Uterus saddle shape: reasons for getting pregnant, postures for conception, consequences

Gynecological problems are sometimes congenital. To such pathologies can be attributed and such a feature as the saddle uterus - is a kind of organ defect, when the uterus is split in the form of a saddle shape.

Usually, a woman learns about this kind of reproductive system from a gynecologist, since other signs of pathology rarely happen: we'll talk about other features of the saddle-uterus in our article.

Epidemiology

Defects of the uterus (irregular configuration, or other defects) are diagnosed in 0.2-0.4% of women who are in reproductive age.

In this case, the diagnosis of the duodenal uterus is established in 60% of these cases, and the diagnosis of the saddle-uterus is 23%.

[1], [2], [3], [4], [5]

Causes of the saddle uterus

The formation of the saddle uterus occurs in the fetus from about 10 to 14 weeks of embryogenesis. During the active development of the embryo, the uterine cavity initially consists of two vaginal-uterine cavities, which are divided among themselves by the middle sagittal membrane.

Before the birth of the child - the girls - the membrane gradually dissolves, and the uterus acquires its normal shape with one full cavity. If intrauterine uterine formation occurred with disturbances, then there remains a slight "depression" of the organ bottom, which is a developmental malformation - a saddle uterus. In addition to the split bottom, pathology is always accompanied by an increase in the uterus in transverse dimensions.

[6], [7], [8], [9]

Pathogenesis

The pathogenesis of irregular formation of the uterus is due to certain provoking factors:

• intoxication during pregnancy, caused by alcohol, nicotine, drugs, medicines, chemicals;
• acute lack of vitamin or mineral substances in the body of a future mother;
• severe stress during pregnancy;
• disorders of the endocrine system (diabetes, endemic goiter);
• heart disease in a future mother.

In addition, the infectious diseases of a woman during childbearing, severe toxicosis, and prolonged hypoxia of the fetus may play a decisive role in the development of the defect.

[10], [11], [12]

Symptoms of the saddle uterus

Usually a woman does not even have a suspicion that she has this particular shape of the uterus. Most often, the defect is detected by contacting the doctor when planning a pregnancy or with a pregnancy already in progress.

Thus, it can be argued that the saddle uterus has an asymptomatic course. And only that a woman can not become pregnant for a long time, or suffers from a habitual miscarriage of pregnancies, can indirectly indicate a pathology.

Saddle-shaped uterus and IVF

The uterine saddle is the organ difference from the usual normal configuration. But this difference is not considered a direct obstacle to the onset of pregnancy. The inability to conceive is present only in some cases, if anatomical changes are clinically significant.

Anxiety at doctors causes not so much difficulty to become pregnant at a saddle uterus, how much greater danger of complications at a bearing of a fetus.

So is IVF necessary for women diagnosed with "saddle-shaped uterus"?

The altered saddle shape of the uterine organ does not affect the ingress of spermatozoa into the tubes, on their meeting with the ovum and directly on fertilization.

Difficulty may appear during the implantation of the embryo into the uterine wall and throughout the pregnancy. In addition, the saddle uterus is often accompanied by other congenital abnormalities of the genital area, which can interfere with normal conception. Thus, in patients with saddle mat, uterine bending, polyposis, etc. Are often diagnosed.

One of the options for successful conception will be IVF - but only with the condition of full preliminary diagnosis and treatment.

Pose for conception with saddle uterus

The diagnosis of "saddle-shaped uterus" is not an excuse to put a cross on conception. In most cases, the patient is able to get pregnant on her own, using certain poses in sexual contact.

It makes no sense to try various "extreme" poses, since they, most likely, can be ineffective. The main condition in choosing the right position is to ensure that sperm enter the uterus, therefore the posture should prevent the outflow of the seed. It is for this reason that experts advise a woman after a sexual act to turn on her stomach, laying a small pillow under the pelvic area, and lie in this position for at least half an hour.

If we talk about choosing the right posture, then here we should pay attention to the knee-elbow position. This position contributes to a deeper penetration of sperm.

The second suitable pose is the one in which the woman, lying on her back, tilts her legs as high as possible (you can bend them in your lap). After the act of ejaculation, the woman brings her legs to her chest, holding her hands, and remains in this position, if possible, to half an hour.

The uterus during pregnancy

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

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

With the development of pregnancy, the risk increases that the baby will take the wrong intrauterine position. In addition, premature placental abruption can occur, accompanied by a different degree of bleeding. In such a situation, a threat of miscarriage is created, and not only: danger is trapped and the woman herself. Therefore, if a saddle-shaped uterus crocks during pregnancy, and even with slight bleeding from the vagina, the pregnant woman should immediately see a doctor.

In a large number of cases in women with saddle uterus, who managed to endure pregnancy, the baby is born before the due date.

Does the saddle uterus affect the fetus?

The saddle configuration of the uterus does not cause any discomfort or inconvenience to the baby, which develops in utero. In addition to a certain degree of threat of termination of pregnancy and some other possible complications, the saddle uterus does not carry any other threats. Neither on the physical, nor on the intellectual development of the baby, this pathology will not be reflected.

[13]

Forms

The uterine saddle may be the only defect in the female reproductive system, or be combined with defects in the cervix or vaginal walls.

