Incomplete septum in the uterus. Pregnancy in extreme conditions

Neither laparoscopy nor hysteroscopy is performed routinely or at the stage of pregnancy planning without sufficient indications. Therefore, a woman receiving nice results annual ultrasound and gynecological examinations, she does not even suspect that she may not be able to bear the child. Spontaneous miscarriages can be repeated many times until an extended gynecological diagnosis using invasive techniques is passed.

This situation is typical for a pathology called "incomplete intrauterine septum". This is a congenital malformation that occurs quite often - in 2-3% of women. In this case, the uterus is divided into 2 parts, which are of different lengths. Sometimes the intrauterine septum (intrauterine septum or septum) runs from top to bottom (then it is called complete).

Getting pregnant and increasing the chances of carrying a child with such a diagnosis is possible only with the help of an operation.

How an intrauterine abnormality occurs

At 3-4 gestational weeks, the primary reproductive gland is formed in the fetus of either sex. If this is a boy, then at 7 weeks this gland turns into 2 testicles and begins to produce testosterone. If a girl, then the ovaries are formed later - at 8-10 weeks.

By the 5th gestational week, the embryo has 2 pairs of reproductive ducts: Wolffian and Müllerian. If by the 8th week these structures do not feel testosterone, then the Wolffian ducts partially die off, and a small part of them takes part in the formation of the kidney.

Müllerian ducts converge and grow together, forming the uterus. The common wall with which they adhere to each other dissolves by 19-20 intrauterine weeks, so that one cavity is formed. If this does not happen, and the wall, which fused the ducts, has not undergone destruction throughout or in part, a developmental anomaly is formed - the uterine cavity divided in two. This is what an intrauterine septum is.

48-55% of all female genital anomalies are septum in the uterus. The most commonly diagnosed incomplete septum, 1-6 cm long; The uterus completely divided by the wall (from its bottom to the canal in the cervix) is much less common. This defect is often combined with abnormalities in the development of the kidneys.

Causes of the anomaly

The reasons for the formation of an intrauterine septum are rarely genetic. Basically, this is the impact unfavorable factors on the fetus just at the time when the formation of the uterus occurs - from 10 to 20 weeks.

The following can act as damaging agents:

• bad habits of the mother;
• toxicosis of pregnancy;
• infections transferred by the mother, especially those included in the list: chlamydia, herpes, and measles;
• diabetes in a pregnant woman - that was available before conception or that appeared during gestation ();
• taking toxic drugs;
• the influence of industrial and household toxins on the body of the mother and fetus;
• violations of the formation or attachment of the placenta, which coincides in time with the formation of the uterus - 12-16 weeks;
• poor maternal nutrition when normal daily requirement in proteins, essential amino acids, vitamins and trace elements;
• getting the mother under ionizing radiation.

Symptoms

This developmental defect does not have noticeable manifestations in everyone: most girls note only a little more painful periods than it should be. But this does not force them to see a doctor, because they do not know how normal periods feel.

The second manifestation of the intrauterine septum is uterine bleeding, sometimes developing in the middle of the cycle, but often appear during menstruation, which increases the volume of the latter.

The third and rarest manifestation is primary, when menstruation does not occur at all.

Most often, an anomaly is detected only when a woman begins to be examined in depth for reasons such as the impossibility of conception or habitual miscarriage. The disease can also be detected if, based on the ultrasound detection of an abnormal structure of the kidneys, the doctor also recommends a thorough examination of the reproductive organs.

Intrauterine septum and pregnancy

The presence of an intrauterine septum can affect a woman's ability to become pregnant in one of two ways.

First, it can cause infertility. In 21-28% of women with this defect, primary infertility is observed - when pregnancy has never occurred. In 12-19% - this is a condition of a secondary nature, when a woman managed to give birth to one child, but after that she can no longer get pregnant.

Secondly, sometimes the septum becomes the cause. In the first trimester, the risk of such a phenomenon is high - 28-60%. This is due to the fact that there is a high chance of embryo attachment not to the wall of the uterus, which will give the placenta the opportunity to develop and provide sufficient nutrition for the developing organism. The embryo is often attached precisely to the intrauterine septum - a formation that does not have vessels and, accordingly, is unable to perform a trophic function.

