of the müllerian ducts to
either fuse and/or resorb properly. Müllerian anomalies include
hypoplastic uterus, arcuate uterus, septate uterus, bicornuate uterus,
unicornuate uterus, T-shaped (DES) uterus, uterus didelphys, Rokitansky
Syndrome, and others.
ducts: Two long tubular structures found in both the male and
the female embryo. In the male, these ducts dissolve, but in the female,
they unite to form the uterus and oviducts.
Abbreviation for the home test kit that predicts ovulation.
menstruation: The reversal of menstrual flow; it goes from
within the uterus to the pelvic cavity by way of the Fallopian tubes.
It is thought to be one cause of endometriosis, which is more common
in women with MAs. Retrograde menstruation is also more common in cases
Syndrome: The congenital absence of a uterus and upper vagina—the
most severe form of Müllerian defect. Also known as "müllerian
horn: the small, undeveloped horn of a unicornuate, didelphic
or bicornuate uterus. A.k.a. anlagen.
SU. Adjective describing a uterus with an extra fibrous/muscular band
in the middle of its cavity, giving it two horn shaped hemi-uterine
cavities. This is the most common müllerian anomaly, and results
from the partial or total failure of the wall between the united müllerian
ducts to dissolve. A.k.a. "uterus septus." Subcategories of
the septate uterus include "total," or "complete,"
in which the septum involves the cervical canal and even the vagina,
and "subseptate," in which the septum's lower end stops short
of the cervical canal.
Surgery to remove a uterine septum, usually done by operative hysteroscopy.
The name for the fibrous wall dividing the cavity of a septate
SHG. Ultrasound of the uterus and its cavity, aided by the distention
of the uterine cavity with saline solution.
metroplasty: A type of alteration of the uterus done through
SU: See: Septate
SSU. A form of septate uterus in which there has been a partial
dissolution of the embryonic structure dividing the uterine cavity in
two. The septum does not run the full length of the uterus.
uterus: The characteristic shape of the cavity of a uterus
affected by diethylstilbestrol.
metroplasty: A type of alteration of the uterus done through
"Trying to conceive"
See: Uterus didelphys
"US." A tool which can reveal the inner and outer contours
of solid bodily organs such as the uterus and kidneys. Sometimes useful
in distinguishing between septate and bicornuate uteri. Synonymous with
Term meaning "one cervix." Most müllerian anomalies involve
the presence of only one cervix. Two cervices are most commonly associated
with uterus didelphys, but not always. E.g.: "uterus didelphys
UU. An asymmetrical uterine anomaly in which one of the two
müllerian ducts has failed to form properly. The hemiuterus is
a small, banana-shaped organ frequently accompanied by an anlage, or
rudimentary uterine horn or bud, which may or may not have an open endometrial
cavity. Pregnancies in the smaller horn almost invariably rupture, and
to prevent this, a hemihysterectomy may be recommended. Women with UU
usually have bilateral ovaries, and may have an associated kidney anomaly
on the side with the anlage.
Didelphys: Term for the existence in a woman of two separate
hemi-uteri, usually each with its own cervix. Some degree of vaginal
duplication may also be present. Literally means "two wombs."
for unicornuate uterus, a.k.a. "uterus unicornis."
Any surgery done to alter the shape of the vagina. With some
müllerian anomalies, especially UD and total SU, there may be a
septum present in the upper end of the vagina.
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on June 16, 2008, by LAA
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