Pregnancy with genital anomalies

Often, pregnancy occurs with diseases such as narrowing of the vagina, chronic inflammation of the uterus and its appendages, immaturity and malformations of the uterus, tumor processes in the pelvic organs, etc.

In such cases, the physiological course of pregnancy, childbirth and the postpartum period is often violated.

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

Infantilism of the genitals

The diagnosis of infantilism in a pregnant woman is based primarily on data from anamnesis: unfavorable developmental conditions in childhood, later onset of menstruation. In a bimanual study outside pregnancy, it is found that the vagina is narrow, the uterus is smaller than normal. Infantilism of the genitals is one of the causes of infertility. The first pregnancy does not occur immediately after the onset of sexual activity. However, if the pregnancy does occur, it often does not wear out and ends with spontaneous abortion or premature birth. With full term pregnancy, primary or secondary weakness of labor activity often occurs, which can lead to detachment of the placenta and related bleeding. In the postpartum period with an underdeveloped uterus, there is insufficient inverted development (subinvolution).

Treatment during pregnancy is primarily aimed at eliminating adverse factors (preventing excessive emotions, significant physical stress). In the process of childbirth, careful monitoring and timely elimination of abnormalities of labor, distress, and pathology of the third stage of labor are necessary.

Congenital anomalies of genital organs

Congenital anomalies of the genital organs are numerous variants of their developmental defects. In some of them, pregnancy is not possible (for example, ovasion of the uterus).

Pregnancy can occur in women with the following abnormalities of the development of the reproductive system; vagina septa, uterus introrsum arcuatus, uterus bicornis and uterus unicormis, uterus, bicornic uterus with one closed rudimentary horn (uterus bicornis cum cornu rudimentario), double uterus and double vagina (uterus et vagine duplex).

The vaginal septum and the double uterus are usually not difficult to detect in a bimanual vaginal-abdominal study. The diagnosis can be clarified with the help of ultrasound.

The septa and cicatricial changes in the vagina can be not only congenital, but also acquired (after a diphtheria disease, a chemical burn). With a significant narrowing of the vagina, deliveries through natural paths are impossible, in such cases, a cesarean section is performed. If the vaginal septum interferes with the birth of the presenting part of the fetus, then the septum stretched on the prevailing part should be cut. Bleeding from the dissected sections of the septum does not happen.

In a double uterus (uterus duplex), pregnancy can develop simultaneously in each of its isolated halves. However, in most women with a similar uterus, pregnancy does develop only in one half. The second half thus slightly increases in volume and in its mucosa occurs decidual changes.

In the uterus, divided by the septum completely or partially - in the region of the bottom (the so-called saddle-uterus), pregnancy usually does not wear out. If a woman still wears out the pregnancy, then in labor, premature or urgent, often there is a weakness of labor. Possible transverse position of the fetus and premature detachment of the placenta.

With a single-horned uterus, pregnancy and childbirth proceed without distinction.

In the rudimentary horn of the uterus, a fertilized egg can attach and develop. Implantation occurs either as a result of the external movement of the fertilized egg from the ovary into the rudimentary horn tube (migratio ovi externa), or due to the movement of the spermatozoon from the developed horn tube to the opposite tube (migratio spermatozoidae externa). In the case of pregnancy in the rudimentary horn of the uterus with the gene in the area of implantation of a fertilized egg, it germinates with villi of the chorion and is stretched by a fetal egg that grows. In the end, most often at the 14-18th week of pregnancy or later, there is a rupture of the fetus, Intraperitoneal bleeding is very abundant and if urgent operational help (removal of the rudimentary horn) is not provided, the patient may die from shock and acute anemia.

Pregnancy in the additional horn is in essence a variant of an ectopic pregnancy. In such a situation, urgent surgical intervention is shown - or excision of the horn of the uterus, or removal of it simultaneously with the uterus.

In the presence of malformations, there may be a threat of termination of pregnancy. Until the end of pregnancy is often detected pelvic presentation, oblique or transverse position of the fetus, in labor there is a weakness or discoordination of labor. If, for some reason, the pathology of the uterus is performed by a cesarean section, it is advisable to perform an instrumental revision of the second uterus in order to remove the decidua.

[4], [5]