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Home » Misc » Shape of the uterus

Shape of the uterus


Anatomy of pregnancy and birth - uterus

Anatomy of pregnancy and birth - uterus | Pregnancy Birth and Baby beginning of content

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What does the uterus look like?

One of the most recognised changes in a pregnant woman’s body is the appearance of the ‘baby bump’, which forms to accommodate the baby growing in the uterus. The primary function of the uterus during pregnancy is to house and nurture your growing baby, so it is important to understand its structure and function, and what changes you can expect the uterus to undergo during pregnancy.

The uterus (also known as the ‘womb’) has a thick muscular wall and is pear shaped. It is made up of the fundus (at the top of the uterus), the main body (called the corpus), and the cervix (the lower part of the uterus ). Ligaments – which are tough, flexible tissue – hold it in position in the middle of the pelvis, behind the bladder, and in front of the rectum.

The uterus wall is made up of 3 layers. The inside is a thin layer called the endometrium, which responds to hormones – the shedding of this layer causes menstrual bleeding. The middle layer is a muscular wall. The outside layer of the uterus is a thin layer of cells.

Illustration showing the female reproductive system.

The size of a non-pregnant woman's uterus can vary. In a woman who has never been pregnant, the average length of the uterus is about 7 centimetres. This increases in size to approximately 9 centimetres in a woman who is not pregnant but has been pregnant before. The size and shape of the uterus can change with the number of pregnancies and with age.

How does the uterus change during pregnancy?

During pregnancy, as the baby grows, the size of a woman’s uterus will dramatically increase. One measure to estimate growth is the fundal height, the distance from the pubic bone to the top of the uterus. Your doctor (GP) or obstetrician or midwife will measure your fundal height at each antenatal visit from 24 weeks onwards. If there are concerns about your baby’s growth, your doctor or midwife may recommend using regular ultrasound to monitor the baby.

Fundal height can vary from person to person, and many factors can affect the size of a pregnant woman’s uterus. For instance, the fundal height may be different in women who are carrying more than one baby, who are overweight or obese, or who have certain medical conditions. A full bladder will also affect fundal height measurement, so it’s important to empty your bladder before each measurement. A smaller than expected fundal height could be a sign that the baby is growing slowly or that there is too little amniotic fluid. If so, this will be monitored carefully by your doctor. In contrast, a larger than expected fundal height could mean that the baby is larger than average and this may also need monitoring.

As the uterus grows, it can put pressure on the other organs of the pregnant woman's body. For instance, the uterus can press on the nearby bladder, increasing the need to urinate.

How does the uterus prepare for labour and birth?

Braxton Hicks contractions, also known as 'false labour' or 'practice contractions', prepare your uterus for the birth and may start as early as mid-way through your pregnancy, and continuing right through to the birth. Braxton Hicks contractions tend to be irregular and while they are not generally painful, they can be uncomfortable and get progressively stronger through the pregnancy.

During true labour, the muscles of the uterus contract to help your baby move down into the birth canal. Labour contractions start like a wave and build in intensity, moving from the top of the uterus right down to the cervix. Your uterus will feel tight during the contraction, but between contractions, the pain will ease off and allow you to rest before the next one builds. Unlike Braxton Hicks, labour contractions become stronger, more regular and more frequent in the lead up to the birth.

How does the uterus change after birth?

After the baby is born, the uterus will contract again to allow the placenta, which feeds the baby during pregnancy, to leave the woman’s body. This is sometimes called the ‘after birth’. These contractions are milder than the contractions felt during labour. Once the placenta is delivered, the uterus remains contracted to help prevent heavy bleeding known as ‘postpartum haemorrhage‘.

The uterus will also continue to have contractions after the birth is completed, particularly during breastfeeding. This contracting and tightening of the uterus will feel a little like period cramps and is also known as 'afterbirth pains'.

Read more here about the first few days after giving birth.

