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T-shaped uterus

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Medical condition
T-shaped uterus
Hysterosalpingography of a T-shaped uterus.
SpecialtyUrology

A t-shaped uterus is a type of uterine malformation wherein the uterus is shaped resembling the letter T. This is typically observed in DES-exposed women. It is recognised in the ESHRE/ESGE classification, and is associated with failed implantation, increased risk of ectopic pregnancy, miscarriage and preterm delivery. There is a surgical procedure to correct the malformation.

A T-shaped uterus with circular constriction noted around the proximal portion of the marker. The lower uterus appears tapered and narrow.

Causes

The T-shaped malformation is commonly associated with in-utero exposure to diethylstilbestrol (the so-called "DES daughters"). It is also presented congenitally.

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. 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.

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.

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. 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. However, risks after the procedure include placenta accreta, Asherman's syndrome and severe haemorrhage.

See also

References

  1. Ben-Baruch G, Menczer J, Mashiach S, Serr DM (1981). "Uterine anomalies in diethylstilbestrol-exposed women with fertility disorders". Acta Obstet Gynecol Scand. 60 (4): 395–7. doi:10.3109/00016348109154132. PMID 7282306. S2CID 33451512.
  2. Rennell CL (1979). "T-shaped uterus in diethylstilbestrol (DES) exposure". AJR Am J Roentgenol. 132 (6): 979–80. doi:10.2214/ajr.132.6.979. PMID 108980.
  3. Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, et al. (2013). "The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies". Hum Reprod. 28 (8): 2032–44. doi:10.1093/humrep/det098. PMC 3712660. PMID 23771171.
  4. ^ Meier, Rose; Campo, Rudi (2015). "T-Shaped Uterus". Female Genital Tract Congenital Malformations: 261–270. doi:10.1007/978-1-4471-5146-3_25. ISBN 978-1-4471-5145-6.
  5. Pui MH (2004). "Imaging diagnosis of congenital uterine malformation". Comput Med Imaging Graph. 28 (7): 425–33. doi:10.1016/j.compmedimag.2004.05.008. PMID 15464882.
  6. Baramki TA (2005). "Hysterosalpingography". Fertil Steril. 83 (6): 1595–606. doi:10.1016/j.fertnstert.2004.12.050. PMID 15950625.
  7. Viscomi, G N; Gonzalez, R; Taylor, K J (1980). "Ultrasound detection of uterine abnormalities after diethylstilbestrol (DES) exposure". Radiology. 136 (3): 733–735. doi:10.1148/radiology.136.3.7403556. ISSN 0033-8419. PMID 7403556.
  8. van Gils AP, Tham RT, Falke TH, Peters AA (1989). "Abnormalities of the uterus and cervix after diethylstilbestrol exposure: correlation of findings on MR and hysterosalpingography". AJR Am J Roentgenol. 153 (6): 1235–8. doi:10.2214/ajr.153.6.1235. PMID 2816640.
  9. Kaufman RH, Binder GL, Gray PM, Adam E (1977). "Upper genital tract changes associated with exposure in utero to diethylstilbestrol". Am J Obstet Gynecol. 128 (1): 51–9. doi:10.1016/0002-9378(77)90294-0. PMID 851159.
  10. ^ Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V (1996). "Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus". Gynecol Obstet Invest. 41 (1): 41–3. doi:10.1159/000292033. PMID 8821883.
  11. Berger MJ, Goldstein DP (1980). "Impaired reproductive performance in DES-exposed women". Obstet Gynecol. 55 (1): 25–7. PMID 7352058.
  12. Lin, Paul C; Bhatnagar, Kunwar P; Nettleton, G.Stephen; Nakajima, Steven T (2002). "Female genital anomalies affecting reproduction". Fertility and Sterility. 78 (5): 899–915. doi:10.1016/S0015-0282(02)03368-X. ISSN 0015-0282. PMID 12413972.
  13. Noyes N, Liu HC, Sultan K, Rosenwaks Z (1996). "Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome". Hum Reprod. 11 (12): 2719–23. doi:10.1093/oxfordjournals.humrep.a019197. PMID 9021378.
  14. Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarini G (2011). "Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus". Gynecol Obstet Invest. 71 (3): 183–8. doi:10.1159/000317266. PMID 21150155. S2CID 2313662.
  15. Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP (1992). "Obstetric outcome in women with congenital uterine malformations". J Reprod Med. 37 (3): 233–6. PMID 1564709.
  16. Fernandez, H.; Garbin, O.; Castaigne, V.; Gervaise, A.; Levaillant, J.-M. (2011). "Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus". Human Reproduction. 26 (7): 1730–1734. doi:10.1093/humrep/der056. ISSN 0268-1161. PMID 21398337.

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