T-shaped uterus explained

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]

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.[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.[16]

See also

Further reading

Notes and References

  1. Ben-Baruch G, Menczer J, Mashiach S, Serr DM . Uterine anomalies in diethylstilbestrol-exposed women with fertility disorders. . Acta Obstet Gynecol Scand . 1981 . 60 . 4 . 395–7 . 10.3109/00016348109154132. 7282306 . 33451512 .
  2. Rennell CL. T-shaped uterus in diethylstilbestrol (DES) exposure. . AJR Am J Roentgenol . 1979 . 132 . 6 . 979–80 . 10.2214/ajr.132.6.979 . 108980 . free .
  3. Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, etal . The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. . Hum Reprod . 2013 . 28 . 8 . 2032–44 . 23771171 . 10.1093/humrep/det098 . 3712660 .
  4. Meier. Rose. Campo. Rudi. T-Shaped Uterus. 2015. 261–270. 10.1007/978-1-4471-5146-3_25. Female Genital Tract Congenital Malformations. 978-1-4471-5145-6 .
  5. Pui MH. Imaging diagnosis of congenital uterine malformation. . Comput Med Imaging Graph . 2004 . 28 . 7 . 425–33 . 10.1016/j.compmedimag.2004.05.008 . 15464882 .
  6. Baramki TA. Hysterosalpingography. . Fertil Steril . 2005 . 83 . 6 . 1595–606 . 10.1016/j.fertnstert.2004.12.050 . 15950625 . free .
  7. Viscomi. G N. Gonzalez. R. Taylor. K J. Ultrasound detection of uterine abnormalities after diethylstilbestrol (DES) exposure.. Radiology. 136. 3. 1980. 733–735. 0033-8419. 10.1148/radiology.136.3.7403556. 7403556.
  8. van Gils AP, Tham RT, Falke TH, Peters AA . Abnormalities of the uterus and cervix after diethylstilbestrol exposure: correlation of findings on MR and hysterosalpingography. . AJR Am J Roentgenol . 1989 . 153 . 6 . 1235–8 . 10.2214/ajr.153.6.1235 . 2816640 .
  9. Kaufman RH, Binder GL, Gray PM, Adam E . Upper genital tract changes associated with exposure in utero to diethylstilbestrol. . Am J Obstet Gynecol . 1977 . 128 . 1 . 51–9 . 10.1016/0002-9378(77)90294-0 . 851159 .
  10. Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V . Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus. . Gynecol Obstet Invest . 1996 . 41 . 1 . 41–3 . 10.1159/000292033. 8821883 .
  11. Berger MJ, Goldstein DP . Impaired reproductive performance in DES-exposed women. . Obstet Gynecol . 1980 . 55 . 1 . 25–7 . 7352058 .
  12. Lin. Paul C. Bhatnagar. Kunwar P. Nettleton. G.Stephen. Nakajima. Steven T. Female genital anomalies affecting reproduction. Fertility and Sterility. 78. 5. 2002. 899–915. 0015-0282. 10.1016/S0015-0282(02)03368-X. 12413972 . free.
  13. Noyes N, Liu HC, Sultan K, Rosenwaks Z . Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome. . Hum Reprod . 1996 . 11 . 12 . 2719–23 . 10.1093/oxfordjournals.humrep.a019197. 9021378 . free .
  14. Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarini G . Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus. . Gynecol Obstet Invest . 2011 . 71 . 3 . 183–8 . 10.1159/000317266 . 21150155 . 2313662 .
  15. Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP . Obstetric outcome in women with congenital uterine malformations. . J Reprod Med . 1992 . 37 . 3 . 233–6 . 1564709 .
  16. Fernandez. H.. Garbin. O.. Castaigne. V.. Gervaise. A.. Levaillant. J.-M.. Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus. Human Reproduction. 26. 7. 2011. 1730–1734. 0268-1161. 10.1093/humrep/der056. 21398337. free.

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