Sources:
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Labour and birth), StatPearls Publishing (Anatomy, Abdomen and Pelvis), Department of Health (Clinical practice guidelines: Pregnancy care), Better Health Channel Victoria (Pregnancy stages and changes), Mater Mother's Hospital (Labour and birth information), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (The First Few Weeks Following Birth), Queensland Health (Queensland Clinical Guidelines – maternity and neonatal), King Edward Memorial Hospital (Fundal height: Measuring with a tape measure), Royal Hospital for Women (Fetal growth assessment (clinical) in pregnancy), MSD Manual (Female internal genital organs)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: October 2020


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Abnormally Shaped Uterus | Reproductive Science Ctr.

of New Jersey

When a woman’s uterus, or womb, is abnormally shaped before birth (congenital), it can cause obstetric or infertility issues in her reproductive years. These abnormalities can complicate child birth and the child’s health. They can also result in irregular periods or not having any period. According to the March of Dimes, about 3 in 100 women are born with an abnormally shaped uterus.

Many times a woman only finds out about this congenital abnormality when a doctor examines her. The primary types of abnormalities in uterine shape include:

  • Bicornuate uterus is partially split so that it has a heart shape. This occurs when the two tubal structures that normally join to form the womb do not unify during fetal development. Bicornuate uterus is sometimes associated with poor obstetric outcomes like miscarriage and preterm labor.
  • Septate uterus occurs when the tissue of the residual septum wall is not absorbed into the single uterine cavity, as it is during the normal final stage of development. This results in a septum wall in the center that divides the space into two uterine cavities. This abnormality is associated with recurrent pregnancy loss.
  • Unicornuate uterus is when only one side of the womb develops fully, usually with the cervix connected to the vagina. This cannot be corrected and can cause premature delivery and difficulties in childbirth.
  • Didelphic uterus, or double uterus, is when a woman has two separate uterine cavities, each having a separate cervix. This type of abnormality has not been shown to be effectively corrected by surgical treatment.

Many women with an abnormally shaped womb do not have problems conceiving or delivering a healthy child. However, some uterine abnormalities benefit from treatment, which is usually by minimally invasive surgical correction.

Other conditions in the uterus can affect fertility, such as uterine fibroids. Sometimes surgery can result in a uterine problem as well. This page only deals with congenital, structural uterine problems.

How the bicornuate uterus and other uterine abnormalities form

An uterine abnormality occurs when the fetus is in the mother’s womb. During development of the female fetus, the Müllerian ducts begin the formation of the female reproductive tract that includes the uterus, fallopian tubes, the cervix and the part of the vagina that connects to the cervix. Malformation during development can result in different types of abnormally shaped uteri and can similarly affect the vagina.

At about 10 weeks into a female fetus’ development, two Müllerian duct tubal structures form side by side and then unify to create the uterine cavity. At that point, there is still a section of a septum wall, which is tissue that is normally eliminated in the final stage of the womb’s development.

An obstructive abnormality can form when the uterus and the vagina have not unified together. This is called a transverse vaginal septum. Such obstructive abnormalities cause the menstrual blood to remain in the uterus and not leave the body through the vagina. This accumulation can cause severe pelvic pain.

Nonobstructive abnormalities include the bicornuate, unicornuate, septate and didelphic uteri mentioned above. These do not prevent the proper outflow of menstrual blood.

Aside from infertility problems from a uterine abnormality, birthing complications and child health issues may arise. These include:

  • Miscarriage.
  • Breech or other baby positioning problems in the womb.
  • Need for Cesarean section birth.
  • Premature birth.
  • Slower baby growth.
  • Birth defects due to restrictions on the fetus’ growth in the womb.

Uterine abnormality symptoms & diagnosis

Most of the time, a uterine abnormality (also called a uterine anomaly or uterine defect) doesn’t cause the woman to experience any symptoms. Discovering an abnormally shaped uterus in these women generally only happens when they get a pelvic exam or ultrasound, either as a routine screening or to determine a cause for possible infertility.

When symptoms do occur from an abnormality, they can include:

  • Recurrent miscarriages.
  • Not ever having a period.
  • Pain: inserting a tampon, during sex, with menstruation.
  • Monthly abdominal pain, in the case of an obstructive uterine abnormality.

