Uterine septum during pregnancy causes and consequences. Which doctors should you contact if you have an intrauterine septum?

The risk of developing a complicated pregnancy always exists. Everyone knows that early diagnosis pathology is the key to successful therapy diseases. However, some complications characteristic of the gestational age may not manifest themselves during the entire pregnancy. One such condition is amniotic septum during pregnancy.

Amniotic band during pregnancy (amniotic band syndrome, Simonard's band) - septum, formed by tissues amnion and located in the cavity amniotic sac. The incidence of this condition is on average 1 case per 1500 births. In 80% of cases, amniotic cords are worn during pregnancy favorable course and don't cause any pathological changes from the side of the fetus. Complications of this condition include compression and tugging of the hands, umbilical cord loops and other organs. Let's consider the main reasons for the appearance of amniotic cords during gestation and ways to solve this problem.

Causes of amniotic septum during pregnancy.

The exact cause of the occurrence of amniotic septations during pregnancy has not been identified. It is known that this state may be a consequence of microdamage to the amniotic sac early stages development of pregnancy by week. Due to the occurrence of partial breakthroughs, fibrous threads appear in the amniotic sac, which do not change in size over the course of pregnancy.

There is another version of the occurrence of amniotic septations during pregnancy, which is directly related to disruption of fetal-placental blood flow. According to this theory, amniotic cords arise as a result of vascular disorders and are often combined with developmental defects such as cleft lip or upper palate.

Experts say that the appearance of an amniotic septum during pregnancy can provoke intrauterine infections. Predisposing factors in this case can be considered:

Chorioamnionitis;
Endometritis;
Low water;
Invasive research methods, for example, amniocentesis, chorionic villus biopsy, etc.

The occurrence of amniotic septa during pregnancy is not genetic disease and is not inherited. Amniotic cords can occur both in the first and in subsequent pregnancies, regardless of the woman’s age and the number of births in the anamnesis.

Amniotic septum during pregnancy. When is it dangerous?

The problem with the occurrence of amniotic cords is that they can pull or compress certain parts of the placenta, the umbilical cord or fetal limbs. This pathology may occur in the first trimester of gestation and worsen in the second half of pregnancy, when the fetus begins to actively grow, in contrast to the amniotic septum, which remains unchanged.

The most common fetal developmental anomalies are in the form of ring-shaped impressions on the limbs. Depending on the location of the amniotic septum and the degree of its pressure on the limbs, certain disorders occur. For example, with a distal location of the cords, damage to the fetal limb may be limited to impaired lymphatic drainage and swelling of the subcutaneous fat. When compressed peripheral nerves the limb atrophies and loses sensitivity, while lymphatic drainage and blood supply in it are preserved. In cases where the amniotic septum compresses during pregnancy great vessels, the blood supply to the limb is disrupted, which leads to the development of tissue necrosis, up to complete amputation.

IMPORTANT! The connection between the syndrome has been proven hallux valgus(clubfoot) and amniotic septum during pregnancy. In 12% of cases, the amniotic septum during pregnancy is combined with such malformations as strabismus, cleft palate, cleft lip", as well as with developmental pathology eyeballs etc. It has been established that amniotic cords that arise during the first 8-10 weeks of pregnancy can cause polydactyly. Compression of the umbilical cord with impaired trophism and antenatal fetal death occurs extremely rarely.

Amniotic septum during pregnancy. How to diagnose?

Diagnosis of amniotic cords is carried out using ultrasound examination(ultrasound). Experience shows that it is possible to establish the presence of an amniotic septum no earlier than after 12 weeks of pregnancy. In addition, it is impossible to predict in advance the further course of the pathology, since the cords can tear and regress with the growth of the uterus or cause a persistent disruption of blood flow in one area or another. In most cases, with a repeat ultrasound, the amniotic septum will be absent.

The structure of a normal uterus

Uterus - organ reproductive system women. It is located in the pelvis between bladder and rectum. The length of the uterus is on average 7-8 cm, width - 4-6 cm, weight - 50-60 g.

The upper, pear-shaped part of the uterus is called the body of the uterus, the lower, connecting to the vagina, is called the cervix. Fallopian tubes extend from the lateral surfaces of the uterus, connecting it to the ovaries. The fallopian tubes “fluff” at the ends, forming fimbriae that help the egg enter the fallopian tubes.

The position of the uterus may change: it may move back when full Bladder, forward - when filling the rectum. During pregnancy, the uterus moves up.

