Correction Of Congenital Uterine Abnormalities
Congenital uterine anomalies or abnormalities (also called Mullerian developmental defects) are defects arising during development of the uterus.These defects can give rise to repeated miscarriages and premature delivery.
The following defects are amenable to correction by endoscopy:
Uterine Septum: The cavity of the uterus is divided by a fibromuscular partition into two halves partially or completely. This is the commonest Mullerian defect seen. It can by corrected by means of a small telescope inserted into the uterine cavity and dividing the partition from within with the means of an electric current or a small scissors. At times the septum may completely seal off one half of the cavity leading to collection of menstrual blood behind the septum. This septum, too, can be cut by hysteroscopy. Sometimes a partition in the vagina is also present which can be divided simultaneously. A very small partition at the top (fundus) of the uterus is called an arcuate uterus and if needed treated in the same way as a septum.
Double Uterus: This can mean two separate parts of the upper part (body and fundus) of the uterus with a single lower canal (cervix) (also called bicornuate uterus or uteri bicornis unicollis) or a two completely separate uteri with a double body, fundus & cervix and often with a division of the vagina by a partition (uteri bicornis bicollis or didelphic uterus). These problems, if associated with recurrent miscarriages, can be treated laparoscopically wherin the the inner or medial aspect of the two halves of the uterus are cut and sutured together to form a single canal.
T-shaped or Triradiate or Hypoplastic Uterus: These terminologies are often used interchangeably and indicate a uterine cavity which is very narrow and splays out at the top in the shape of a capital T. This can be associated with recurrent miscarriages due to the extremely reduced space and poor blood supply to the inner muscle layer and the lining of the uterus (endometrium). This is treated by hysteroscopy wherin, using an electric current or a scissors, the top part (fundus) of the cavity and the side walls are cut along the length of the uterus till the normal shape of the cavity is achieved.
Unicornuate Uterus: This is a rare anomaly where only one half of the uterus is developed leading to a small cavity and is associated with premature deliveries and recurrent miscarriages. This can be corrected by giving cuts along the side walls of the cavity with an electrode or scissors using a hysteroscope. The efficacy of this procedure is not known. The other half of the uterus is usually absent or at times small. If it is present and contains a lining a pregnancy can implant in the horn and rupture through the thin wall leading to massive bleeding. Hence, this rudimentary part is excised via laparoscopy.
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