Diagnosis & treatment

A physician will first do a physical examination, if one hasn’t already been conducted. We generally use different types of diagnostic testing to identify if a woman has an abnormally shaped uterus, what kind it is, and what is the best course of action and treatment. Sometimes we will need to conduct more than one of these tests, which include the following.

  • Sonohysterogram (SIS). This involves placement of a catheter into the uterus to allow distention of the uterine cavity with saline. Then while the catheter is inside, a transvaginal ultrasound is performed to visualize the cervix, uterus and ovaries.
  • Hysterosalpingogram (HSG). A contrast dye is injected into the cervix and uterus and X-rays are taken of those areas and the fallopian tubes. The dye results in better images of these organs. Sonohysterogram is often used to distinguish between a septate or bicornuate uterus.
  • Laparoscopy and/or Hysteroscopy. This uses a thin tube with a camera that’s inserted through very small incisions in the woman’s abdomen or through the vagina and cervix (for the latter procedure) to view into the uterus. The images are relayed to a computer screen. If surgical correction needs to be done, it can be done at this time with special surgical instruments inserted through the tube.
  • MRI. A magnetic resonance imaging (MRI) test gives us very good images of the womb and surrounding structures. It is very accurate in diagnosing most uterine abnormality issues.

If these tests result in a diagnosis of an abnormally shaped uterus, the physician will discuss next steps with the patient.

Treatment of an abnormally shaped uterus

Surgery is the only treatment to correct an abnormally shaped uterus, yet many women with such abnormalities don’t need the issue to be surgically corrected. We generally recommend a surgical correction if the woman has had recurrent miscarriages or has compromised fertility due to the uterine abnormality. We may also recommend surgery to correct the issue if she experiences uncomfortable pain regularly.

When appropriate, surgeons will most often perform minimally invasive surgery via laparoscopy or hysteroscopy.

Surgically correcting a septate uterus can improve the chances of a successful pregnancy in a woman with recurrent miscarriages. In the past, surgery could be considered on a bicornuate uterus; however, surgery these days is not the norm for this condition and is reserved mostly for recurrent adverse obstetric outcomes. Additionally, surgical corrections of unicornuate uterus and didelphic uterus have not been shown to be effective treatments at improving pregnancy outcomes.

 

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Saddle uterus.

What is a saddle uterus?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

The saddle uterus is a type of bicornuate uterus; a malformation in which the fundus of the uterus is split in the form of a saddle. The degree of splitting of the bottom of the uterus into two horns varies, but in all cases the shape of the uterus in the section resembles a saddle. The presence of a saddle uterus may not manifest itself in any violations or be accompanied by an increased risk of miscarriage, premature birth, weakness and incoordination of labor, postpartum hemorrhage. The saddle uterus is often combined with other malformations. The saddle uterus is detected, as a rule, by chance - during ultrasound, hysteroscopy, MRI. Surgical correction of the saddle uterus is indicated in case of impaired pregnancy.

    • Causes of saddle uterus
    • Symptoms of saddle uterus
    • Diagnostics
    • Saddle uterus treatment
    • Prices for treatment

    General

    The saddle uterus is a particular manifestation of the bicornuate uterus. With a saddle uterus, a small concave depression in the form of a saddle is formed on the outer surface of the bottom of the organ. In gynecology, of the total number of anomalies in the development of the uterus, the saddle uterus accounts for about 23% of cases. The degree of splitting of the bottom of the uterus into two horns varies: expansion of the transverse size, flattening of the bottom, a slight divergence of the bottom into two horns. In all cases, the shape of the uterus in section resembles a saddle.

    The saddle uterus is often combined with malformations of the urinary system, intrauterine septum, and narrow pelvis. Therefore, the presence of a saddle uterus can be dangerous for the development of primary infertility, various pathologies of pregnancy, birth injuries, postpartum complications, intrauterine fetal death.