The structure of the uterus changes with age. IN childhood it is small in size, and no cyclic changes occur in the endometrium (inner layer of the uterus). In adolescence and beyond - in reproductive period the uterus increases in size, the endometrium begins to function. During menopause, the uterus decreases in size and ages.

Incorrect “device” of the uterus

There are pathologies in which septa are found inside the uterus or vagina. Such anomalies include: vaginal septum, saddle-shaped, one-horned and two-horned uterus, double uterus and double vagina, two-horned uterus with one closed rudimentary horn. Some of these pathologies do not interfere with motherhood, and for some, pregnancy and childbirth are possible only after plastic surgery. Sometimes the diagnosis (vaginal septum, saddle-shaped or bicornuate uterus) is established during pregnancy, causing a difficult birth and surgical intervention.

These uterine malformations are quite rare (0.1-0.5% of women). This is mainly a bicornuate or saddle-shaped uterus. It has been established that malformations of the uterus often cause infertility, spontaneous miscarriages, premature birth, weakness labor activity, abnormal fetal positions, bleeding in postpartum period, as well as increased perinatal mortality, especially in the absence of the necessary monitoring during pregnancy.

Normal at 10-14 weeks intrauterine development In girls, the formation of the uterus begins from the fused so-called Müllerian ducts, that is, from two identical halves - right and left. Their fusion leads to the formation of two uterovaginal cavities, separated by a median septum, which subsequently disappears, and the uterus becomes single-cavity.

Treatment before pregnancy

Surgical treatment is most effective if there is intrauterine septum and synechiae - intrauterine adhesions. Preference is given to hysteroresectoscopy - removal of septa and adhesions during hysteroscopy. The rate of subsequent miscarriages in this group of women is 10% compared to 90% before surgery. Removal of the intrauterine septum is performed using a hysteroresectoscope with mandatory control from the abdominal cavity over the depth of the dissection. For this purpose in abdominal cavity An optical device - a laparoscope - is inserted through small holes, allowing you to see what is happening in the pelvic cavity.

Intrauterine septum. It is a remnant of tissue with poor blood supply in the uterine cavity. In this case, a septum is formed, extending from the fundus of the uterus. The attachment of the embryo in this septum or in the uterus with a septum makes it very probable interruption pregnancy, premature birth And incorrect position fetus (breech presentation). Hysteroscopic correction of this defect is easy and very effective. (Hysteroscopy is a procedure during which a special optical device is inserted into the uterus - a hysteroscope; it allows you to see everything that is inside the uterus, at the same time it can be inserted into the uterus surgical instruments.) The frequency of miscarriage in operated patients decreases from 80-90% to 10-15%.

Unicornuate uterus. Occurs as a result of a violation of the development of one of the Müllerian ducts, as a result of which a woman has only one oviduct. The probability of pregnancy largely depends on the size of the cavity of the unicornuate uterus. Usually a one-horned uterus leads to high risk miscarriage compared to other anomalies of fusion of uterine buds. Unfortunately, effective treatment this vice does not exist. A unicornuate uterus is often combined with other developmental anomalies (agenesis - absence of a kidney on the side of the absent Müllerian duct) and a complicated obstetric history (improper position of the fetus, intrauterine growth retardation, premature birth, miscarriages). Pregnancy in a one-horned uterus can be complicated by the threat of its interruption and premature birth. Childbirth with a one-horned uterus is sometimes accompanied by weakness of labor.

Bicornuate uterus. Violation of the fusion of the Müllerian ducts leads to the formation of one cervix and two uterine cavities.

The bicornuate uterus is divided into two parts various levels, which always merge in the lower sections. With pronounced splitting into two parts, two one-horned uteruses are determined. In other cases, the splitting may be very weak; in this case, there is an almost complete fusion of both horns, with the exception of the bottom, where a saddle-shaped depression is formed, forming the uterus of the same name.

There are three types of bicornuate uterus: saddle-shaped, incomplete and complete.

At incomplete form bicornuate uterus, division into two horns is observed only in upper third; the size and shape of the uterine horns are usually the same.

At full form the division into two horns occurs in such a way that they diverge in opposite directions at a greater or lesser angle, which depends on the severity of the given malformation.

