Medicine:T-shaped uterus
| T-shaped uterus | |
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| Hysterosalpingography of a T-shaped uterus. | |
| Specialty | Urology |
A t-shaped uterus is a type of uterine malformation wherein the uterus is shaped resembling the letter T.[1] This is typically observed in DES-exposed women.[2] It is recognised in the ESHRE/ESGE classification,[3] and is associated with failed implantation, increased risk of ectopic pregnancy, miscarriage and preterm delivery. There is a surgical procedure to correct the malformation.[4]
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Causes
The T-shaped malformation is commonly associated with in-utero exposure to diethylstilbestrol (the so-called "DES daughters"). It is also presented congenitally.[5]
Diagnosis
Women are often diagnosed with this condition after several failed pregnancies, proceeded by exploratory diagnostic procedures, such as magnetic resonance, sonography, and particularly hysterosalpingography.[6][7][8] In such studies, a widening of the interstitial and isthmus of uterine tube is observed, as well as constrictions or narrowing of the uterus as a whole, especially the lower and lateral portions, hence the "t" denomination. The uterus might be simultaneously reduced in volume, and other abnormalities might be concomitantly present.[9]
Prognosis
Although fertility is impaired, T-shaped uterus sufferers can bear children. However, they carry a greater risk of complications, such as miscarriages, reduced fertility and preterm births, both before and after any treatment.[10][11]
The current surgical procedure to treat this malformation, termed a hysteroscopic correction or metroplasty, is undertaken by performing a lateral incision of the uterine walls, and can return the organ to a normal morphology, while improving the patient's former reproductive performance.[4][10][12] It is considered a low-risk procedure, and can also improve term delivery rate by up to 10-fold, as long as the endometrium is considered to be in good condition.[13][14][15] However, risks after the procedure include placenta accreta, Asherman's syndrome and severe haemorrhage.[4][16]
See also
- Vaginal adenosis
References
- ↑ "Uterine anomalies in diethylstilbestrol-exposed women with fertility disorders.". Acta Obstet Gynecol Scand 60 (4): 395–7. 1981. doi:10.3109/00016348109154132. PMID 7282306.
- ↑ Rennell CL (1979). "T-shaped uterus in diethylstilbestrol (DES) exposure.". AJR Am J Roentgenol 132 (6): 979–80. doi:10.2214/ajr.132.6.979. PMID 108980.
- ↑ "The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies.". Hum Reprod 28 (8): 2032–44. 2013. doi:10.1093/humrep/det098. PMID 23771171.
- ↑ 4.0 4.1 4.2 Meier, Rose; Campo, Rudi (2015). "T-Shaped Uterus". Female Genital Tract Congenital Malformations: 261–270. doi:10.1007/978-1-4471-5146-3_25. ISBN 978-1-4471-5145-6.
- ↑ Pui MH (2004). "Imaging diagnosis of congenital uterine malformation.". Comput Med Imaging Graph 28 (7): 425–33. doi:10.1016/j.compmedimag.2004.05.008. PMID 15464882.
- ↑ Baramki TA (2005). "Hysterosalpingography.". Fertil Steril 83 (6): 1595–606. doi:10.1016/j.fertnstert.2004.12.050. PMID 15950625.
- ↑ Viscomi, G N; Gonzalez, R; Taylor, K J (1980). "Ultrasound detection of uterine abnormalities after diethylstilbestrol (DES) exposure.". Radiology 136 (3): 733–735. doi:10.1148/radiology.136.3.7403556. ISSN 0033-8419. PMID 7403556.
- ↑ "Abnormalities of the uterus and cervix after diethylstilbestrol exposure: correlation of findings on MR and hysterosalpingography.". AJR Am J Roentgenol 153 (6): 1235–8. 1989. doi:10.2214/ajr.153.6.1235. PMID 2816640.
- ↑ "Upper genital tract changes associated with exposure in utero to diethylstilbestrol.". Am J Obstet Gynecol 128 (1): 51–9. 1977. doi:10.1016/0002-9378(77)90294-0. PMID 851159.
- ↑ 10.0 10.1 "Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus.". Gynecol Obstet Invest 41 (1): 41–3. 1996. doi:10.1159/000292033. PMID 8821883.
- ↑ "Impaired reproductive performance in DES-exposed women.". Obstet Gynecol 55 (1): 25–7. 1980. PMID 7352058.
- ↑ Lin, Paul C; Bhatnagar, Kunwar P; Nettleton, G.Stephen; Nakajima, Steven T (2002). "Female genital anomalies affecting reproduction". Fertility and Sterility 78 (5): 899–915. doi:10.1016/S0015-0282(02)03368-X. ISSN 0015-0282. PMID 12413972.
- ↑ "Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome.". Hum Reprod 11 (12): 2719–23. 1996. doi:10.1093/oxfordjournals.humrep.a019197. PMID 9021378.
- ↑ "Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus.". Gynecol Obstet Invest 71 (3): 183–8. 2011. doi:10.1159/000317266. PMID 21150155.
- ↑ "Obstetric outcome in women with congenital uterine malformations.". J Reprod Med 37 (3): 233–6. 1992. PMID 1564709.
- ↑ Fernandez, H.; Garbin, O.; Castaigne, V.; Gervaise, A.; Levaillant, J.-M. (2011). "Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus". Human Reproduction 26 (7): 1730–1734. doi:10.1093/humrep/der056. ISSN 0268-1161. PMID 21398337.
Further reading
- Kaufman RH (1982). "Structural changes of the genital tract associated with in utero exposure to diethylstilbestrol.". Obstet Gynecol Annu 11: 187–202. PMID 7110645.
- Goldberg, Jeffrey M; Falcone, Tommaso (1999). "Effect of diethylstilbestrol on reproductive function". Fertility and Sterility 72 (1): 1–7. doi:10.1016/S0015-0282(99)00153-3. ISSN 0015-0282. PMID 10428139.
- KALTFMANL, RAYMOND H., MD ERVIN ADAM, and Gary L. Binder. "Upper genital tract changes and pregnancy outcome in offspring exposed in utero to diethylstilbestrol." (1980).
- Lin PC (2004). "Reproductive outcomes in women with uterine anomalies.". J Womens Health (Larchmt) 13 (1): 33–9. doi:10.1089/154099904322836438. PMID 15006276.
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