Pregnancy with genital anomalies

Pregnancy often occurs due to 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 disrupted.

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Infantilism of the genitals

The diagnosis of infantilism in a pregnant woman is based primarily on anamnesis data: unfavorable conditions of development in childhood, late onset of menstruation. Bimanual examination outside of pregnancy reveals 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 pregnancy does occur, it is often not carried to term and ends in spontaneous abortion or premature birth. In full-term pregnancies, primary or secondary weakness of labor often occurs, which can lead to placental abruption and associated bleeding. In the postpartum period, with an underdeveloped uterus, insufficient reverse development (subinvolution) is observed.

Treatment during pregnancy is aimed primarily at eliminating unfavorable factors (prevention of excessive emotions, significant physical stress). During labor, careful observation and timely elimination of labor anomalies, distress mode, and pathology of the third stage of labor are necessary.

Congenital anomalies of the genital organs

Congenital anomalies of the genitals are numerous variants of their developmental defects. In some of them pregnancy is impossible (for example, absence of the uterus).

Pregnancy can occur in women with the following anomalies in the development of the reproductive system: vaginal septum (vagina septa), saddle-shaped (uterus introrsum arcuatus), bicornuate (uterus bicornis) and unicornuate (uterus unicormis) uterus, bicornuate uterus with one closed rudimentary horn (uterus bicornis cum cornu rudimentario), double uterus and double vagina (uterus et vagina duplex).

A vaginal septum and a double uterus are usually easy to detect with a bimanual vaginal-abdominal examination. The diagnosis can be clarified with ultrasound.

Septa and cicatricial changes in the vagina can be not only congenital, but also acquired (after diphtheria, chemical burns). With significant narrowing of the vagina, natural childbirth is impossible, in such cases a cesarean section is performed. If the vaginal septum prevents the birth of the presenting part of the fetus, then the septum stretched over the presenting part should be cut. Bleeding from cut sections of the septum does not occur.

In a double uterus (uterus duplex), pregnancy can develop simultaneously in each of its separate halves. However, in most women with such a uterus, pregnancy still develops in only one half. The second half slightly increases in volume and decidual changes occur in its mucous membrane.

In a uterus divided by a septum, either completely or partially - in the fundus area (the so-called saddle-shaped uterus), pregnancy usually does not carry to term. If a woman does carry a pregnancy to term, then during labor, premature or urgent, weakness of labor activity is often observed. Transverse fetal position and premature placental abruption are possible.

With a unicornuate uterus, pregnancy and childbirth proceed without any special features.

In the rudimentary horn of the uterus, a fertilized egg can attach and develop. Implantation occurs either as a result of external movement of the fertilized egg from the ovary into the tube of the rudimentary horn (migratio ovi externa), or as a result of movement of the spermatozoon from the tube of the developed horn into the opposite tube (migratio spermatozoidae externa). In case of pregnancy in the rudimentary horn of the uterus with a gene in the area of implantation of the fertilized egg grows with chorionic villi and is stretched by the fertilized egg, which grows. Eventually, most often at 14-18 weeks of pregnancy or later, a rupture of the fetal receptacle occurs. Intra-abdominal bleeding can be very profuse and, if urgent surgical care is not provided (removal of the rudimentary horn), the patient may die from shock and acute anemia.

Pregnancy in an additional horn is essentially a variant of ectopic pregnancy. In such a situation, urgent surgical intervention is indicated - either excision of the uterine horn or its removal simultaneously with the body of the uterus.

In the presence of developmental defects, there may be a threat of termination of pregnancy. By the end of pregnancy, breech presentation, oblique or transverse position of the fetus are often detected, weakness or discoordination of labor activity is observed during labor. If for some reason a cesarean section is performed due to uterine pathology, it is advisable to perform an instrumental revision of the second uterus in order to remove the decidual membrane.

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