With a bicornuate uterus, which has one cervix, pregnancy often occurs in one of the horns, less often in both horns at the same time. Pregnancy and childbirth can proceed without complications. However, pregnancy in women with a bicornuate uterus often occurs with signs of threatened miscarriage, so in this case careful medical supervision. Noted increased risk premature birth and malpresentation (breech). Pathology of the location of the placenta may occur ( low placentation, placenta previa), which threatens abruption. With this structure of the uterus, the position of the fetus may be such that delivery through natural birth canal will be impossible, then they resort to caesarean section. As already mentioned, with this pathology, a woman, starting from the earliest stages of pregnancy, should be under the careful supervision of a doctor, follow all his recommendations, and if the slightest warning signs ask for help.

Patients with recurrent miscarriage (several miscarriages), bicornuate uterus and eliminated other possible reasons miscarriage, the uterine cavity is restored promptly. In this case, an operation is performed with dissection of the anterior abdominal wall(laparotomy), the formation of a more complete uterine body. The rehabilitation period after laparotomy is long (several weeks). Result surgical treatment is quite successful, the risk of miscarriage drops from 90-95% to 25-30% after surgery.

With a saddle-shaped uterus, the uterus is somewhat expanded in diameter, its bottom has a slight depression, and the split into two horns is slightly expressed, i.e. There is almost complete fusion of the uterine horns with the exception of the fundus. A bicornuate uterus forms in the 10-14th week of intrauterine development, then acquires a saddle shape and by the time of birth often retains a mild saddle shape.

Conception is possible with this structure of the uterus. But due to the fact that the malformation of the uterus is a manifestation of other problems of the body, for example, it can be combined with defects of the urinary system, problems with carrying a pregnancy are possible. Pregnancy and childbirth with a saddle uterus can proceed without complications. If the saddle uterus has a septum, the pregnancy often ends in spontaneous miscarriage.

Availability saddle uterus often combined with a narrowing of the pelvis, pathology of the uterus leads to abnormal position of the fetus, which makes childbirth through the natural birth canal impossible; in such cases it is necessary to resort to caesarean section.

Currently, hysterosalpingography, hysterography and magnetic resonance imaging are used to diagnose the saddle uterus - various shapes x-ray examination. During hysterosalpingography and hysterography, an x-ray is inserted into the uterus. contrast agent, after which they produce x-rays, during tomography, images of the pelvic organs are taken different levels. Most characteristic feature saddle uterus during hysterosalpingography is the identification on radiographs of a small depression in the form of a saddle in the fundus of the uterus.

Duplication of the uterus. That's what they call it complete violation fusion of the Müllerian ducts with duplication of the uterus and its cervix (both are smaller than normal). Usually combined with the presence of a septum in the vagina. In this case, sometimes obstruction (obstruction) of one of the ducts is observed, which leads to the formation of hematometra: in the uterus, which does not have communication with the vagina, accumulates menstrual blood, what causes pain syndrome- such phenomena occur in a girl in adolescence, with the onset of menstruation.

The anomaly is also associated with an increased incidence of preterm birth and fetal malposition. A double uterus can sometimes lead to difficulty conceiving and carrying to pregnancy. To be sure that both uteruses can bear a pregnancy, a thorough examination should be performed. If this is true, then pregnancy is possible. It will develop in one of the uteruses, and the other uterus increases slightly, its mucous membrane undergoes changes characteristic of pregnancy. There is often a threat of miscarriage, and premature birth is possible. In cases where the pregnancy in one of the uteruses is terminated, curettage of the mucous membrane is performed non-pregnant uterus due to the risk of uterine bleeding. Since this condition is still an anomaly, it is possible that there are defects at another level. Such women usually have hypofunction (decreased function) of the ovaries and hormonal deficiency, underdevelopment of the uterus, etc. However, this does not exclude the possibility of having children. You should carefully prepare for pregnancy, and also be under close supervision throughout the pregnancy. medical supervision- preferably in a large medical institution.

Termination of pregnancy with these anatomical anomalies of the uterus may be associated with unsuccessful implantation (attachment) ovum(often on the intrauterine septum), underdeveloped vascular network and endometrial receptors, often with concomitant isthmic-cervical insufficiency, in which the muscles of the cervix do not close the exit from the uterine cavity, as well as with hormonal disorders.

Longitudinal septum of the vagina.

The pregnancy prognosis is favorable. If the longitudinal vaginal septum is incomplete, childbirth is carried out through the natural birth canal, since it, as a rule, does not interfere with the passage of the presenting part of the fetus. It is less common to excise the septum during childbirth. With a complete longitudinal vaginal septum, a caesarean section is often used.