During pregnancy in the 2nd trimester, if the fetus was able to gain a foothold on the wall of the uterus, and not on the septum, the risk of miscarriage still exists, albeit much lower - only 5%. One of the reasons is that the intrauterine membrane, especially if it is full, leads to non-closure of the walls of the cervical canal. As a result, the cervix loses its ability to withstand intrauterine pressure, which increases as the fetus grows, and without timely correction, a miscarriage may occur. The second reason for a miscarriage in the second trimester is that an obstruction inside the uterus prevents the cavity from enlarging in proportion to the growing fetus.

But the statistics are comforting: in 50% of cases, the septum in the uterine cavity does not interfere with either conception or bearing a fetus. Although its presence increases the risk that the fetus will be located transversely, and it will need conduction for its birth.

The influence of pathology on the course of childbirth

Intrauterine septum can cause:

• ... They begin due to the pressure of the septum on the fetus, which has already become quite large.
• Deterioration of the contractile ability of the uterus: the muscles of the second half of the uterus (on the side where the fetus did not develop) did not stretch so much during its growth. As a result, discoordination or weakness develops. generic activity... Less often, the intrauterine membrane becomes the cause of a life-threatening condition for the woman in labor, when, after the end of labor, the uterus relaxes, which causes profuse bleeding, which can only be stopped by deleting it.

Such complications are more common with a complete intrauterine membrane.

Diagnostics

A septate uterus is an abnormality that is often difficult to diagnose. When gynecological examination it cannot be found. Ultrasound of the small pelvis also turns out to be uninformative, and if it reveals a thin-walled structure in the middle of the uterine cavity, then it is not clear whether it is an intrauterine membrane or. The method of hydrosonography is more informative - carrying out ultrasound diagnostics against the background of filling the uterine cavity with sterile fluid.

Hysteroscopy or its subspecies, fibrohysteroscopy - the introduction of an optical device into the uterine cavity - is performed under anesthesia, since it will be necessary to open the cervix, which has a huge number of nerve receptors, and then fill the uterus itself with gas or liquid. This study allows you to see the connective tissue membrane with your eyes, estimate its length and thickness, and also examine the volume of the uterine cavity. The study is carried out in the first half menstrual cycle while the endometrium is still small enough.

The diagnosis of the length of the intrauterine septum is made according to the data obtained (this is important for treatment). As a result, there are:

• full septum: extending to the internal or external os;
• incomplete - 10-40 mm long;
• septum on a broad base (triangle in projection).

Laparoscopy is the introduction of an optical device into the abdominal cavity and small pelvis through incisions. It allows you to examine the uterus "from above", to see that there are no two muscle ridges (that is, the uterus is not two-horned), and the organ itself can be expanded in the transverse direction. Laparoscopy allows you to see if the uterine halves are asymmetrical. The method also evaluates the condition of the ovaries, fallopian tubes, peritoneum.

Considering that only a combination of hysteroscopy and laparoscopy is the "gold standard" in diagnosis, the definition of an intrauterine septum during pregnancy is difficult.

Treatment

The septum cannot be eliminated in any other way than surgical. But not all surgeons are ready to do this only on the basis of the diagnosis: many undertake the operation only when primary infertility or recurrent miscarriage, but not if the patient has a history of one successful pregnancy. They explain this by the fact that the chance of a successful pregnancy after surgery is not 100%, but 85-90%. Other specialists, on the contrary, believe that only the presence of pathology itself serves as an indication for its removal.

The dissection of the intrauterine septum is performed under full visual control through a hysteroscope

On the currently the operation consists in dissecting the intrauterine septum. It is carried out through a hysteroscope, under full visual control. Anesthesia is common. As preoperative preparation sometimes antigonadotropin drugs are prescribed for a course of 2-3 months. They cause an artificial menopause, but at the same time reduce the thickness of the endometrium, and thereby reduce the volume of blood lost during the intervention.

If the septum is thin, it is dissected with endoscopic scissors or a laser. In the case of a thick or vascular-rich septum, it is removed with a hysteroresectoscope - a "loop" introduced through the channel of the hysteroscope, which "cut" with an electric current, while simultaneously cauterizing the bleeding vessels.

If the septum of the uterus was complete and entered the cervical canal, its cervical part is preserved in order to prevent the development of isthmic-cervical insufficiency, complicating the normal course of pregnancy.

If the uterine cavity has been deformed, after removal of the septum, it is reconstructed. The total duration of the intervention is up to 60 minutes.

After the operation, you should not immediately plan a pregnancy: 2-3 months will have to be taken hormonal drugs-estrogens - to prevent the formation of intrauterine adhesions. You may need to follow contraceptive measures for up to 13 months after surgery.

