Anomalies of the uterus

Under the incorrect position of the genitals should be understood as a persistent deviation from their typical ("normal") position, usually accompanied by pathological phenomena. The position of the genitalia changes with age. In childhood, the uterus is located higher than during puberty. In old age, on the contrary, lower, often deviates backward.

[1], [2], [3], [4]

Causes of the abnormalities of the uterus

In the position of the female genitalia, violations (anomalies) are relatively frequent, which are predominantly secondary and depend on a variety of pathological processes that occur both in the genitals and outside the uterus and its appendages. The disorders observed in this case are not only determined by the mixing of the uterus, but depend on the underlying disease that caused the anomaly. Less often the wrong positions of the uterus are congenital.

The cause of hyperanteflexia may also be a shortening of the sacro-uterine ligaments due to a prolonged chronic inflammatory process. In such cases, due to the reduction of the sacro-uterine ligaments, the area of their attachment to the uterus is pulled back, and the body approaches the cervix.

Among the causes of retroflexia are organic (reducing the tone of the uterus and its ligaments in infantilism, asthenic syndrome, birth trauma, inflammation, uterine and ovarian tumors) and constitutional (15% of healthy mature women have retrodeaviation).

[5], [6], [7], [8], [9], [10]

Risk factors

Factors ensuring the normal position of female genital organs are:

• own tone of genital organs;
• the relationship between internal organs and the coordinated activity of the diaphragm, abdominal wall and pelvic floor;
• Suspension, fixing and supporting apparatus of the uterus.

[11], [12], [13]

Pathogenesis

A typical position is conventionally considered to be the position of the genital organs in a healthy, mature, nonpregnant and non-pregnant woman, who is in an upright position with the bladder and rectum emptied. In this case, the uterus occupies the middle position in the small pelvis, the uterine base does not protrude above the plane of entry into the small pelvis, the vaginal part of the cervix is at the level of the plane passing through the sciatic forearms. The uterus is turned upward and anteriorly, the vaginal part of the cervix is down and down. The whole axis of the uterus is slightly tilted anteriorly (anieversio). Between the body and the neck of the uterus, a bend is formed. The resulting angle is obtuse and anterior to the anteflexio.

Own tone of the genital organs depends on the proper functioning of all body systems. Decrease in tone can be associated with a decrease in the level of sex hormones, a violation of the functional state of the nervous system, age-related changes.

The relationship between the internal organs (intestine, omentum, parenchymal and genital organs) form a single complex due to their direct contact with each other. In this case, a capillary cohesion is formed, which together with the gaseous contents of the intestine contributes to the balancing of the gravity of the internal organs and limits their pressure on the genital organs.

The hanging device consists of round and wide ligament of the uterus, own and the hanging ligament of the ovary.

The fastening device includes sacro-uterine, cardinal, uterine-vesicle and vesicle-pubic ligaments.

The supporting apparatus is represented by the muscles of the pelvic floor, a vesicovaginal septum, a rectal-vaginal septum and a dense connective tissue located at the side walls of the vagina.

[14], [15], [16], [17], [18]

Symptoms of the abnormalities of the uterus

Symptoms of hyperanthexia correspond to that of the underlying disease (symptoms of infantilism, inflammatory process, etc.). Since retroflexia is not an independent disease, its clinical picture is determined by the symptoms of the disease that caused retroflexia - pain, impaired function of neighboring organs, violation of menstrual and secretory functions. Constitutional retroflexia is asymptomatic and is found by accident during preventive examinations.

[19]

Forms

Uterine displacement can occur along a vertical plane (up and down), around the longitudinal axis and along the horizontal plane.