When managing pregnancy in patients with anomalies of the uterine structure in the early stages, it is advisable bed rest, prescription of antispasmodic SHO-SPA) and herbal sedatives, therapy with DUPHASTON 1 and UTROZHESTAN - drugs that help maintain pregnancy up to 16-20 weeks. Other medications are also prescribed, including more late dates, for normal metabolic processes and prevention of fetal growth restriction. A woman is also recommended to take drugs that improve blood circulation in the vessels of the placenta: ESSENTIALE-FORTE, ACTOVEGIN, TROXEVAZIN.

Childbirth with all types of these anatomical disorders of the structure of the uterus can be complicated various disorders labor activity. Therefore, women with abnormalities in the structure of the uterus must necessarily give birth in conditions medical institution where possible timely provision emergency assistance.

Neither laparoscopy nor hysteroscopy is performed routinely or at the pregnancy planning stage without sufficient indications. Therefore the woman receiving good results annual ultrasounds and gynecological examinations, does not even suspect that she may not be able to carry a child. Spontaneous miscarriages can be repeated many times until the extended gynecological diagnostics using invasive techniques.

This situation is typical for a pathology called “incomplete intrauterine septum.” This is a congenital malformation that occurs quite often - in 2-3% of women. In this case, the uterus is divided into 2 parts, which are of different lengths. Sometimes the intrauterine septum (intrauterine septum or septum) even extends from bottom to top (then it is called complete).

Getting pregnant and increasing the chances of bearing a child with this diagnosis is only possible with the help of surgery.

How does an intrauterine anomaly occur?

At 3-4 gestational weeks, a fetus of either sex develops a primary gonad. If it is a boy, then at week 7 this gland turns into 2 testicles and begins to produce testosterone. If it is a girl, then the ovaries form later - at 8-10 weeks.

By the 5th gestational week, the embryo has 2 pairs of reproductive ducts: Wolffian and Müllerian. If by the 8th week these structures do not sense testosterone, then the Wolffian ducts partially die, and a small section of them takes part in the formation of the kidney.

The Müllerian ducts come together and grow together, forming the uterus. The common wall with which they grow to each other, by 19-20 intrauterine week dissolves to form one cavity. If this does not happen, and the wall with which the ducts are fused is not destroyed along its entire length or partially, a developmental anomaly is formed - a uterine cavity divided in two. This is what an intrauterine septum is.

48-55% of cases of all anomalies female genitalia- This is the septum in the uterus. The most commonly diagnosed is an incomplete septum, 1-6 cm long; A completely wall-divided uterus (from its fundus to the canal in the cervix) is much less common. This defect is often combined with abnormalities of kidney development.

Causes of the anomaly

The causes of the formation of an intrauterine septum are rarely genetic. Basically, this is the impact unfavorable factors on the fetus just during the period when the formation of the uterus occurs - from 10 to 20 weeks.

Damaging agents may include:

mother's bad habits;
toxicosis of pregnancy;
infections suffered by the mother, especially those included in the list: chlamydia, herpes, and measles;
diabetes mellitus in a pregnant woman - existing before conception or appearing during gestation ();
taking toxic medications;
the influence of industrial and household toxins on the body of the mother and fetus;
disturbances in the formation or attachment of the placenta, which coincides in time with the formation of the uterus - 12-16 weeks;
poor maternal nutrition when normal nutrition is not provided daily requirement in proteins, essential amino acids, vitamins and microelements;
exposure of the mother to ionizing radiation.

Symptoms

This developmental defect has noticeable manifestations not everyone: most girls report only a little more painful menstruation what they should be. But this does not force them to see a doctor, because they do not know what normal periods feel like.

The second manifestation of the intrauterine septum is uterine bleeding, which sometimes develops in the middle of the cycle, but often appears during menstruation, which increases the volume of the latter.

The third and rarest manifestation is primary, when menstruation does not occur at all.

Most often, the anomaly is discovered only when a woman begins to undergo in-depth examination for reasons such as the inability to conceive or recurrent miscarriage. The disease can also be detected if, based on the detection of an abnormal kidney structure on an ultrasound, the doctor also recommends a thorough examination of the reproductive organs.

Intrauterine septum and pregnancy

The presence of an intrauterine septum can affect a woman's ability to become pregnant in one of two ways.

Firstly, it can cause infertility. In 21-28% of women with this defect, primary infertility is observed - when pregnancy has never occurred. In 12-19%, this is a secondary condition, when a woman managed to give birth to one child, but after that she can no longer get pregnant.