The structure of a normal uterus

The uterus is an organ reproductive system women. It is located in the small pelvis between bladder and rectum. The length of the uterus is on average 7-8 cm, width - 4-6 cm, weight - 50-60 g.

The upper, pear-shaped, part of the uterus is called the body of the uterus, the lower, which connects to the vagina, is called the cervix. From the lateral surfaces of the uterus, the fallopian tubes extend, connecting it to the ovaries. The fallopian tubes "fluff" at the ends, forming fimbriae, which help the egg to get into the fallopian tubes.

The position of the uterus can change: it can move backward when filling Bladder, forward - when filling the rectum. During pregnancy, the uterus rises up.

The structure of the uterus changes with age. IN childhood it is small, no cyclical changes occur in the endometrium (the inner layer of the uterus). Into adolescence and further into reproductive period the uterus increases in size, the endometrium begins to function. During menopause, the uterus shrinks and becomes older.

Incorrect "device" of the uterus

There are pathologies in which septa are found inside the uterus or vagina. Such anomalies include: vaginal septum, saddle, one-horned and two-horned uterus, double uterus and double vagina, two-horned uterus with one closed vestigial horn... Some of these pathologies do not interfere with motherhood, and for some, pregnancy and childbirth are possible only after plastic surgery. Sometimes the diagnosis (vaginal septum, saddle or bicornuate uterus) is established during pregnancy, causing difficult labor and surgery.

These malformations of the uterus are quite rare (in 0.1-0.5% of women). Basically it is a two-horned or saddle-shaped uterus. It has been established that uterine malformations are often the cause of infertility, spontaneous miscarriages, premature birth, weakness of labor, abnormal fetal positions, bleeding in the postpartum period, as well as increased perinatal mortality, especially in the absence of the necessary monitoring during pregnancy.

Normal at 10-14 weeks intrauterine development girls, the formation of the uterus begins from the merged so-called Müllerian ducts, that is, from two identical halves - the right and left. Their fusion leads to the formation of two uterovaginal cavities, separated by a median septum, which later disappears, and the uterus becomes unicameral.

Treatment before pregnancy

Surgical treatment is most effective in the presence of an intrauterine septum and synechiae - intrauterine adhesions. Preference is given to hysteroresectoscopy - removal of septa and adhesions during hysteroscopy. The incidence of subsequent miscarriages in this group of women is 10%, compared with 90% before surgery. Removal of the intrauterine septum is performed with a hysteroresectoscope with mandatory control from the abdominal cavity for the depth of the dissection. For this in abdominal cavity injected through small holes optical instrument- a laparoscope that allows you to see what is happening in the pelvic cavity.

Intrauterine septum. It is a remnant of tissue with poor blood supply in the uterine cavity. In this case, a septum is formed, extending from the fundus of the uterus. The attachment of the embryo in this septum or in the septal uterus makes abortion, premature birth and fetal malposition (breech presentation) very likely. Hysteroscopic correction of this defect is easy and very effective. (Hysteroscopy is a procedure during which a special optical device, a hysteroscope, is inserted into the uterus; it allows you to see everything inside the uterus, while surgical instruments can be inserted into the uterus.) The frequency of miscarriage in operated patients decreases from 80-90% to 10%. fifteen%.

One-horned uterus. It occurs as a result of a violation of the development of one of the Müllerian ducts, as a result of which a woman has only one oviduct... The likelihood of carrying a pregnancy largely depends on the size of the cavity of the one-horned uterus. Usually, a one-horned uterus leads to the highest risk of miscarriage compared to other anomalies of the fusion of the uterine buds. Unfortunately, effective treatment this vice does not exist. A one-horned uterus is often combined with other developmental anomalies (agenesis - the absence of a kidney on the side of the missing Müllerian duct) and a complicated obstetric history (malposition of the fetus, intrauterine growth retardation, premature birth, miscarriages). Pregnancy in a one-horned uterus can be complicated by the threat of termination, premature birth. Childbirth with a one-horned uterus is sometimes accompanied by weakness of labor.

Bicornuate uterus. Violation of the fusion of the Müllerian ducts leads to the formation of one cervix and two uterine cavities.