To the displacement of the uterus along the vertical plane include raising the uterus, omission, prolapse and uterine eversion. When raised, the uterus moves upward, its bottom is located above the plane of entry into the small pelvis, and the vaginal part of the cervix is above the spinal plane. Pathological uplift of the uterus occurs when the menstrual blood accumulates in the vagina due to atresia of the hymen or the lower part of the vagina, with volumetric tumors of the vagina and rectum, with imprints of inflammatory effusions in the Douglas space. Elevation (elevation) of the uterus can also be in its adhesions to the anterior abdominal wall after laparotomy (caesarean section, ventrofixation).

At the descent (descensus uteri) the uterus is located below the normal level, however, the vaginal part of the cervix does not protrude from the genital gaps even when straining. If the cervix protrudes beyond the sexual fissure, they speak of the prolapse of the uterus. There is incomplete and complete prolapse of the uterus. With incomplete loss of the uterus from the vagina, only the vaginal part of the cervix extends, and the body of the uterus is located higher, outside the genital gaps. With complete loss of the uterus, its neck and uterine body are located below the genital slit. Omission and prolapse of the uterus is accompanied by loss of the vagina.

Eversion of the uterus is extremely rare. With this anomaly, the serous membrane is located inside, and the mucous membrane is outside, the inverted body of the uterus is located in the vagina, and the cervix, fixed in the vault region, is above the body level.

Uterus reversal in most cases occurs when the postpartum period is incorrectly administered (squeezing the afterbirth, pulling on the umbilical cord for the purpose of extracting the afterbirth), and less frequently when the tumor is expelled from the uterus with a short, inextensible leg.

Displacement of the uterus around the longitudinal axis has two forms: turning the uterus (rotation of the body and cervix from right to left or vice versa) and twisting of the uterus (torsio uteri). When the uterus is twisted, the body of the uterus rotates in the region of the lower segment with a fixed neck.

Displacement of the uterus in the horizontal plane can be of several types: displacement of the entire uterus (antepositio, retropositio, dextropositio and sinistropositio), abnormal inclinations of the uterus (retroversio, dextroversio, sinistroversio) and pathological kink of the uterus.

Displacement of the entire uterus can be in four forms; antepositio, retropositio, dextropositio and sinistropositio.

Normally, between the body and the neck of the uterus, an obtuse angle is formed, which is open anteriorly. However, with a pathological inflection, this angle can be acute, open anteriorly (hyperanteflexio) or posterior (retroflexio).

Of all the types of anomalies, the position of the genital organs is most important in clinical importance, the uterine displacements down (prolapse), retrodeviation (posterior displacement, mainly retroflection), and pathological anteflexia (hyperanthelexia).

Hyperanthelexia, as a rule, accompanies sexual infantilism - the size of the neck exceeds the length of the body of the uterus. With hyperanteflexia, the uterus does not cover the bladder, intestinal loops enter between the bladder and the uterus, putting pressure on the bladder. With prolonged exposure, the bladder and vagina may shift to the bottom.

With retroflection, the angle between the body and the cervix is not open anteriorly, as in the normal position, but posteriorly. The uterus is directed posteriorly, and the cervix is somewhat anterior. With this arrangement of the uterus, the normal position of the internal organs is disrupted. The bladder is not covered by the uterus, intestinal loops enter the vestibular space and are pressed against the wall of the bladder and on the front surface of the uterus. Therefore, retroflexia is a risk factor for genital prolapse.

[20], [21], [22]

Diagnostics of the abnormalities of the uterus

The diagnosis of retroflection does not present any difficulties. When vaginal examination is established that the cervix is facing anteriorly, the uterus body is located posteriorly and is defined through the posterior fornix, between the body and the cervix, the angle open to the back. With mobile retroflection, it is often possible to bring the uterus to the correct position, with fixed retroflection it is usually not possible to withdraw it.

[23], [24], [25], [26], [27]

Treatment of the abnormalities of the uterus

The treatment of hyperanthoeflexia is aimed at eliminating the cause that caused its development. Treatment of retroflexia is aimed at eliminating the cause of the underlying disease that caused retroflexia (patients with asymptomatic retroflexia do not need treatment).