Secondly, sometimes the septum becomes the cause. In the first trimester, the risk of this phenomenon is high – 28-60%. This is due to the fact that there is a high chance that the embryo will not attach to the wall of the uterus, which will give the placenta the opportunity to develop and provide adequate nutrition developing organism. The embryo is often attached precisely to the intrauterine septum - a formation that does not have blood vessels and, accordingly, is unable to perform a trophic function.

During pregnancy in the 2nd trimester, if the fetus was able to attach itself to the wall of the uterus and not to the septum, the risk of miscarriage still exists, although much lower - only 5%. One of the reasons is due to the fact that the intrauterine membrane, especially if it is full, leads to non-closure of the walls of the cervical canal. As a result, the cervix loses its ability to withstand intrauterine pressure, which increases as the fetus grows, and without timely correction, a miscarriage may occur. The second reason for miscarriage in the second trimester is that an obstruction inside the uterus prevents the cavity from expanding in proportion to the growing fetus.

But the statistics are comforting: in 50% of cases, a septum in the uterine cavity does not interfere with either conception or gestation. Although its presence increases the risk that the fetus will be positioned transversely and will require a fetus to be born.

The influence of pathology on the course of labor

An intrauterine septum can cause:

. They begin due to the pressure of the septum on the fetus, which has already become quite large.
Deterioration contractility uterus: the muscles of the second half of the uterus (on the side where the fetus did not develop) did not stretch as much as it grew. As a result, incoordination or weakness of labor develops. Less commonly, the intrauterine membrane becomes the cause of a life-threatening condition for the mother in labor, when after the end of labor the uterus relaxes, which causes heavy bleeding, which can only be stopped by removing it.

Such complications are more typical for a complete intrauterine membrane.

Diagnostics

A septate uterus is an abnormality that is often difficult to diagnose. At gynecological examination it cannot be detected. A pelvic ultrasound also turns out to be uninformative, and if it reveals a thin-walled structure in the middle of the uterine cavity, it is not clear whether it is an intrauterine membrane or. The hydrosonography method is more informative - carrying out ultrasound diagnostics against the background of filling the uterine cavity with sterile liquid.

Hysteroscopy or its subtype, fibrohysteroscopy - the introduction of an optical device into the uterine cavity - is carried out under anesthesia, since it will be necessary to open the cervix, which has great amount nerve receptors, and then fill the uterus itself with gas or liquid. This test allows you to see the membrane with your eyes connective tissue, assess its length and thickness, and also examine the volume of the uterine cavity. The study is carried out in the first half menstrual cycle while the endometrium is still quite small.

The diagnosis of the length of the intrauterine septum is made based on the data obtained (this is important for treatment). As a result, we distinguish:

complete septum: extends to the internal or external pharynx;
incomplete – 10-40 mm long;
septum on a wide base (triangle in projection).

Laparoscopy is the introduction of an optical device into the cavity of the abdomen and pelvis through incisions. It allows you to examine the uterus “from above”, to see that there are no two muscular ridges (that is, the uterus is not bicornuate), and the organ itself can be expanded in the transverse direction. Laparoscopy allows you to see if uterine halves asymmetrical. The method also evaluates the condition of the ovaries, fallopian tubes, and peritoneum.

Considering that only a combination of hysteroscopy and laparoscopy is the “gold standard” in diagnosis, determining the intrauterine septum during pregnancy is difficult.

Treatment

The septum cannot be removed by any method other than surgery. But not all surgeons are ready to do this only on the basis of a diagnosis: many undertake surgery only for primary infertility or recurrent miscarriage, but not if the patient has a history of one successful pregnancy. They explain this by the fact that the chance of a successful pregnancy after surgery is not 100%, but 85-90%. Other experts, on the contrary, believe that the very presence of pathology serves as an indication for its removal.

Dissection of the intrauterine septum is carried out under full visual control through a hysteroscope.

On currently The operation involves cutting the intrauterine septum. It is performed through a hysteroscope under full visual control. Anesthesia - general. As preoperative preparation Sometimes antigonadotropin drugs are prescribed for a course of 2-3 months. They cause artificial menopause, but at the same time reduce the thickness of the endometrium, and thereby reduce the volume of blood lost during the intervention.

If the septum is thin, it is cut with endoscopic scissors or a laser. In case of thick or rich in blood vessels its septum is removed using a hysteroresectoscope - a “loop” inserted through the hysteroscope channel, which is “cut” electric shock, while simultaneously cauterizing the bleeding vessels.