The bicornuate uterus is divided into two parts at different levels, which always merge in the lower sections. With pronounced splitting into two parts, two one-horned uterus are determined, as it were. In other cases, the cleavage may be very mild; at the same time, there is an almost complete fusion of both horns, with the exception of the bottom, where a saddle-shaped depression is formed, which forms the uterus of the same name.

There are three types of two-horned uterus: saddle, incomplete and complete.

When incomplete form two-horned uterus, division into two horns is observed only in the upper third; the size and shape of the uterine horns are usually the same.

When full form division into two horns occurs in such a way that they diverge in opposite directions at a greater or lesser angle, which depends on the severity of this malformation.

With a bicornuate uterus with one neck, pregnancy often occurs in one of the horns, less often in both horns at the same time. Pregnancy and childbirth can proceed without complications. However, pregnancy in women with a bicornuate uterus often occurs with symptoms of the threat of termination, therefore, in this case, careful medical supervision is required. There is an increased risk of preterm labor and breech presentation. There may be a pathology of the location of the placenta (low placentation, placenta previa), which threatens with detachment. With this structure of the uterus, the position of the fetus may be such that childbirth through natural birth canal will be impossible, then resort to caesarean section... As already mentioned, with this pathology, a woman, starting from the earliest stages of pregnancy, should be under the close supervision of a doctor, follow all his recommendations and when the slightest appears warning signs ask for help.

Patients with recurrent miscarriage (multiple miscarriages), bicornuate uterus and eliminated others possible reasons miscarriages restore the uterine cavity promptly. In this case, an operation is performed with a dissection of the anterior abdominal wall(laparotomy), the formation of a more complete body of the uterus. The rehabilitation period after laparotomy is long (several weeks). Result surgical treatment successful enough, the risk of miscarriage falls from 90-95% to 25-30% after surgery.

With a saddle-like shape, the uterus is somewhat expanded in diameter, its bottom has a slight depression, splitting into two horns is not very pronounced, i.e. there is an almost complete fusion of the uterine horns with the exception of the bottom. The bicornuate uterus is formed at the 10-14th week of intrauterine development, then acquires a saddle shape and by the time of birth often retains a weakly expressed saddle shape.

Conception with this structure of the uterus is possible. But due to the fact that a malformation of the uterus is a manifestation of other problems of the body, for example, it can be combined with defects of the urinary system, there may be problems with carrying a pregnancy. Pregnancy and childbirth with a saddle uterus can proceed without complications. If the saddle uterus has a septum, pregnancy often ends in spontaneous miscarriage.

Availability saddle uterus often combined with a narrowing of the pelvis, the pathology of the uterus leads to an incorrect position of the fetus, which makes it impossible to give birth through the natural birth canal; in such cases, you have to resort to caesarean section.

Currently, hysterosalpingography, hysterography and magnetic resonance imaging are used to diagnose the saddle uterus - various forms X-ray examination... With hysterosalpingography and hysterography, an X-ray contrast agent is injected into the uterus, after which X-rays are taken, with tomography, the pelvic organs are taken at different levels. Most characteristic feature saddle uterus with hysterosalpingography is the identification on radiographs in the bottom of the uterus of a small depression in the form of a saddle.

Doubling of the uterus. This is the name of a complete violation of the fusion of the Müllerian ducts with a doubling of the uterus and its cervix (both are smaller than normal). Usually combined with the presence of a septum in the vagina. At the same time, obstruction (obstruction) of one of the ducts is sometimes observed, which leads to the formation of hematometers: in the uterus, which does not have communication with the vagina, menstrual blood accumulates, which causes pain syndrome- such phenomena occur in a girl in adolescence, with the onset of menstruation.

This anomaly also has an increased incidence of premature birth and fetal misalignment. Doubling of the uterus can sometimes lead to difficulties in conception and gestation. To be sure that both uterus can tolerate pregnancy, you should be carefully examined. If this is true, then pregnancy is possible. It will develop in one of the uterus, while the other uterus increases slightly, its mucous membrane undergoes changes characteristic of pregnancy. Often there is a threat of termination of pregnancy, premature birth is possible. In cases where pregnancy in one of the uterus is interrupted, curettage of the mucous membrane of the non-pregnant uterus is performed due to the danger of uterine bleeding. Since this condition is still an anomaly, it is possible that there are defects at a different level. Such women usually have hypofunction (decreased function) of the ovaries and hormonal deficiency, underdevelopment of the uterus, etc. However, this does not exclude the possibility of having children. You should carefully prepare for pregnancy, as well as the entire pregnancy should be under close medical supervision - preferably in a large medical institution.

