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T-shaped uterus sufferers can bear children, however they carry a greater risk of complications, such as micarriages, reduced fertility and preterm births, both before and after any treatment.<ref name="pmid8821883">{{cite journal| author=Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V| title=Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus. | journal=Gynecol Obstet Invest | year= 1996 | volume= 41 | issue= 1 | pages= 41-3 | pmid=8821883 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8821883 }} </ref><ref name="pmid7352058">{{cite journal| author=Berger MJ, Goldstein DP| title=Impaired reproductive performance in DES-exposed women. | journal=Obstet Gynecol | year= 1980 | volume= 55 | issue= 1 | pages= 25-7 | pmid=7352058 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7352058 }} </ref>
T-shaped uterus sufferers can bear children, however they carry a greater risk of complications, such as micarriages, reduced fertility and preterm births, both before and after any treatment.<ref name="pmid8821883">{{cite journal| author=Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V| title=Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus. | journal=Gynecol Obstet Invest | year= 1996 | volume= 41 | issue= 1 | pages= 41-3 | pmid=8821883 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8821883 }} </ref><ref name="pmid7352058">{{cite journal| author=Berger MJ, Goldstein DP| title=Impaired reproductive performance in DES-exposed women. | journal=Obstet Gynecol | year= 1980 | volume= 55 | issue= 1 | pages= 25-7 | pmid=7352058 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7352058 }} </ref>


The current surgical procedure to treat this malformation, termed a [[hysteroscopy|hysteroscopic]] correction or [[metroplasty]], is undertaken by performing a lateral [[incision]] of the uterine walls, and can return the organ to a normal morphology, and improve the patient's reproductive performance.<ref name="pmid8821883" /><ref name="MeierCampo2015" /><ref name="LinBhatnagar2002">{{cite journal|last1=Lin|first1=Paul C|last2=Bhatnagar|first2=Kunwar P|last3=Nettleton|first3=G.Stephen|last4=Nakajima|first4=Steven T|title=Female genital anomalies affecting reproduction|journal=Fertility and Sterility|volume=78|issue=5|year=2002|pages=899–915|issn=00150282|doi=10.1016/S0015-0282(02)03368-X}}</ref> It is considered a low-risk procedure, and can also improve [[Preterm birth|term delivery]] rate by up to 10-fold, as long as the [[endometrium]] is considered to be in good condition.<ref name="pmid9021378">{{cite journal| author=Noyes N, Liu HC, Sultan K, Rosenwaks Z| title=Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome. | journal=Hum Reprod | year= 1996 | volume= 11 | issue= 12 | pages= 2719-23 | pmid=9021378 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9021378 }} </ref><ref name="pmid21150155">{{cite journal| author=Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarini G| title=Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus. | journal=Gynecol Obstet Invest | year= 2011 | volume= 71 | issue= 3 | pages= 183-8 | pmid=21150155 | doi=10.1159/000317266 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21150155 }} </ref><ref name="pmid1564709">{{cite journal| author=Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP| title=Obstetric outcome in women with congenital uterine malformations. | journal=J Reprod Med | year= 1992 | volume= 37 | issue= 3 | pages= 233-6 | pmid=1564709 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1564709 }} </ref> However, risks after the procedure include [[placenta accreta]], [[Asherman's syndrome]] and severe [[haemorrhage]].<ref name="MeierCampo2015" /><ref name="FernandezGarbin2011">{{cite journal|last1=Fernandez|first1=H.|last2=Garbin|first2=O.|last3=Castaigne|first3=V.|last4=Gervaise|first4=A.|last5=Levaillant|first5=J.-M.|title=Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus|journal=Human Reproduction|volume=26|issue=7|year=2011|pages=1730–1734|issn=0268-1161|doi=10.1093/humrep/der056}}</ref>
The current surgical procedure to treat this malformation, termed a [[hysteroscopy|hysteroscopic]] correction or [[metroplasty]], is undertaken by performing a lateral [[incision]] of the uterine walls, and can return the organ to a normal morphology, while improving the patient's former reproductive performance.<ref name="pmid8821883" /><ref name="MeierCampo2015" /><ref name="LinBhatnagar2002">{{cite journal|last1=Lin|first1=Paul C|last2=Bhatnagar|first2=Kunwar P|last3=Nettleton|first3=G.Stephen|last4=Nakajima|first4=Steven T|title=Female genital anomalies affecting reproduction|journal=Fertility and Sterility|volume=78|issue=5|year=2002|pages=899–915|issn=00150282|doi=10.1016/S0015-0282(02)03368-X}}</ref> It is considered a low-risk procedure, and can also improve [[Preterm birth|term delivery]] rate by up to 10-fold, as long as the [[endometrium]] is considered to be in good condition.<ref name="pmid9021378">{{cite journal| author=Noyes N, Liu HC, Sultan K, Rosenwaks Z| title=Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome. | journal=Hum Reprod | year= 1996 | volume= 11 | issue= 12 | pages= 2719-23 | pmid=9021378 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9021378 }} </ref><ref name="pmid21150155">{{cite journal| author=Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarini G| title=Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus. | journal=Gynecol Obstet Invest | year= 2011 | volume= 71 | issue= 3 | pages= 183-8 | pmid=21150155 | doi=10.1159/000317266 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21150155 }} </ref><ref name="pmid1564709">{{cite journal| author=Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP| title=Obstetric outcome in women with congenital uterine malformations. | journal=J Reprod Med | year= 1992 | volume= 37 | issue= 3 | pages= 233-6 | pmid=1564709 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1564709 }} </ref> However, risks after the procedure include [[placenta accreta]], [[Asherman's syndrome]] and severe [[haemorrhage]].<ref name="MeierCampo2015" /><ref name="FernandezGarbin2011">{{cite journal|last1=Fernandez|first1=H.|last2=Garbin|first2=O.|last3=Castaigne|first3=V.|last4=Gervaise|first4=A.|last5=Levaillant|first5=J.-M.|title=Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus|journal=Human Reproduction|volume=26|issue=7|year=2011|pages=1730–1734|issn=0268-1161|doi=10.1093/humrep/der056}}</ref>


