Uterine Anatomic Abnormalities & Miscarriage

Uterine anatomic abnormalities, also known as uterine malformations, can interfere with the ability to carry a pregnancy to term and lead to recurrent miscarriage.

Uterine anatomical abnormalities & repeated miscarriage

More than 12 percent of recurrent miscarriages are linked to uterine abnormalities that are congenital (present at birth). The uterus forms between 8 and 16 weeks of fetal development. If there are problems during any of the three stages of uterine development, the uterus can fail to form properly.

Women with uterine abnormalities may experience higher preterm delivery and first trimester miscarriage than those with normal uterine anatomy.

Types of uterine abnormalities

Some examples of congenital uterine anomalies include the following:

• Septate uterus – A uterus with a thin fibrous band partially or completely dividing it. This common congenital uterine abnormality is associated with high recurrent pregnancy loss
• Bicornuate uterus – The uterus cavity is a heart-shaped uterus that is completely divided into two separate smaller cavities. Miscarriage rates are slightly elevated with a bicornuate uterus and there may be a greater risk of preterm delivery
• Didelphic uterus – A rare condition where there are two separate uterine bodies each with their own cervix. It occurs when the Mullerian ducts (two tubes) don’t fuse together to create a single uterus, but rather remain separate to form double uteri. The condition increases preterm deliveries and miscarriage rates
• Unicornuate uterus – A condition where only one half of the uterus forms. Typically, there is only one fallopian tube, although a partially formed rudimentary tube may be present. Risk of miscarriage, premature birth and breech birth
• Arcuate uterus – A uterus with a slight depression of the fundus. An arcuate uterus is different from a bicornuate uterus because the uterus is normal except for the slight indentation on the external fundus. The condition does not appear to have an impact on pregnancy outcome
• Uterine agenesis – This term describes the complete absence of a uterus, due to failure to develop. This condition renders a woman unable to carry a fetus, but IVF and gestational carrier is an option

Diagnosis of uterine anatomic abnormalities

Uterine anatomic abnormalities are usually diagnosed through the following:

• Ultrasound – a test that uses sound waves to create images of pelvic structures on a computer screen to diagnose certain conditions
• Magnetic Resonance Imaging (MRI) – an imaging test that uses radio waves and a powerful magnet to make detailed pictures of your reproductive organs. MRI does not require radiation
• Fluroroscopy – hysterosalpingogram is a fluoroscopic exam that allows the uterus and fallopian tubes to be visualized by filling the uterus and fallopian tubes with a liquid containing iodine. The path of the fluid is then tracked by x-ray
• Laparoscopy – a minimally invasive procedure that allows your doctor to visualize the organs inside the abdomen.

Symptoms of uterine anatomic abnormalities

Often there are no symptoms of uterine abnormalities and the conditions may not be discovered without pelvic examination or imaging studies. When symptoms are present, they include:

• Never having experienced a menstrual period
• Pain with sex or tampon insertion
• Painful menstruation
• Preterm labor
• Infertility
• Recurrent miscarriage

Treatment & management of uterine anatomic abnormalities

Uterine anatomic abnormalities that impact pregnancy retention may require surgical treatment. Septate uterus may require removal of the band dividing the uterus. Rarely, bicornuate uterus is treated surgically, although treatment is not necessary in most cases.

Surgery is not typically attempted in the case of didelphic uterus, unless the wall separating the cavities is very thin and the health of the fetus is threatened.

In some cases of unicornuate uterus, there is a rudimentary horn and tube that occur when one Mullerian duct fails to develop properly. Studies have shown removal of the rudimentary horn is beneficial to reproductive outcome.

Arcuate uterus requires no treatment.

Cervical cerclage may be indicated, if there is an incompetent cervix associated with a uterine anatomic abnormality.

Contact your local URA clinic in Hasbrouck Heights, Hoboken, and Wayne, NJ for more information. Your friendly URA team will be happy to diagnose and provide treatment options for uterine anatomic abnormalities.