    Saddle uterus

    Causes of saddle uterus formation

    Saddle shaped deformity of the uterus is formed between the 10th and 14th weeks of embryogenesis during the fusion of the mesonephric ducts. At the stage of embryonic development, the uterine cavity is initially represented by two uterovaginal cavities separated by a median sagittal septum. By the time of the birth of the female fetus, the septum gradually resolves, i.e., the initially bicornuate uterus first takes on a saddle shape, and then a normal, pear-shaped single cavity. In cases of incompleteness of the formation of the uterus, by the time the girl is born, the concavity in the bottom area remains, which leads to a congenital defect - the saddle uterus. In addition to splitting the bottom with a saddle uterus, there is always its expansion in diameter.

    The causes of disembryogenesis and the formation of a saddle uterus can be various damaging factors that disrupt the proper formation of organs during pregnancy: maternal intoxication (alcohol, nicotine, narcotic, drug, chemical), beriberi, stress, endocrinopathies (thyrotoxicosis, diabetes mellitus), heart defects. Infectious diseases of a pregnant woman - measles, influenza, rubella, syphilis, toxoplasmosis, etc. - have an extremely unfavorable effect on organogenesis. Pregnancy under conditions of toxicosis, chronic fetal hypoxia can contribute to the formation of a saddle uterus.

    Saddle uterus symptoms

    Outside of pregnancy, a woman may not be aware of the presence of a saddle uterus. A slight saddle-shaped deformity of the uterine fundus does not prevent the onset of pregnancy, does not complicate the bearing of the fetus and childbirth. With more pronounced changes, there may be a threat of spontaneous abortion, pathology of the placenta (lateral or low location, placenta previa, premature detachment), transverse position of the fetus, pelvic presentation of the fetus, premature birth.

    During childbirth, the saddle uterus can be a factor in the development of abnormal labor activity - weakness or discoordination. Often, with a saddle uterus in obstetrics, one has to resort to a caesarean section. Anatomical and functional inferiority of the uterus can provoke postpartum hemorrhage. In the absence of proper monitoring of a woman during pregnancy, the risk of perinatal mortality increases. In cases of severe deformation of the uterine fundus, primary infertility may occur.

    Diagnostics

    In the diagnosis of the saddle uterus, a decisive role is played by instrumental studies - ultrasound, USGSS, hysteroscopy, hysterosalpingography, magnetic resonance imaging. A standard gynecological examination with a saddle uterus is not informative.

    In the process of echography of the small pelvis (ultrasound), the saddle uterus is not always detected. With significant deformation, transverse scanning reveals an increase in the width of the fundus of the uterus up to 68 mm, thickening of the myometrium of the fundus wall up to 10-14 mm and its bulging into the cavity of the organ. To detect a saddle uterus, it is preferable to conduct an ultrasound scan with a vaginal probe in the second phase of the cycle with a sufficiently pronounced thickness of the endometrium.

    The most reliable characteristic signs of the saddle uterus are found during hysterosalpingography: on radiographs, 2 mouths of the fallopian tubes are determined, in the bottom area, a small depression in the form of a saddle protruding into the uterine cavity is clearly read. Similar signs are detected during MRI. Hysteroscopy is used to directly visually examine the uterine cavity. In the process of pregnancy management in patients with a saddle uterus, dopplerography of the uteroplacental blood flow is monitored, cardiotocography, and fetal phonocardiography are performed.

    Saddle uterus treatment

    Surgical tactics in the saddle uterus is used only if conception is impossible (in the absence of other reasons) or habitual miscarriage of the fetus. Reconstruction of the uterine cavity is often performed in the process of hysteroscopy through natural routes, without incisions. After correcting the defect, the chances of a normal pregnancy increase tenfold.

    Patients with a saddle uterus should be under the close supervision of an obstetrician-gynecologist from the early stages of pregnancy, strictly follow all the recommendations, and if the slightest violations appear, be hospitalized in a maternity facility. In the case of a complicated pregnancy in patients with a saddle uterus, bed rest, antispasmodics, herbal sedatives, gestagens, deproteinized calf blood hemoderivat, essential phospholipids are prescribed. Tactics regarding the upcoming birth in pregnant women with a saddle uterus is decided in advance.


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