If the uterine septum was complete and extended into cervical canal, its cervical part is preserved in order to prevent the development of isthmic-cervical insufficiency, complicating normal course pregnancy.

If the uterine cavity has been deformed, after removing the septum, it is reconstructed. The total duration of the intervention is up to 60 minutes.

After the operation, you should not immediately plan a pregnancy: you will have to take hormonal estrogen medications for 2-3 months to prevent the formation of intrauterine adhesions. You may need to use contraception for up to 13 months after surgery.

Collapse

During the process of ontogenesis, various morphological disorders of the girl’s reproductive system are possible. One of them is a septum in the uterus - a pathology that can subsequently lead to infertility and miscarriage.

What is a septum in the uterus?

Under the influence of a number of unfavorable factors during pregnancy, the internal membrane does not dissolve. As a result, the uterine cavity is formed from 2 parts, which can have different sizes.

The intrauterine septum appears painful and heavy menstruation, infertility and spontaneous abortions. Diagnosed using ultrasound, hysteroscopy, MRI. Treatment is carried out surgically. Using a hysteroscope, the doctor removes the defect through the cervical canal. After the operation, the woman is capable of childbearing in a natural way. The anomaly is often combined with kidney pathology.

Reasons for education

In prenatal period The uterus is formed by the fusion of the Müllerian ducts. A cavity is formed, which consists of two identical halves. At 19-20 weeks of pregnancy, the septum resolves. If this does not happen, the inner membrane blocks the uterine cavity completely or partially. Pathology occurs in 2-3% of girls.

Predisposing factors are:

Severe toxicosis in the early and late stages of pregnancy;
Taking certain medications;
Effect of radiation;
Heredity;
Bad habits of women - alcoholism, smoking;
Diabetes;
Pathology of the placenta;
Infectious diseases of the mother during pregnancy - measles, toxoplasmosis, rubella.

Intrauterine septum options

Depending on the degree of separation of the uterus, there are 2 variants of the defect.

Full partition. It stretches from the fundus of the uterus and reaches the cervix. Sometimes the septum extends onto the vagina and divides it into two halves. It is impossible to carry a child to term with this type of anomaly.
An incomplete septum in the uterus partially blocks its cavity (by 1-4 cm). This is a more favorable option for a woman, but it does not exclude problems after conception.

The intrauterine septum varies in thickness and can be located longitudinally (a more common pathology) or transversely.

Sometimes the anomaly is combined with other malformations of the reproductive system. More common:

Bicornuate uterus - the bottom of the organ is divided into 2 parts, and a single cavity is formed closer to the vagina;
The saddle uterus is the curvature of its arch in the form of a saddle.

Symptoms

Typically, a defect in the reproductive system does not manifest itself until puberty, at this time the girl begins to experience symptoms of menstrual dysfunction. In some cases, an intrauterine septum is detected in a woman who has consulted a doctor about infertility.

Patients experience menstrual irregularities in the form of algomenorrhea - cramping abdominal pain during menstruation. Women also complain of large blood loss. An incomplete septum in the uterus may not cause any symptoms.

The uterus itself with an internal septum is not an obstacle to fertilization, but the embryo can attach to the membrane, which is partially supplied with blood. As a result, the fetus does not receive nutrition and dies, a miscarriage occurs.

The small volume of the cavity does not allow the child to grow and develop. The presence of an anomaly disrupts the contractility of the uterus during contractions, causing an imbalance in labor. The malformation leads to improper placement of the fetus and premature birth.

Complete separation of the uterus is a cause of infertility.

Diagnostics

There are several ways to diagnose an anomaly.

Hysterosalpingography

This is an x-ray method during which a contrast agent is injected into the uterine cavity and fallopian tubes. During the examination, the doctor can only see the internal contours of the uterus. External boundaries are not visible for visualization, so it is easy to confuse the septum with other uterine defects.

Ultrasonography

The method also does not always allow identifying pathology. On ultrasound, the intrauterine septum appears as a thin-walled structure extending in the anteroposterior direction. Using the method, it is quite difficult to distinguish between a bicornuate uterus and a septum.

Sometimes doctors find an intrauterine membrane in the 1st trimester, and with subsequent studies the anomaly is no longer present. What does this mean? Most likely, there was an independent rupture of the thin septum due to the growth of the fetus.

