Double-breasted uterus and pregnancy

Double-breasted uterus and pregnancy - an actual problem of obstetrics and gynecology, since it is this pathology that causes a third of cases of miscarriage of women with developmental defects of the uterus.

The double-horned uterus is a congenital anomaly. The uterus begins to form from the Mullerian ducts of the embryo from about the 6th week of pregnancy. Due to genetic or teratogenic causes, these ducts do not merge, which leads to a split in the upper part of the uterus, and then the girl is born with uterus bicornuate - a two-legged uterus. And for adult women, the bicornylum, pregnancy and childbirth represent a chain of problems with the birth of children.

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Bleeding at the 2 nd uterus during pregnancy

The main cause of hemorrhage in the two-legged uterus during pregnancy is placenta previa, which is the result of implantation of the fetal egg not in the region of the posterior and lateral walls of the body or the bottom of the uterus, but in the endometrium of its lower part.

After implantation - from the 3rd week of pregnancy - the formation of the placenta begins, and inside the tissues of the uterus wall there is a process of vascularization, that is, the formation of additional blood vessels. If the fetus has settled in the uterus too low, then the placenta (whose formation is completed by the 13th week of pregnancy) can close its internal pharynx. As a result, the pregnant woman has bloody discharge or bleeding (with pain in the lower abdomen). And this is the main precursor of abortion.

Bleeding during the two-horned uterus during pregnancy is most often after 6-8 weeks of gestation and is observed in almost 35% of pregnant women. A partial presentation of the placenta is observed on average in 40-45% of cases of pregnancy with the two-horned uterus.

If bleeding occurs during the pregnancy during late pregnancy (after 30-32 weeks), then its etiology is due to the fact that the present part of the placenta can not stretch as the size of the uterus increases and begins to exfoliate.

Double-breasted uterus and frozen pregnancy

Frozen pregnancy - that is, the termination of fetal development and its death - if the pregnant woman has a full or incomplete duodenal uterus, it is a natural unfavorable outcome if the egg is attached not to the walls of the uterus, but to the septum.

The fact is that the tissues of these partitions do not have blood vessels, and, therefore, the embryo can not develop normally and dies

In addition, the septum in the two-legged uterus - when the embryo is located close to it - can simply interfere with the natural process of fetal growth because of insufficient volume of free space in the uterine cavity.

Two-horned saddle uterus and pregnancy

Two-horned saddle uterus and pregnancy - the most favorable of the considered variants of this pathology. However, it can lead to complications.

The obstetricians note that this type of duodenal uterus can also lead to miscarriage (although much less often than with a full or incomplete duodenal uterus), fetal fading, and premature birth. Thus, in 15-25% of pregnant women with a two-sided saddle-shaped uterus, labor begins much earlier than expected. And this increases not only the overall perinatal morbidity of newborns, but also the risk of death of premature babies.

Also this congenital pathology of the uterus affects the position of the fetus, and most often doctors state a transverse or oblique presentation, in which it is necessary to do a caesarean section. And after a natural delivery, the uterus shrinks very badly and takes a long time to cover.

Double-breasted uterus and twin pregnancy

Pregnancy of twins with anatomical structure of the uterus, in the case under consideration - in the presence of the two-horned uterus, does not have a direct causal relationship. After all, the conception of twins is the result of the fertilization of two follicles that have matured at the same time.

Nevertheless, according to some reports, the pregnancy of twins (one- or raznoyaytsevoy) more often develops in women who have anatomical pathologies of the structure of the uterus. At the same time, a pathology such as complete bifurcation of the uterus leads - that is, when the septum of the duodenal uterus reaches the internal throat or cervical canal with the formation of two separate cavities.

Double-breasted uterus and twin pregnancy are referred to as midwives to a group of very high risk of abortion. There are even ruptures of the uterus. And the births after 32-34 weeks of pregnancy twins are 90%.

As a result of many years of clinical observation, it is established that the probability of fertilization of two eggs with a double-breasted uterus or its complete bifurcation is only one case per million.

In the case when the bicornylum and pregnancy - in terms of the ability to bear and give birth to a child - are mutually exclusive concepts, a woman can undergo an operation to restore the uterine cavity. It is open (with dissection of the abdominal cavity) or hysteroscopic metroplasty. During this surgical intervention, the septum is dissected, and the uterus "reconstructed" into a single cavity. In almost 63% of clinical cases, the reproductive capacity of the uterus has been fully restored.

Double-breasted uterus and pregnancy: features and complications

Among pathologies that arise in the process of intrauterine development, the uterus's bicorne is quite common: it is detected in approximately 0.5% of women of childbearing age. Does this pathology affect the ability to conceive? Most experts claim that the bicornylum and pregnancy - in the sense of being able to conceive - are mutually exclusive concepts. Many women, having such an anatomical defect of the genital organ, become pregnant and give birth. Here the whole point is how deformed the uterine cavity is.

When the full two-horned uterus is in its cavity, there is a septum (sometimes two-thirds of the depth of the cavity), which divides the uterus into two parts, and the fetus can develop in one of them. In the incomplete two-horned uterus, a small division of the cavity is observed in its upper third. And the so-called saddle-shaped (or arcuate) bicornate uterus has only a slight depression at the bottom of the cavity.

It should be noted that pregnancy with any of the three types of duodenal uterus is associated with complications and requires additional medical monitoring. Risks are in such unfavorable outcomes as habitual miscarriages (miscarriage reaches 45-50% of cases) and frozen pregnancy (about 5%).

Duplicate uterus and pregnancy have other complications. This is an incorrect presentation of the fetus and premature birth. Gluteal presentation of the fetus is recorded in 50% of pregnancies with a partial two-horned uterus. And in 40% there is a leg presentation, complicating the course of childbirth and threatening a newborn asphyxia.

The number of preterm labor in the presence of the two-horned uterus ranges from 25% to 35%. Doctors explain this by increased overgrowth of the uterus, which has an irregular shape. Because of this, the birth begins early. Another factor that provokes premature births is the inability of the neck and neck of the uterus to withstand internal pressure and to keep the growing fetus before the due date (this is called ischemic-cervical uterine insufficiency). So the caesarean section becomes in 65-70% of cases the only way out.

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