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Abnormalities of Uterus
14. Feb, 2010
There are serious displacements of uterus usually during pregnancy. Generally, they occur together, but occasionally simple retro-version is found. The cause in majority of cases of uterus displacement has existed before pregnancy ensured and merely persists after the uterus begins to enlarge.
Uterus didelphys (complete duplication of uterus, cervix and vagina).
Uterus bicornis bicollis.
Uterus bicornis unicollis.
Uterus bicornis unicollis (with one horn rudimentar).
Generally the enlargement of uterus and abdomen occurs due to pregnancy plus large tumor, hydramnios, multiple pregnancies or even a mere mistake as to the date of conception. The bladder must be carefully emptied by catheter before examination.
Increase in backward displacement.
Pain on micturition occurs, passing into retention if incarceration occurs.
If by 12th week the uterus is still retroverted, then a large ring pessary (made of plastic) is inserted into the vagina.
The patient is instructed to adopt the semi-prone position and remain in bed for a couple of days in the Sim’s position. It is found after 24 to 48 hours the fundus can be felt in the abdomen. The pessary should be left in vagina until after the 16th week of pregnancy.
If the uterus remains retroverted after 48 hours, then manual reposition of the uterus may be undertaken. Simple manual reposition is done by inserting two fingers in the posterior fornix and pushing the fundus upwards and forwards, maneuvering it past the side of the sacral promontory; the cervix is then caught backwards by one finger and the other hand on the abdomen catches the fundus and depresses it into its ordinary position. After the uterus has been replaced a large ring pessary should be inserted and not removed until after the 16th week of pregnancy.
In case patient with a history of previous abortions, a laparotomy should not be delayed.
The malfunctions of the uterus are usually the result of incomplete fusion of two mullerian ducts or of incomplete absorption of the septum between them. The complications recorded include a high incidence of abortion and premature labor, of inertia during labor, retained placenta, of transverse lies and breech presentations. There are eight types of major developmental abnormalities of the uterus which were shown above.
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