Saddle-shaped uterus: causes, how to get pregnant, positions for conception, consequences

Gynecological problems are sometimes congenital. Such pathologies include such a feature as a saddle-shaped uterus - a peculiar organ defect, when the uterus has a split saddle-shaped form.

Usually, a woman learns about this type of reproductive system from a gynecologist, since other signs of pathology are rare: we will talk about this and other features of the saddle-shaped uterus in our article.

Epidemiology

Uterine defects (abnormal configuration or other malformations) are diagnosed in 0.2-0.4% of women of reproductive age.

Moreover, the diagnosis of a bicornuate uterus is established in 60% of these cases, and the diagnosis of a saddle-shaped uterus is established in 23%.

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Causes saddle uterus

The formation of the saddle-shaped uterus occurs in the fetus approximately from the 10th to the 14th week of embryogenesis. During the period of active development of the embryo, the uterine cavity initially consists of two vaginal-uterine cavities, which are divided between themselves by the median sagittal membrane.

Before the birth of a child - a girl - the membrane gradually dissolves, and the uterus acquires its normal outlines with one full cavity. If the intrauterine formation of the uterus occurred with violations, then a small "indentation" of the organ's bottom remains, which is a developmental defect - a saddle-shaped uterus. In addition to the split depressed bottom, the pathology is always accompanied by an increase in the uterus in transverse size.

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Pathogenesis

The pathogenesis of abnormal formation of the uterus is caused by certain provoking factors:

• intoxications during pregnancy caused by alcohol, nicotine, drugs, medications, chemicals;
• acute deficiency of vitamins or minerals in the body of the expectant mother;
• severe stress during pregnancy;
• endocrine system disorders (diabetes, endemic goiter);
• heart defect in the expectant mother.

In addition, infectious diseases of the woman during pregnancy, severe toxicosis, and prolonged fetal hypoxia can play a decisive role in the development of the defect.

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Symptoms saddle uterus

Usually, a woman does not even suspect that she has this peculiarity of the shape of the uterus. Most often, the defect is discovered when visiting a doctor when planning a pregnancy or when pregnancy has already occurred.

Thus, it can be stated that the saddle-shaped uterus has an asymptomatic course. And only the fact that a woman cannot get pregnant for a long time, or suffers from habitual miscarriage, can indirectly indicate pathology.

Saddle uterus and IVF

A saddle-shaped uterus is a difference of the organ from the usual normal configuration. But this difference is not considered a direct obstacle to pregnancy. The inability to become pregnant is present only in some cases, if the anatomical changes are clinically significant.

Doctors are concerned not so much about the difficulty of getting pregnant with a saddle-shaped uterus, but about the great risk of complications during pregnancy.

So, do women diagnosed with saddle-shaped uterus need IVF?

The altered saddle-shaped form of the uterine organ does not affect the entry of sperm into the tubes, their meeting with the egg, or fertilization itself.

Difficulty may arise during the implantation of the embryo into the uterine wall and throughout the pregnancy. In addition, a saddle-shaped uterus is often accompanied by other congenital pathologies of the genital area, which can interfere with normal conception. Thus, patients with a saddle-shaped uterus are often diagnosed with a uterine bend, polyposis, etc.

One of the options for successful conception may be IVF – but only with the condition of complete preliminary diagnostics and treatment.

Position for conception with a saddle-shaped uterus

The diagnosis of "saddle-shaped uterus" is not a reason to put an end to conception. In most cases, the patient is able to get pregnant on her own, using certain positions during sexual intercourse.

There is no point in trying various "extreme" positions, as they are likely to be ineffective. The main condition when choosing the right position is to ensure that sperm gets into the uterus, so the position should prevent the semen from leaking out. It is for this reason that experts advise a woman to turn over onto her stomach after intercourse, placing a small pillow under the pelvic area, and lie in this position for at least half an hour.

When it comes to choosing the right position, you should pay attention to the knee-elbow position. This position promotes deeper penetration of sperm.

The second suitable position is considered to be the one in which the woman, lying on her back, throws her legs back as high as possible (they can be bent at the knees). After the act of ejaculation, the woman brings her legs to her chest, holding them with her hands, and remains in this position, if possible, for up to half an hour.

Saddle-shaped uterus during pregnancy

The probability of successful conception directly depends on the degree of concavity of the uterine fundus, therefore it is considered that a bicornuate uterus is the most unfavorable for the onset of pregnancy.

With a saddle-shaped uterus, an important condition for the normal development of pregnancy is the presence of sufficient intrauterine space, as well as normal stretching of the uterine walls for the comfortable stay and growth of the fetus.

As pregnancy progresses, the risk of the baby taking an incorrect intrauterine position increases. In addition, premature placental abruption may occur, accompanied by varying degrees of bleeding. In such a situation, there is a risk of miscarriage, and not only: the woman herself is also in danger. Therefore, if the saddle uterus bleeds during pregnancy, and even with slight bleeding from the vagina, the pregnant woman should immediately see a doctor.

In a large number of cases, women with a saddle-shaped uterus who managed to carry a pregnancy to term have a baby born prematurely.

Does a saddle-shaped uterus affect the fetus?

The saddle-shaped configuration of the uterus does not cause any discomfort or inconvenience to the baby developing in utero. Apart from a certain degree of threat of termination of pregnancy and some other possible complications, the saddle-shaped uterus does not pose any other threats. This pathology will not affect the physical or intellectual development of the baby.

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Forms

A saddle-shaped uterus may be the only defect of a woman's reproductive system, or it may be combined with defects of the cervix or vaginal walls.

In general, experts distinguish such varieties of uterine forms as unicornuate, bicornuate, double uterus, etc.

