What Are Uterine Abnormalities?
Uterine abnormalities differ from conditions that affect the uterus, in that they describe congenital defects of the womb itself. Simply put, a uterine abnormality means that your uterus formed in an unusual way before you were born. There are often no symptoms or signs of discomfort, meaning many women only discover these abnormalities as a result of miscarriage, unusually heavy bleeding, or difficulties conceiving.
Uterine abnormalities are quite common, though the effect that they have on pregnancy is not always clear; depending on the shape of your womb, there may be a greater risk of miscarriage or premature birth, or you may have difficulties carrying a baby to term. Though these abnormalities may seem frightening, many women successfully get pregnant and have healthy children, and your healthcare professionals will be able to support you during pregnancy to minimise risks.
Some known abnormalities include:
- Bicornuate Womb. This means your uterus has a deep indentation at the top. A bicornuate womb has no associated difficulties with conception or early pregnancy, though there is a slightly higher risk of miscarriage and premature birth. It may also affect a baby’s position later in the pregnancy, and a caesarean birth might be recommended.
- Unicornuate Womb. This is much rarer, and means that your womb is half the size it should be, because one side didn’t develop. There are increased risks of ectopic pregnancies, late miscarriage or premature births. Women with unicornuate wombs can conceive, though they are more common in women who are infertile.
- Didelphic Womb. Also known as a double womb, this means your uterus is split in two with each side having its own cavity. This usually affects the womb and cervix, but can also affect the other pelvic organs. There are no associated difficulties associated with conception, and a double womb is only linked to a small increase in the risk of premature birth.
- Septate or Subseptate Womb. A septate womb has a wall of muscle down the centre, splitting the space in two. This is known as a subseptate womb if the muscle only comes partway down the uterus. Women with either of these are more likely to have difficulties conceiving, and have increased risk of miscarriage and premature birth. In later pregnancy, the baby may be lying in an awkward position, and you might be advised to have a caesarean birth.
- Arcuate Womb. An arcuate womb looks like a normal womb, but with a dip at the top. This does not increase your risk of early miscarriage or premature birth, but it might increase the risk of late miscarriage, or necessitate a caesarean birth.
How Are Abnormalities of the Uterus Diagnosed?
It is unlikely that women with a uterine abnormality will know about it when they become pregnant, as it is unlikely they will have physical symptoms. You may only know when you have difficulty conceiving, or you have miscarried. Some women may find out during gynaecological examinations to investigate the cause of problems like chronic pain, ovarian cysts, fibroids or recurrent miscarriage. A more noticeable abnormality such as a double womb or a unicornuate womb might be identified during routine pregnancy scans or examinations, but it may be harder to identify milder abnormalities.
Investigations typically might include a hysteroscopy, a laparoscopy, or a three-dimensional pelvic ultrasound, the details of which are outlined below:
- Hysteroscopy. This is a procedure to examine the inside of the uterus. It involves inserting a tiny camera through the cervix into the womb cavity, which is expanded with fluid to get a better view. During this procedure, your doctor can identify the shape of the womb, as well as any other anomalies like fibroids or endometriosis. You may experience some bleeding, or a minor infection or perforation, but these risks are uncommon and usually easily dealt with. It is normal to experience some period-like pains and light vaginal bleeding for a few days following the procedure.
- Laparoscopy. This is a surgical procedure that allows a surgeon to access your abdominal cavity, observing your uterus and pelvic organs through a small incision and the use of a narrow telescope (or laparoscope). For more information on laparoscopy, see the linked article.
- Pelvic Ultrasound. This is a procedure that uses soundwaves to view the womb. A transvaginal ultrasound is preferred, where a small wand-like device called a transducer is inserted into your vagina to emit soundwaves, gather the reflections, and translate them to images on a video screen. This allows a close, accurate examination of the uterus and ovaries, to determine where your abnormality lies, and what type it is.
What Treatments Are Available for Uterine Abnormalities?
Treatment for uterine abnormalities will vary depending on what kind of abnormality you have been diagnosed with. Surgery is an option, though this can sometimes lead to later infertility and problems occurring during pregnancy. If your womb is identified as abnormal before pregnancy, your gynaecologist will discuss treatment options with you if you plan to become pregnant in the future. If a uterine abnormality is discovered during pregnancy, you will likely be put in the care of an obstetric team, and receive extra scans and hospital visits to ensure the health of your baby throughout the pregnancy.
If you know you have a uterine abnormality, you may be afraid during your pregnancy, especially if you have had complications in the past. It is important to go to all your appointments to receive your tests and scans, and if you feel something is wrong, contact your hospital or healthcare professional right away. Even if nothing is wrong, it is much better to raise a false alarm than ignore your anxieties—and your healthcare professionals would rather make sure that you and your baby are safe.
If you are experiencing abnormalities in the uterus , make an appointment with Dr.Nicole Stamatopoulos here.