Termination of pregnancy with these anatomical abnormalities of the uterus may be associated with unsuccessful implantation (attachment) fetal egg(often - on the intrauterine septum), an underdeveloped vascular network and endometrial receptors, often - with concomitant isthmic-cervical insufficiency, in which the muscles of the cervix do not close the exit from the uterine cavity, as well as with hormonal disorders.

Longitudinal septum of the vagina.

The prognosis for pregnancy is good. With an incomplete longitudinal septum of the vagina, childbirth is carried out through the natural birth canal, since it, as a rule, does not interfere with the passage of the presenting part of the fetus. Less commonly, the septum has to be excised during childbirth. With a full longitudinal septum of the vagina, cesarean section is more often resorted to.

In the management of pregnancy in patients with anomalies in the structure of the uterus in the early stages, bed rest is advisable, the appointment of antispasmodic SHO-SHPA) and herbal sedatives, therapy with DUFASTON 1 and UTROZHESTAN - drugs that contribute to the preservation of pregnancy up to 16-20 weeks. Other medications are also prescribed, including more late dates, for normal metabolic processes and prevention of fetal growth retardation. A woman is also recommended to take drugs that improve blood circulation in the vessels of the placenta: ESSENTIALE-FORTE, ACTOVEGIN, TROXEVASIN.

Childbirth with all types of these anatomical disorders of the structure of the uterus can be complicated by various disorders of labor. Therefore, women with anomalies in the structure of the uterus must necessarily give birth in conditions medical institution, where there is the possibility of timely provision of emergency assistance.

Nowadays, many women suffer from various pathologies uterus, which often lead to a violation reproductive function... One of the most common pathologies, which occurs in 48-55% of cases, is the presence of an intrauterine septum. This anomaly characterized by the presence of two halves in the uterus, which are separated by a septum. Talking about the total women who suffer from this defect, it is 2-3% of the total female population.

It can have different lengths, in this regard, there is a division into a complete and incomplete intrauterine septum. It should be noted that the complete intrauterine septum reaches the cervical canal, in individual cases the septum reaches the vagina. But this species is very rare. The second type occupies only part of the cavity, the length of such a septum varies from 1 to 4 cm. Nevertheless, even an incomplete intrauterine septum can provoke infertility.

The intrauterine septum is quite dangerous, since it can provoke the development of many diseases, and most importantly, deprive a woman of the ability to bear and give birth to a child. If you have been diagnosed with an intrauterine septum, you must immediately begin treatment, the development of pathology is very dangerous.

The reasons for the development of the intrauterine septum

How does the intrauterine septum develop? The uterus is formed by the Müllerian ducts. As a result of a natural process, which is characteristic of the 19-20th week of gestation, the median septum dissolves, and a single uterine cavity is formed. If this does not happen, the median septum is preserved.

Also, an intrauterine septum can occur for the following reasons:

• infectious diseases of the mother (rubella, measles, toxoplasmosis, etc.);
• heredity;
• drug exposure;
• severe toxicosis during pregnancy;
• heavy endocrine diseases mothers (diabetes mellitus, etc.);
• onizing radiation;
• unsatisfactory nutrition;
• bad habits.

Quite often, the intrauterine septum may not manifest itself long time... That is why women often find out about this pathology through accidental diagnosis.

Intrauterine septum symptoms

The intrauterine septum is accompanied nonspecific symptoms, which in each case appear individually. First of all, it is worth highlighting menstrual irregularities by the type of pathological uterine bleeding.

Also, a deviation can manifest itself with the help of other symptoms:

• primary amenorrhea;
• infertility;
• dysmenorrhea;
• premature birth;
• spontaneous miscarriages.

A woman who has been found to have an intrauterine septum runs the risk of not carrying a child, even if she has already managed to become pregnant. In the first trimester of pregnancy, the risk of miscarriage is 30-60%, in the second it decreases by only 5%. In addition, the intrauterine septum during pregnancy often leads to premature birth.

You can also highlight the violation of the contractile abilities of the uterus and the wrong position of the fetus. Along with this, the physiological process of pregnancy will change.

Thus, the intrauterine septum has a negative effect on the body during pregnancy, due to the following factors:

• isthmic-cervical insufficiency;
• implantation of the embryo on the septum;
• insufficient volume of the uterine cavity (the fetus cannot develop freely).