==See Also==
==See Also==

Revision as of 12:45, 28 May 2015

A t-shaped uterus is a type of uterine malformation wherein the uterus is shaped resembling the letter t.[1] This is typically observed in DES-exposed women.[2] It is recognised in the ESHRE/ESGE classification,[3] and is associated with failed implantation, increased risk of ectopic pregnancy, miscarriage and preterm delivery. There is a surgical procedure to correct the malformation.[4]

Hysterosalpingography of a T-shaped uterus.
A T-shaped uterus with circular constriction noted around the proximal portion of the marker). The lower uterus appears tapered and narrow.

Causes

The t-shaped malformation is commonly associated with in-utero exposure (the so-called "DES-daughters") to DES, although it is also presented congenitally.[5]

Diagnosis

Women are often diagnosed with this condition after several failed pregnancies, proceeded by exploratory diagnostic procedures, such as magnetic resonance, ecography, and particularly hysterosalpingography.[6][7][8] In such studies, a widening of the interstitial and isthmus of uterine tube is observed, as well as constrictions or narrowing of the uterus as a whole, especially the lower and lateral portions, hence the "t" denomination. The uterus might be simultaneously reduced in volume, and other abnormalities might be concomitantly present.[9]

Prognosis

T-shaped uterus sufferers can bear children, however they carry a greater risk of complications, such as micarriages, reduced fertility and preterm births, both before and after any treatment.[10][11]