In general, specialists distinguish such varieties of uterine forms as the one-horned, two-horned, double uterus, etc.

Double-horned uterus can also occur in three versions:

1. A full bicornate uterus is an organ divided into two "horns" in sacro-uterine folds.
2. An incomplete bicornate uterus is an organ that also has two "horns", which are the same only in the upper 1/3.
3. The saddle uterus is an extension of the size of the organ in the transverse segment, with a characteristic impression in the bottom zone (visually similar to the saddle). Splitting horns is weakly expressed.

[14]

Complications and consequences

The uterine saddle can be accompanied by problems with conception, but these problems a woman may not be the only ones. In some cases, the fixation of the egg occurs in the lower segment of the placenta, which greatly complicates the further development of pregnancy.

In addition, during pregnancy often there is an incorrect attachment of the placenta or a placental detachment.

It is not uncommon for such a consequence of the saddle uterus, as uncoordinated labor, in which the independent birth of the fetus is considered impossible - the doctor has to resort to an emergency cesarean section.

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

[15]

Diagnostics of the saddle uterus

The diagnosis of the saddle-uterus can not be made after a gynecological examination, nor after a woman's palpation. Even on ultrasound, the true shape of the uterus becomes visible only, either during pregnancy or in the second phase of the monthly cycle.

Analyzes of urine and blood in this case are also uninformative and can be prescribed only to clarify the general state of the body.

Instrumental diagnosis of the saddle uterus is most often performed using the following procedures:

• Intravaginal and abdominal ultrasound;
• hysterosalpingography (one of the radiographic methods);
• hysteroscopy (introduction of a specific device into the uterine cavity - hysteroscope);
• Magnetic resonance imaging.

The uterine saddle on ultrasound has practically no characteristic differences from the usual uterus. The exceptions are cases in which a transverse scan of the uterine bottom reveals its expansion and the presence of two M-echoes in the zone of tube angles. Echoes of the saddle uterus can be defined thus:

• the presence of a divergence of the M-echo in the area of the mother-bottom;
• the exponent of compression of the myometrium into the uterine cavity ranges from 10 to 14 mm.

[16], [17],

Differential diagnosis

Differential diagnosis is carried out with a normal and complete two-legged uterus.

	Length	Thickness	Width	The difference in the M-echo in the bottom of the uterus	Thickness of the uterine myometrium	The thickness of the myometrium in the right corner of the uterus	The 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

[18], [19],

Treatment of the saddle uterus

Operation with the saddle uterus is rarely done - only in cases when attempts to become pregnant end unsuccessfully, and the reason for this is precisely the incorrect configuration of the uterine fundus. Most often, surgery is used for the two-legged uterus, when it is necessary to remove the uterine septum (membrane).

Operative treatment consists in using a hysteroscopic method - a minimally invasive technology that allows you to perform an operation without blood and incisions.

Recovery after surgery occurs quickly, sometimes even without disrupting the cycle of menstruation.

Metoplastic surgery is performed by laparoscopic method, with piercing in several places of the abdominal wall. This operation is also considered to be minimally invasive. The patient stays in the inpatient department for a maximum of two days, and the postoperative period is short and relatively light.

The listed surgical interventions practically always proceed without complications. In this case, the chances of a woman's pregnancy increase many times.

After the operation, a woman with a diagnosis of "saddle-uterus" should be observed by the doctor throughout the planning stage of the child.

Saddle and delivery

A woman with a saddle-shaped uterus during pregnancy is always in danger. But, even having overcome them, it is possible to face difficulties and during childbirth.

Most often, a baby of such a woman will be born before the expected time.

Moreover, in the process of labor activity, nervous innervation in fights is often violated, which affects the quality of the generic forces. For example, a woman can already withdraw water, and fights are weak, or they are not at all. In such a situation, they speak of the weakness of labor: most often the problem is solved by performing a caesarean section operation.

The risk of bleeding in the saddle uterus exists not only during the period of gestation, but also immediately after birth, since the saddle uterus can not always contract normally. All these moments the doctor takes into account, therefore, they take all possible measures to preserve the life and health of the child and mother.

It is worth noting that the problems in women with the diagnosis of "saddle-uterus" do not always happen, so do not "adjust" yourself to the negative - just such women should be aware of the possible difficulties on the way to motherhood.

Prevention

Preventing the development of the saddle-uterus in the child is carried out by his mother, even before the pregnancy. Prevention measures include:

• maintaining the health of reproductive organs, timely treatment of inflammatory and infectious pathologies;
• thoughtful preparation for pregnancy, with the delivery of necessary tests and the intake of vitamin preparations;
• adherence to a healthy lifestyle;
• quality food with fresh products, with a sufficient amount of vegetable components and vegetable oils;
• regular consultations of a gynecologist - before and during pregnancy;
• early registration for pregnancy (up to 12 weeks).

[20], [21],

Forecast

A sufficient volume of the uterine cavity allows for normal pregnancy, but a strong separation in the bottom may cause miscarriage or premature labor.

A doctor who leads a pregnant woman with a saddle-shaped uterus must constantly take measures to prevent miscarriage and placental abruption.

Caesarean section surgery can be used when there is a threat of termination of pregnancy in the third trimester.

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

[22], [23]