An incomplete intrauterine septum during pregnancy is not so dangerous. But this anomaly can provoke bleeding, algomenorrhea, inability to conceive or bear a child.

In any case, doctors assure that even an intrauterine septum will not prevent a woman from enduring and giving birth completely healthy child... However, pregnancy will be more complex, which should be understood by every patient.

Diagnostics of the intrauterine septum

It should be understood that diagnostics will reveal the features, stage and complexity of the course of the disease. Modern medicine proposes different methods studies that make it possible to diagnose a pathology such as an intrauterine septum. Let's take a closer look at this process.

Hysterosalpingography. In relation to this method, the opinions of specialists differ somewhat. Carrying out hysterosalpingography will allow to examine only the internal contours of the uterine cavity. External contours are not taken into account. The patient can be considered healthy, although this does not guarantee that she does not have any types of uterine malformations. Therefore, hysterosalpingography is not always able to detect such an anomaly as an intrauterine septum.

Ultrasound procedure. In most cases, an ultrasound scan coincides with the period of pregnancy, so women learn about the presence of a disease such as an intrauterine septum during pregnancy. But ultrasound does not always help identify septa in the uterus. On the echogram, the septum is defined as a thin-walled structure that has an anteroposterior direction. Best result gives hydrosonography, with the help of which it is possible to understand whether a woman has an intrauterine septum. Currently, they began to use ultrasound devices that allow you to display an image in three dimensions. This method allows you to identify the septum with a probability of 95%. If fears were confirmed that the patient has an intrauterine septum, then doctors prescribe another examination of the kidneys and liver.

Endoscopic research methods. A more accurate result can be obtained with a combination of hysteroscopy and laparoscopy. The fact is that the results of hysteroscopy give an identical picture both with a septum in the uterus and with a two-horned uterus. In turn, conducting laparoscopy will allow you to more accurately determine the nature of the uterine malformation. In addition, when the septum is excised, laparoscopy allows you to monitor the progress of the hysteroscopy.

They also practice magnetic resonance imaging and X-ray computed spiral tomography. These methods make it possible to make a more accurate diagnosis if an intrauterine septum was initially identified.

Intrauterine septum treatment

According to many experts, the intrauterine septum should be removed surgically immediately after detecting violations of the functions of childbirth. According to other experts, the patient should plan the excision of the septum in advance so that complications do not arise.

Modern medicine proposes to deal with the intrauterine septum using transcervical dissection under the control of a hysteroscope. A thin septum is dissected using endoscopic scissors, wide, thick, vascularized - with a hysteroresectoscope. A laser is also used, with which it is easy to cut the intrauterine septum.

Prognosis after removal of the intrauterine septum

As practice shows, the intrauterine septum is best removed using the excision method, which is the most gentle and less traumatic among all operations, after which no scars are formed and the possibility (by 70-85%) of a natural outcome of childbirth increases. But in some cases, complications may arise that cause infertility. In any case, the most suitable method treatment can only be prescribed by a specialist.

Collapse

One of the reasons for miscarriage is the septum in the uterus during pregnancy. If a woman has such an anomaly, she may be completely sterile or suffer miscarriage after miscarriage all the time. Of course, there are cases when the pregnancy proceeded normally, and the child was born healthy, but once at a time it is not necessary. IN modern world there is a way out, medicine works wonders and will correct all the mistakes of nature in a short time, you will not need to hope for a chance.

What is a septum in the uterus?

The septum in the uterus is determined in 3% of women. If we talk about all anomalies of the genital organs, then this is about 50%. It comes in various lengths, and the diagnosis and treatment depend on it. The septum can be full, and go to the very neck and incomplete. There is also a transverse and longitudinal pathology.

Main female organ develops from 2 identical halves, in the process of formation they must reunite and thus form one whole. But, if there is any negative factor exposure, then a septum remains, which is considered a developmental defect.

Reasons for the appearance

An anomaly may appear due to:

• hereditary predisposition, gene factor;
• maternal infections, especially during the 1st trimester (rubella, influenza, chickenpox, measles, toxoplasmosis, herpes and other similar diseases);
• the presence of severe preeclampsia;
• smoking, drinking alcohol in any quantity and addiction to narcotic substances;
• endocrine diseases;
• insufficient functioning of the placenta;
• poor nutrition (low-quality, vitamin-free);
• the use of dangerous medicines;
• the action of chemicals, radiation, etc.