A bicornuate uterus can also occur in three variants:

1. A complete bicornuate uterus is an organ divided into two “horns” at the uterosacral folds.
2. An incomplete bicornuate uterus is an organ that also has two “horns”, which are identical only in the upper 1/3.
3. Saddle-shaped uterus is an enlargement of the organ in the transverse segment, with a characteristic depression in the fundus area (visually similar to a saddle). The splitting of the horns is weakly expressed.

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Complications and consequences

A saddle-shaped uterus can be accompanied by problems with conception, but these problems may not be the only ones a woman has. In some cases, the egg is attached to the lower segment of the placenta, which significantly complicates the further development of pregnancy.

In addition, during pregnancy, abnormal placental attachment or placental abruption often occurs.

Another common consequence of a saddle-shaped uterus is uncoordinated labor, in which spontaneous birth of the fetus is considered impossible - the doctor has to resort to an emergency cesarean section.

Thus, with a saddle-shaped uterus, the main difficulties occur not so much with conception, but with carrying a pregnancy. Therefore, patients with this problem should pay increased attention and take all necessary measures to preserve the fetus.

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Diagnostics saddle uterus

The diagnosis of a saddle-shaped uterus cannot be made either after a gynecological examination or after a palpation examination of a woman. Even on an ultrasound, the true shape of the uterus becomes visible only during pregnancy or in the second phase of the monthly cycle.

Urine and blood tests in this case are also uninformative and can only be prescribed to clarify the general condition of the body.

Instrumental diagnostics of the saddle-shaped uterus is most often carried out using the following procedures:

• intravaginal and abdominal ultrasound;
• hysterosalpingography (one of the X-ray methods);
• hysteroscopy (insertion of a specific device – a hysteroscope – into the uterine cavity);
• magnetic resonance imaging.

The saddle-shaped uterus on ultrasound has virtually no characteristic differences from the normal uterus. The exceptions are cases in which transverse scanning of the uterine fundus reveals its expansion and the presence of two M-echo in the area of the tubal angles. Echo signs of the saddle-shaped uterus can be determined as follows:

• the presence of M-echo divergence in the area of the uterine fundus;
• the degree of myometrium indentation into the uterine cavity ranges from 10 to 14 mm.

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Differential diagnosis

Differential diagnosis is carried out with normal and complete bicornuate uterus.

	Length	Thickness	Width	The difference between M-echo in the bottom of the uterus	Thickness of the myometrium of the uterine fundus	Myometrium thickness in the right corner of the uterus	Thickness of the myometrium in the left corner of the uterus
Normal uterus	~ 5.09	~ 3.55	~ 5.36	~ 1.76	~ 1.25	~ 0.7	~ 0.7
Saddle uterus	~ 5.44	~ 3.43	~ 5.81	~ 2.16	~ 1.85	~ 0.69	~ 0.69

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Treatment saddle uterus

Surgery for a saddle-shaped uterus is rarely performed - only in cases where attempts to become pregnant fail, and the reason for this is the incorrect configuration of the uterine fundus. Most often, surgery is used for a bicornuate uterus, when it is necessary to remove the uterine septum (membrane).

Surgical treatment involves the use of the hysteroscopic method – a minimally invasive technology that allows the operation to be performed without blood or incisions.

Recovery after surgery occurs quickly, sometimes even without disruption of the menstrual cycle.

Metroplastic surgery is performed laparoscopically, with puncturing the abdominal wall in several places. This surgery is also considered minimally invasive. The patient stays in the hospital for a maximum of two days, and the postoperative period is short and relatively easy.

The listed surgical interventions almost always proceed without complications. At the same time, a woman's chances of pregnancy increase many times over.

After the operation, a woman diagnosed with a saddle-shaped uterus should be monitored by a doctor throughout the entire period of planning a child.

Saddle-shaped uterus and childbirth

A woman with a saddle-shaped uterus is constantly in danger during pregnancy. But even after overcoming them, difficulties can arise during childbirth.

Most often, such a woman's baby will be born earlier than expected.

Moreover, during labor, the nervous innervation is often disrupted during contractions, which affects the quality of labor forces. For example, a woman's water may have already broken, but the contractions are weak or absent altogether. In such a situation, they speak of weak labor: most often, the problem is solved by performing a cesarean section.

The danger of bleeding with a saddle-shaped uterus exists not only during the period of bearing a child, but also immediately after birth, since a saddle-shaped uterus cannot always contract normally. The doctor takes all these points into account, so he takes all possible measures to preserve the life and health of the child and mother.

It is worth noting that women diagnosed with a saddle-shaped uterus do not always have problems, so you should not “set yourself up” for negativity - such women should simply be aware of possible difficulties on the path to motherhood.

Prevention

Prevention of the development of a saddle-shaped uterus in a child is carried out by its mother, even before the start of pregnancy. Preventive measures include:

• maintaining the health of reproductive organs, timely treatment of inflammatory and infectious pathologies;
• thoughtful preparation for pregnancy, including taking the necessary tests and taking vitamin supplements;
• maintaining a healthy lifestyle;
• high-quality nutrition with fresh products, with a sufficient amount of plant components and vegetable oils;
• regular consultations with a gynecologist – before and during pregnancy;
• early registration for pregnancy (before 12 weeks).

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Forecast

A sufficient volume of the uterine cavity allows for normal pregnancy, but a strong division in the fundus area can cause miscarriage or premature labor.

A doctor who monitors the pregnancy of a woman with a saddle-shaped uterus must constantly take measures to prevent miscarriage and placental abruption.

A cesarean section may be used if there is a risk of miscarriage in the third trimester.

Surgical intervention for patients diagnosed with saddle-shaped uterus can reduce the risk of miscarriage to 30%.

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