Hysteroscopy and laparoscopy

The combined use of methods gives full picture diseases. Hysteroscopy allows you to determine the direction, length and thickness of the septum. When placing the endoscope in internal os the doctor sees 2 holes, between them there is a whitish triangular strip. If the hysteroscope immediately enters one of the hemicavities, making a diagnosis is difficult. In this case, a uterus with a septum is diagnosed by the presence of only one opening of the fallopian tube.

Laparoscopy allows you to assess the condition pelvic organs women. A retraction or whitish stripe is noticeable on the uterus, in addition, the body of the organ is expanded in the transverse direction. One part of the uterus may be larger than another.

Magnetic resonance or computed tomography

This is very informative methods, allowing you to get exact information about vice. Their only drawback is their high cost.

In case of internal defects of the uterus, an ultrasound scan of the kidneys is required, since abnormalities of the reproductive and urinary system often observed together.

Treatment

Surgery

Removal of the septum in the uterus is performed surgically. Reconstruction is performed using therapeutic hysteroscopy under laparoscope control. Indications for surgery include a history of several miscarriages and infertility. At the same time, some experts do not recommend touching an incomplete septum, since conception and pregnancy in 50% of cases occurs without intervention.

Hysteroscopic surgery is relatively simple and low-traumatic method reconstruction. First, the uterine cavity is stretched using an isotonic solution. Then the thin intrauterine septum is removed with special scissors through the cervical canal. Resection is carried out in stages, starting with lower section. IN last resort The membrane in the bottom area is carefully excised. Resection of the area with the septum is carried out along the midline, since this area consists of fibrous tissue and has a weak vascular branch. The technique helps to avoid intrauterine bleeding.

With a thick-walled septum optimal method is hysteroresectoscopy. The principle of intervention is the same, but removal is carried out using electrodes in the form of a knife or loop. During the operation, electrical coagulation of tissue is performed. The advantages are as follows: the operation time is reduced, the risk of bleeding is reduced. When completely separated, they retain bottom part membranes. This allows you to avoid the development of isthmic-cervical insufficiency during pregnancy.

Electric current during resectoscopy causes little damage to the internal layer of the organ. Full recovery of the uterine mucosa is observed 3 months after the intervention.

Justified sharing hysteroscopy and laparoscopy. Laparoscopic control allows:

Assess the size of the organ, the presence of asymmetry, accurately identify the nature of the anomaly (bicornuate or saddle-shaped uterus);
Determine the direction of tissue cutting using a lighting system that shines through muscle layer. This avoids perforation;
Move the intestinal loops to the side so as not to damage them during surgery;
Quickly close the perforation in case of uterine injury.

Treatment with hormones

Performed after surgery to prevent synechiae and accelerate epithelization wound surface. Women are prescribed a course of estrogen for 2-3 months. The issue of installing a spiral is controversial. Some doctors believe that tissue restoration proceeds well without the use of intrauterine contraception.

Immediately after the operation, antibiotic treatment is carried out to prevent inflammatory processes.

Consequences and complications

After hysteroscopic removal of the intrauterine membrane, a woman is able to become pregnant and successfully carry a baby to term in most cases. Childbirth takes place naturally, there is no need for a caesarean section.

Planning for conception is allowed 3-4 months after control hysteroscopy; the timing is set by the doctor depending on the condition of the endometrium.

During the intervention there is a risk of perforation and heavy bleeding. In the early postoperative period, fever may begin, which is a symptom of inflammation of the mucous membrane and muscle layers organ.

Among late complications It is worth noting synechiae, which are prevented by hormonal therapy.

When pregnancy occurs, a woman needs special attention by a gynecologist. Since the muscle layer becomes thinner during the operation, organ rupture is possible during childbirth.

←Previous article Next article →

One of the main conditions for implantation of an embryo in the uterine cavity is the “readiness” of its mucous membrane to accept the embryo. Corpus luteum, formed after ovulation, releases progesterone, which prepares the endometrium for pregnancy. In this case, special structures are formed in the uterine mucosa that ensure contact between the endometrium and the embryo.

Therefore, any disturbances in the structure of the uterine cavity mucosa violate the conditions necessary for embryo implantation. All disorders leading to miscarriage or infertility are divided into congenital and acquired.

Congenital disorders are malformations of the uterus that formed during the intrauterine development of the child.