If any factor influenced the body of a pregnant woman, especially in the initial period (first 14 weeks), when all organs in the baby are laid, then there is a risk of various anomalies in their structure.

The influence of the septum of the uterus on the course of pregnancy

The intrauterine septum during pregnancy is not always a barrier to a woman becoming a mother. 45% of females with such an anomaly successfully become pregnant, carry and give birth.

Before planning a pregnancy in the first place, you should consult your doctor, go through full examination... If necessary, the defect must be removed even before conception. In the absence of medical supervision, pregnancy can result in the loss of the fetus for early term or premature birth, with the loss of an already formed small organism.

The septum in the uterus during pregnancy means that its course will be 65% with pathologies. Most women spend years trying to get pregnant, but, alas, conception does not occur.

Septum of the uterus on ultrasound

If conception has occurred, then further problems occur due to the fact that:

• the uterine cavity has a small volume, which prevents the growth and development of the fetus;
• the embryo was attached to the septum, which does not have blood vessels, and this affects the fetus;
• the anomaly becomes the cause of the impaired "locking" function of the cervical canal.

With an incorrect anatomical structure of the uterus, only surgical intervention can save from infertility.

If there is an incomplete septum in the uterus, then surgery can be avoided, but it is important to constantly be under the supervision of a doctor. The specialist is obliged to thoroughly study all the nuances and lead the pregnancy responsibly.

During the first trimester, there is a risk of miscarriage in pregnant women - this is about 45%. During the second trimester, premature delivery occurs, resulting in fetal death - this is 6%. During childbirth, the contractility of the organ is impaired, the fetus takes the wrong position.

In females with an intrauterine septum, regular uterine bleeding and dysmenorrhea are mainly present.

What to do if a septum is found during pregnancy?

It is easy to find the septum on ultrasound examination- the triangular tissue divides the uterus in two. A full septum is a lot of problems, so many experts recommend removing it before conception. If it is incomplete, then it is sometimes left, since 50% of women can normally bear and give birth to a baby without pathologies.

If the septum is found during pregnancy. Most gynecologists try not to touch anything and actively monitor the development of the embryo.

The doctor regularly examines the patient, carefully listens to the fetal heartbeat and probes the size of the uterus. A special role is given to ultrasound, which, perhaps, puts all the points. The most pregnant is shown:

• lead healthy image life (in any case, do not smoke, or use alcohol and drugs);
• give up harmful production, the use of any chemicals in everyday life;
• consume as many vitamins as possible, eat well and properly;
• do not overwork, avoid heavy physical labor;
• walking more in the fresh air;
• at the slightest discomfort, go to the hospital immediately.

But this continues as long as everything coincides in terms of time, and there are no deviations. In case of a desperate situation, endoscopic surgical treatment is offered. This restores fertility and minimizes all risks of complications. The procedure is less traumatic and the subsequent pregnancy will not be problematic. Sometimes this diagnosis is the reason for a cesarean section.

If the pregnancy had to be terminated or a spontaneous miscarriage occurred, doctors wait 2-3 months until the body recovers, and only then begin to act. Before surgical treatment prescribe hormonal drugs, which a woman must drink for about three months. After them, the endometrium becomes thinner. If there is no time to wait, then the operation is performed in the 1st phase of the cycle and hormone therapy optional.

To clarify the anomaly and to observe it in the future, laparoscopy, hysteroscopy or fibrohysteroscopy are used.

If the patient is given the opportunity to choose a corrective surgical intervention, it is better to choose a technique that preserves the muscle layers of the uterus. This will improve the functionality of the organ during childbirth and during gestation. Previously, they always used the traditionally Jones operation, according to Strassman, Tompkins. There are many disadvantages in such surgical interventions, namely: the abdomen was dissected, protectors were inserted into the uterine cavity, the woman had to stay in the hospital for a long time, after adhesions and synechiae formed. After such treatment, spontaneous delivery was rare, because the uterus could simply rupture, so a cesarean section was performed in two to three weeks. It is possible to carry out the operation even now with the usual surgical intervention, but after that the wound heals for a very long time. Recovery period can take up to 12 months due to serious injuries. The duration of the operation itself is much more significant, there is blood loss.

It is still preferable to remove the defect using hysteroresectoscopy, general anesthesia. Laparoscopic observation is carried out if necessary. This method does not damage the muscles of the organ and during childbirth the contractile ability of the middle layer is preserved. After manipulation, there are no extensive bleeding and adhesions. After treatment, the chances of becoming a mother increase several times, and you can give birth on your own.

