LESSON PLAN

UTERINE ABNORMALITIES AND DYSFUNCTION

DEFINITION:
Uterine abnormalities is a type of female genital malformation resulting from an abnormal
development of the mullerian duct during embryogenesis.

When a women is in her mother’s womb, her uterus develops as to separate halves that fuse together
before she is born. When a women’s uterus develops differently from most women, it is called uterine
anomaly.

CLASSIFICATION OF UTERINE ABNORMALITIES:

 CLASS 1 – Hypoplasia uterus or agenesis Segmental or complete (absent uterus)
 CLASS 2 - Unicornuate uterus with or without rudimentary horn (a one-sided uterus)
 CLASS 3 – Didelphus uterus also uterus didelphis (double uterus)
 CLASS 4 – Bicornuate uterus Complete or partial (uterus with two horns).
 CLASS 5 – Septate uterus complete or partial (uterine septum or partition)
 CLASS 6 - Arcuate uterus : there is a concave dimple in the uterus fundus within the cavity.
 CLASS 7 – Des related uterus : the uterine cavity has a ‘t’ shaped as a result of fetal exposure to
diethylstilbestrol.
This classification is given by AMERICAN FERLITY SOCIETY ASSOCIATION

CLASS 1 : VAGINAL AGENESIS / HYPOPLASIA

It is characterized by an absence or hypoplasia of the uterus, proximal vagina and sometimes the
fallopian tube.

 Diagnosed at the age of 15-18 yrs.

 Assessment and physical examination.
 Treatment: surgical correction – plastic surgery

CLASS 2 : UNICORNUATE UTERUS

The unicornuate uterus forms when one mullerian duct fail to elongated but the another one
develops normally.

 Treatment: no surgical intervention is required unless endometrial tissue in a rudimentary horn results
in pain or a pelvic mass or unless an incompetent cervix is suspected during pregnancy.
CLASS 3 : DIDELPHUS UTERUS
 It is a rare congenital anomaly and is a consequence of unilateral or bilateral mullerian duct
duplication
 It’s exact cause is unknown but it is a generally present from birth, though often becomes noticeable
after puberty.
 Diagnosis is carried out by using a physical examination alongside USG and 3D USG more recently.
 There is no treatment as such for the condition, but it must be managed especially during pregnancy.

CLASS 4 : BICORNUATE UTERUS

When the mullerian ducts fuse incompletely at the level of the fundus then bicornuate formed. The
lower uterus and cervix are completely fused resulting in 2 separate but communicating endometrial cavities
with a single cervix and vagina

 Pre-term birth : The rate of preterm delivery is 15 to 20%

 A pregnancy may not be reach full term in a bicornuate uterus when then baby begins to grow in
either.

CLASS 5 : SEPTATE UTERUS

 Most common form of mullerian duct defect.
 From incomplete resorption of the medial septum after the complete fusion of the mullerian duct has
occurred.
 It is not considered necessary to remove a septum that has not caused problems, especially in women
who are not considering pregnancy.

CLASS 6 : ARCUATE UTERUS

 It is characterized by a small septate indentation the superior aspect of the uterine cavity in the fundus.
 Many patient with an arcuate uterus will not experience any reproductive problems and do not require
any surgery. In patients with recurrent.
 Pregnancy loss throughout to be caused by an arcuate uterus hysteroscopic resection can be
performed.

CLASS 7 : DES RELATED ANOMALIES

 DES is a synthetic estrogen that was prescribed to women for recurrent miscarriage and premature
delivery during the year 1940- early 1970.
 The uterine cavity has a T shape as a result of fetal exposure to diethylstilbestrol .
CLINICAL FEATURES:
 No any symptoms
 Difficulty in getting pregnant.
 Pelvic pain
 Dysmenorrheal
 Uterine rupture during pregnancy
 Recurrent pregnancy loss
 Concurrent renal abnormalities
 Imperforated hymen

DIAGNOSTIC MEASURES:

 History taking
 Physical examination
 USG
 X ray
 MRI

COMPLICATION:
 Infertility
 Early pregnancy loss
 Uterine rupture due to its poor development
 Malpresentations
 Prolonged obstructed labor
 Abortion
 Weak uterine action

MANAGEMENT:
1. No non surgical treatment is present only symptomatic treatment is done.
2. Surgical intervention is considered when a septate uterus is found.
3. Bicornuate, unicornuateis considered didelphic uterus rarely require surgical management.