Acquired disorders in the uterine cavity occur at any age. This large group disorders: fibrous adhesions (synechias) in the uterine cavity, proliferation and thickening of the uterine mucosa (endometrial polyps, hyperplasia), endometritis, submucosal location of myomatous nodes, scar after surgical treatment on the uterus.

Septum in the uterine cavity

This pathology refers to congenital defects development, which is characterized by the division of the uterine cavity into two halves by a septum of varying lengths. In the structure of malformations of the genital organs, the septum in the uterine cavity accounts for 48-55% of all cases. In this case, a septum in the uterine cavity occurs in 2-3% of women. Occurs varying degrees severity of the defect, depending on the size: complete and incomplete septum of the uterine cavity.

The negative impact of a septum in the uterine cavity on the course of pregnancy is as follows:

insufficient volume of the uterine cavity, which impedes the development of the fetus;
the possibility of embryo implantation on a septum that cannot support fetal development;
frequent combination of a septum of the uterine cavity with a violation of the obturator ability of the cervix.

In women with an incomplete septum of the uterine cavity, miscarriage and, much less frequently, infertility are observed. The risk of spontaneous miscarriage in the first trimester of pregnancy is 28-60%, and 5% in the second trimester.
In patients with an incomplete septum of the uterine cavity, premature birth, abnormal fetal position, and impaired contractility of the uterus are observed much more often. However, despite the fact that a septum in the uterine cavity reduces the chances of getting pregnant, it is not a 100% factor in infertility.

To diagnose septum in the uterine cavity, use various methods studies: hysterosalpingography, ultrasound, endoscopic methods research - hysteroscopy and laparoscopy. Spiral X-ray computed tomography and magnetic resonance imaging are also highly informative in identifying defects of the uterine cavity. The use of these methods is advisable in difficult cases to clarify the diagnosis at the examination stage in order to avoid the use of invasive diagnostic methods.

Treatment of the septum in the uterine cavity is carried out by dissecting it through a hysteroscope under visual control in a transcervical manner. In order to reduce the likelihood of formation of synechiae at the site of dissection and rapid epithelization, estrogens are prescribed for 2–3 months in the postoperative period. Hysteroscopic dissection of the uterine cavity septum is a relatively gentle method that shortens postoperative period and promoting a smoother flow.

Synechiae in the uterine cavity

Adhesions - synechiae in the uterine cavity are strands of connective tissue formed as a result of trauma or inflammation of the endometrial mucosa. Most often, its traumatization occurs during curettage of the uterine cavity during diagnostic examination, abortion, use intrauterine device, surgical interventions on the uterus.

Synechiae in the uterine cavity are also formed during the inflammatory process of the endometrium, which accompanies various surgical operations, abortions, complicated childbirth. Often inflammatory process and mechanical trauma are combined.

The clinical manifestations of synechia are extremely varied and depend on the severity of the adhesive process in the uterine cavity. As a rule, in mild cases there are no complaints and synechiae in the uterine cavity are detected only during hysteroscopy. With more pronounced adhesive process There are cycle disturbances in the form of delayed menstruation or a decrease in menstrual blood loss, sometimes until it stops completely - amenorrhea. Synechiae in the uterine cavity can cause miscarriage and infertility.

Polyp in the uterine cavity

Polyps in the uterine cavity and cervix refer to diseases characterized by excessive growth of the inner mucous membrane of the uterus with the formation of several or one growths called polyps.

The main reason for the formation of polyps in the uterine cavity is an imbalance in the production of female sex hormones - increased secretion estrogens that stimulate endometrial growth. In this regard, the inner lining of the uterus (endometrium) grows and thickens, forming small outgrowths - a polyp in the uterine cavity.

Predisposing factors for the development of a polyp in the uterine cavity are chronic inflammatory diseases genital area: inflammation of the uterine appendages (adnexitis), inflammation of the inner lining of the uterus (endometritis).

A polyp in the uterine cavity is clinically manifested:

smearing bloody discharge or uterine bleeding occurring after menstruation a few days later or in the middle of the cycle;
discomfort and pain during sexual intercourse;
bloody discharge after sexual intercourse;
A polyp in the uterine cavity is quite often the cause of infertility.

Diagnosis of polyps in the uterine cavity is carried out during a gynecological examination of the patient, ultrasound of the uterus, and also hysteroscopy. Treatment of polyps in the uterine cavity in the vast majority of cases is surgical - polypectomy or curettage of the uterine cavity. The removed polyp must be sent for histological examination. If necessary, hormonal treatment is prescribed.