The congenital uterine anomalies (CUAs) are developmental malformations of the shape of the uterus that happen in fetal life. The overall prevalence of CUAs is estimated to be 5.5% in an unselected population, 8.0% in infertile women, 13.3% in those with a history of miscarriage and 24.5% in those with miscarriage and infertility.

Classification

The commonest types of CUAs are:

 

  • Septate uterus
    The uterine cavity is partitioned by a fibromuscular septum, but has normal external contour
  • Bicornuate uterus
    The uterus is present as two separate uterine horns with external indentation
  • Uterus didelphus
    There is double uterus with two separate cervices, and rarely a double vagina. Each uteri horn is linked to one fallopian tube and ovary.
  • Unicornuate uterus
    Only one horn of the uterus is present which is linked to one fallopian tube and ovary with the other horn of uterus is absent or rudimentary.

Symptoms

CUAs are usually asymptomatic. However, they could be associated with subfertility, recurrent miscarriages or preterm birth.

Women with a history of recurrent miscarriages or preterm birth need to have an ultrasound assessment of the shape of their uterus.

Diagnosis

3D ultrasound is a simple and reliable method for the diagnosis of CUAs. It is preferably performed in the 2nd phase of the half of the menstrual cycle and it is a painless procedure that does not require any medication or contrast medium.

Hysteroscopy is the procedure of choice for the confirmation of the type of CUA.

Management

The management of CUAs depends on the type of abnormality and needs to be individualized depending on each woman’s history.

  • Women who have septate uterus and history of subfertility or recurrent miscarriages, it is recommended to have hysteroscopic repair of the shape of the uterus.
  • The repair of bicornuate uterus is performed with metroplasty that is a surgical procedure done by laparotomy or laparoscopy and is associated with increased risk of complications, without proven benefits. Therefore, metroplasty is not recommended.
  • Uterus didelphus and unicornuate uterus behave to some extent as normal uteri and there is no need for intervention.