If the operation is performed in a resestoscope, then a bipopular loop, special ultra-flexible and thin scissors or a spherical electrode are used. Thin partitions are removed with scissors. It is difficult to dissect large partitions with them; it is advisable to use a resestoscopic loop. The branches conduct electricity to the organ, and the loop cuts through the septum. First, it happens from below, then the movement goes to the bottom, this is how a smooth surface is formed.

During resection, the cervix dilates. To do this, use Hegara dilators, then a resectoscopic sleeve is inserted into the uterine cavity. If there is local or diffuse bleeding, then hemostasis is done.

The mouths of the pipes should be visualized at all times. To see the thickness of the organ wall, the specialist uses a luminous ball. If there is a sanitary groove on the organ, then everything is done with extreme caution. To stretch the uterine cavity, a special fluid is injected through a hysteroscopic pump. The most commonly used solutions are Mannitol and Rheopolyglucin.

What are the consequences for a pregnant woman?

The septum in the uterus during pregnancy can lead to fetal loss in the 1st or 2nd trimester. If the pregnancy persists, then in 65% it will proceed with pathologies. Sometimes doctors keep it and lead it to the end. But, if, according to the indications, it makes sense to terminate the pregnancy, then you should not resist. Some women with such a diagnosis will not be able to give birth on their own, they need a cesarean section.

The septum found in the uterus during pregnancy does not always lead to a disastrous outcome. It makes sense to be patient, visit a doctor regularly, follow all his prescriptions, and as a result, you will have a wonderful healthy baby... If possible, treat before planning.

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One of the pathologies of the uterus is the presence of a septum in it, which divides the uterus itself into two parts. For her there is special term- two-horned uterus. The main problem is that women with such a diagnosis often face a number of problems. She is more likely to have a premature miscarriage, and in the second trimester, there is a risk of premature birth. Modern treatment from specialists will help to reduce such risks without endangering the health of both the baby and the mother.

Types of partitions

Depending on the location of the septum in the uterus, they are divided into several types:

• Full septum: the uterine cavities are interconnected by a septum.
• Incomplete septum: it occupies only part of the cavity.
• Serloid septum: in case the degree of septum separation is minimal: there is only a slight depression.

When making a diagnosis of any of these types, medical supervision is necessary to avoid various complications. In some cases, your doctor may advise you to remove the septum to ensure successful conception and the development of pregnancy.

Problems during conception and pregnancy

• Often, due to the septum, the uterus has insufficient volume, thereby impeding the growth of the fetus.
• The embryo can attach itself to the septum itself, which has no vessels. As a result, there is no possibility of its normal development.
• Locking function uterine cervix can be violated.
• The septum can interfere with the correct positioning of the fetus.

Diagnostics

If there is a suspicion of the presence of a septum in the uterus, doctors prescribe a study using one of the following methods. Often, the septum is found during ultrasound already during pregnancy.

• Hysterosalpingography. Not really exact method, allowing to diagnose the septum in only half of the cases. The fact is that this method allows you to see only the inner contours of the uterus, and the outer ones are not visible at all.
• Ultrasound. The accuracy in comparison with the first method increases up to 95%. However, there are difficulties in determining the type of partition and its features.
• Hydrosonography. Very effective method, which allows you to determine both the type and thickness of the partition.
• Hysteroscopy coupled with laparoscopy provides the most accurate diagnosis. Laparoscopy makes it possible to assess the external contours of the uterus and create a more complete picture in the presence of this pathology.
• Tomography. The method is accurate, but quite expensive.

Solution to the problem

In the case of a complete uterine septum, which prevents the process of conception, doctors advise to remove the septum to restore anatomical structure. Surgical intervention- the main method of treatment for this pathology. This intervention is non-traumatic and does not leave scars. Therefore, no consequences are observed during subsequent conception and gestation. It is, of course, better to do this before planning a pregnancy.

• If a septum is found in the uterus during the next ultrasound scan, then active monitoring is necessary. Sometimes the presence of a septum is an indication for a caesarean section. In most cases, with the right approach, both successful conception and bearing of the fetus are possible. Surgical intervention during pregnancy is not possible.
• Sometimes the septum is so thin and small in size that if it is detected at an early ultrasound scan, it may not show up on subsequent ones. The fact is that in such cases, it simply naturally bursts with the growth of the uterus and fetus without any unpleasant consequences.