Müllerian Anomalies FAQ


By 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 (lizbethager@yahoo.com).

Disclaimer: This FAQ contains individual experience and opinion, and is meant as a learning aid, not a substitute for professional medical advice and care.


Table of Contents

1. 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 during pregnancy?
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?


1. 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 anomaly.



2. What are the different types of müllerian anomalies?

a. 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..

b. Unicornuate 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.

c. Uterus 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.

d. Bicornuate 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.

e. Septate 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.

f. Arcuate 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.

g. DES-related 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.

 
3. 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. 


4. 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.

a. You Cannot Have Children

1.You 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 so well.

b.Your 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.

c. You 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 alone.

d. One 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.”

e. Your "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.


5. 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.

a. 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 stretches upward.

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.


6. 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 see them.”

        “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.”


7. 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.

Other methods have better levels of reliability:

Transvaginal 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 upon alone.
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 an HSG.”

        “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 it.”

        “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 on this.”


8. Should I have my uterus surgically repaired?

Hysteroscopic 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 with reproduction.
       
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.


9. 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.


10. What is surgery like?

a. Hysteroscopic metroplasty (uterine septum resection via the vagina) ; a.k.a. septoplasty, septotomy

       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.       
        "Resection" is 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.”

b. Abdominal metroplasty

c. Laparoscopy

        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.

d. Hysteroscopy (HSC)


       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 infection.
        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 ascending infections.
        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).

e. Vaginoplasty


f. Cerclage

        Cerclage 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 following surgery.
        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.
        One contraindication 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).


g. C-section

        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.
        Regional anesthesia 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.
        Meanwhile, nurses 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 your obstetrician).
        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 a c-section.
        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.
       


11. What are non-surgical diagnostic procedures like? 

a. Hysterosalpingogram (HSG)

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?

        If you 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 dye.
       
If 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.

What will 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.

How will it feel?
        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 films.

Please note:
        If you experience nausea or breathing difficulties, please inform the technologist immediately.

e. Magnetic resonance imaging (MRI)

What is 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 bones.
        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 to radiation.

How do 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.

What will happen?
        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.

How long will it take?
        The scan should take from 30–90 minutes. Sometimes it is hard to get just the right angle of the uterus.

 


12. 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.

a. Unicornuate
        "At around 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
c. Bicornuate
        "I have a bicornuate uterus with a septum and 2 cervices. So the
joke was that the baby could pick the exit when the time came.
      " But that never happened because my daughter was, of course, breech
presentation.
       " 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) for the
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
meantime."


d. Septate
        "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."


e. Other


13. What do the abbreviations mean?

Müllerian Anomalies: Terms

This is a short list of abbreviations and specialized terms used in the Müllerian Anomalies e-mail list.

AF: "Aunt Flow" or menstrual period.

Anlage: The name for the undeveloped or rudimentary müllerian duct.

Arcuate: AU A variation of normal uterine development in which the top of the uterus has a slight dip. Rarely a problem.

AU: "Arcuate uterus"

BD: "Baby-dancing," or sex intended for conception.

BFN: "Big Fat Negative," on a home pregnancy test. "Fat" may be substituted by the F-word of one's choice.

Bicollis: Meaning "2 cervices." Many septate, bicornuate and didelphys uteri can have a double cervix. Eg. "uterus bicornis bicollis."

Bicornuate: 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."

BMS: "Baby-making sex"

BU: See: Bicornuate uterus.

CC: See: Clomid

Clomid: Brand name of "clomiphene citrate," an oral fertility drug. A.k.a. CC.

Cornua: 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.

DD: "Dear daughter."

DES: See: Diethylstilbestrol.

DH: "Dear husband."

Diethylstilbestrol: 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.

DS: "Dear son."

DW: "Dear wife."

Dysmenorrhea: 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.

hCG: "Human chorionic gonadotropin." This is the hormone made by the embryo's placenta. The pregnancy hormone.

Hemihysterectomy: Removal of one uterine horn, commonly done for the tiny, undeveloped horn opposite a unicornuate uterus.

Horn: Common term for the hemi-uterine cavities found in bicornuate and septate uteri.

HPT: Abbreviation for "home pregnancy test."

HSC: "See: "Hysteroscopy"

HSG: See: "Hysterosalpingogram"

Hypoplastic: Term meaning small, or underdeveloped. The small uterus of a DES daughter is said to be hypoplastic.

Hysterosalpingogram: The x-ray "dye test" good for showing the shape of the uterine cavity and whether or not the oviducts are open.

Hysteroscopy: 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.

IC: See: incompetent cervix.

Incompetent 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.

Intrauterine insemination: Placement of live, washed sperm inside the uterine cavity with a catheter. A.k.a. IUI.

Intravenous 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.

IUGR: "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.

IUI: See: Intrauterine insemination.

IVP: See: "Intravenous pyelogram"

Jones & Jones metroplasty: A type of alteration of the uterus done through a laparotomy.

Lap/hyst: 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.

Laparoscopy: 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."

Laparotomy: a surgical incision in the wall of the abdomen large enough to admit conventional surgical instruments.

MA: See: Müllerian anomaly. A.k.a.: Müllerian duct anomaly.

Magnetic resonance imaging: MRI A noninvasive test useful in seeing the contours of the uterus and differentiating between a septate and bicornuate uterus.

Malpresentation: 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.

M/c: "Miscarriage."

Metroplasty: 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.

MDA: Abbreviation for müllerian duct anomaly. a.k.a. müllerian anomaly.

MRI: See: Magnetic resonance imaging

Müllerian 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.

Müllerian 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.

OPK: Abbreviation for the home test kit that predicts ovulation.

Retrograde 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 of MA.

Rokitansky Syndrome: The congenital absence of a uterus and upper vagina—the most severe form of Müllerian defect. Also known as "müllerian agenesis."

Rudimentary horn: the small, undeveloped horn of a unicornuate, didelphic or bicornuate uterus. A.k.a. anlagen.

Septate: 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.

Septoplasty: Surgery to remove a uterine septum, usually done by operative hysteroscopy.

Septum: The name for the fibrous wall dividing the cavity of a septate uterus.

SHG: See: Sonohysterogram

Sonohysterogram: SHG. Ultrasound of the uterus and its cavity, aided by the distention of the uterine cavity with saline solution.

SSU: "Subseptate uterus"

Strassman metroplasty: A type of alteration of the uterus done through a laparotomy.

SU: See: Septate uterus.

Subseptate: 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.

T-shaped uterus: The characteristic shape of the cavity of a uterus affected by diethylstilbestrol.

Tompkins metroplasty: A type of alteration of the uterus done through a laparotomy.

TTC: "Trying to conceive"

UD: See: Uterus didelphys

Ultrasound: "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 "sonogram."

Unicollis: 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 unicollis."

Unicornuate: 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.

US: Abbreviation for "ultrasound."

Uterus 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."

UU: Abbreviation for unicornuate uterus, a.k.a. "uterus unicornis."

Vaginoplasty: 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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Last updated on June 16, 2008, by LAA
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