The current surgical procedure to treat this malformation, termed a hysteroscopic correction or metroplasty, is undertaken by performing a lateral incision of the uterine walls, and can return the organ to a normal morphology, while improving the patient's former reproductive performance.[10][4][12] It is considered a low-risk procedure, and can also improve term delivery rate by up to 10-fold, as long as the endometrium is considered to be in good condition.[13][14][15] However, risks after the procedure include placenta accreta, Asherman's syndrome and severe haemorrhage.[4][16]

See Also

References

  1. ^ Ben-Baruch G, Menczer J, Mashiach S, Serr DM (1981). "Uterine anomalies in diethylstilbestrol-exposed women with fertility disorders". Acta Obstet Gynecol Scand. 60 (4): 395–7. PMID 7282306.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  2. ^ Rennell CL (1979). "T-shaped uterus in diethylstilbestrol (DES) exposure". AJR Am J Roentgenol. 132 (6): 979–80. doi:10.2214/ajr.132.6.979. PMID 108980.
  3. ^ Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M; et al. (2013). "The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies". Hum Reprod. 28 (8): 2032–44. doi:10.1093/humrep/det098. PMC 3712660. PMID 23771171. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: PMC format (link) CS1 maint: multiple names: authors list (link)
  4. ^ a b c Meier, Rose; Campo, Rudi (2015). "T-Shaped Uterus": 261–270. doi:10.1007/978-1-4471-5146-3_25. {{cite journal}}: Cite journal requires |journal= (help)
  5. ^ Pui MH (2004). "Imaging diagnosis of congenital uterine malformation". Comput Med Imaging Graph. 28 (7): 425–33. doi:10.1016/j.compmedimag.2004.05.008. PMID 15464882.
  6. ^ Baramki TA (2005). "Hysterosalpingography". Fertil Steril. 83 (6): 1595–606. doi:10.1016/j.fertnstert.2004.12.050. PMID 15950625.
  7. ^ Viscomi, G N; Gonzalez, R; Taylor, K J (1980). "Ultrasound detection of uterine abnormalities after diethylstilbestrol (DES) exposure". Radiology. 136 (3): 733–735. doi:10.1148/radiology.136.3.7403556. ISSN 0033-8419.
  8. ^ van Gils AP, Tham RT, Falke TH, Peters AA (1989). "Abnormalities of the uterus and cervix after diethylstilbestrol exposure: correlation of findings on MR and hysterosalpingography". AJR Am J Roentgenol. 153 (6): 1235–8. doi:10.2214/ajr.153.6.1235. PMID 2816640.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ Kaufman RH, Binder GL, Gray PM, Adam E (1977). "Upper genital tract changes associated with exposure in utero to diethylstilbestrol". Am J Obstet Gynecol. 128 (1): 51–9. PMID 851159.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ a b Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V (1996). "Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus". Gynecol Obstet Invest. 41 (1): 41–3. PMID 8821883.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ Berger MJ, Goldstein DP (1980). "Impaired reproductive performance in DES-exposed women". Obstet Gynecol. 55 (1): 25–7. PMID 7352058.
  12. ^ Lin, Paul C; Bhatnagar, Kunwar P; Nettleton, G.Stephen; Nakajima, Steven T (2002). "Female genital anomalies affecting reproduction". Fertility and Sterility. 78 (5): 899–915. doi:10.1016/S0015-0282(02)03368-X. ISSN 0015-0282.
  13. ^ Noyes N, Liu HC, Sultan K, Rosenwaks Z (1996). "Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome". Hum Reprod. 11 (12): 2719–23. PMID 9021378.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarini G (2011). "Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus". Gynecol Obstet Invest. 71 (3): 183–8. doi:10.1159/000317266. PMID 21150155.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP (1992). "Obstetric outcome in women with congenital uterine malformations". J Reprod Med. 37 (3): 233–6. PMID 1564709.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ^ Fernandez, H.; Garbin, O.; Castaigne, V.; Gervaise, A.; Levaillant, J.-M. (2011). "Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus". Human Reproduction. 26 (7): 1730–1734. doi:10.1093/humrep/der056. ISSN 0268-1161.

Further Reading


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