abnormal uterine development
Introduction
Introduction to uterine dysplasia Congenital uterine dysplasia is the most common type of genital malformation, and its clinical significance is relatively large. In the process of evolution, the bilateral middle and middle kidney tubes are affected and interfered by certain factors, and can stop developing at different stages of evolution to form various dysplastic uterus. basic knowledge The proportion of sickness: 0.01% Susceptible people: women Mode of infection: non-infectious Complications: amenorrhea, dysmenorrhea, infertility, habitual abortion
Cause
Cause of uterine dysplasia
The causes of uterine dysplasia are multifaceted. At present, the basic research in this field is not deep enough. The study found that the bilateral renal tube in the process of evolution is affected and interfered by certain factors, and can be stopped at different stages of evolution. Developed to form a variety of dysplastic uterus.
Prevention
Uterine dysplasia prevention
When your mother is pregnant, care should be taken to avoid exposure to substances that are harmful to development.
Complication
Uterine dysplasia complications Complications amenorrhea dysmenorrhea infertility habitual abortion
Can cause amenorrhea, dysmenorrhea, infertility or habitual abortion.
Symptom
Symptoms of uterine dysplasia Common symptoms Lower abdominal pain Primary dysmenorrhea Abdominal pain Amenorrhea Dysmenorrhea Bleeding abnormal fetal position Single or double uterus Postpartum hemorrhage Muscular dysplasia
First, several types of uterine dysplasia
(1) Congenital absence of uterus and uterine hypoplasia:
The latter refers to the different naive stages in which uterine development stays from the fetal period to the puberty.
1. Congenital absence of uterus: the bilateral renal tube on both sides extends to meet the midline and meets. If the development is stopped before the midline, no uterus is formed. Congenital absence of uterus often combines congenital absence of vagina, but may have normal The fallopian tube and the ovary, in the anus examination, in the cervix, the uterus, can not touch the uterus and only the peritoneal pleats.
2. The primordial uterus: If the bilateral renal tube is extended to the midline and the development is stopped shortly after the convergence, the uterus is very small, and there is no uterine cavity or no uterine cavity without endometrial growth, so there is no menstruation. The tide.
3. Naive uterus: At any stage of pregnancy or after the birth of the fetus to any time before puberty, the uterus stops developing, and various degrees of uterine hypoplasia can occur. The cervix of this type of uterus is relatively long, mostly conical, and the outer mouth is small. The uterus is smaller than normal, often with extreme flexion or flexion. The anterior uterus often has dysplasia of the anterior wall of the uterus. The posterior flexion often has dysplasia of the posterior wall of the uterus. The naive uterus can cause dysmenorrhea, less menstruation, amenorrhea or no pregnant.
(2) The bilateral renal tube junctions are blocked:
This type is the most common and has important clinical significance. Due to the different periods and extents of its obstruction, it can be expressed as follows:
1. Single-horned uterus: One side of the middle kidney tube is well developed, forming a well-developed single-horned uterus with a normal developing fallopian tube. The development of the contralateral middle renal tube is completely stopped. The function of the single-horned uterus may be normal, such as pregnancy. , pregnancy and childbirth can be normal, but may also cause miscarriage or dystocia.
2. Remnant uterus: one side of the middle kidney tube is normal development, the other side is abnormal during the development process, and forms different degrees of residual uterus, most of which pass only the fiber bundle and the contralateral single-horned uterus Coupling, because the intima is mostly non-functional, often asymptomatic. If there is function, there will be periodic bleeding symptoms such as periodic lower abdominal pain after puberty, some have a narrow cavity with the contralateral uterus, in this case can occur Horn uterine pregnancy, the symptoms of the tubal interstitial pregnancy, often rupture in 3 to 4 months of pregnancy, severe internal bleeding.
3. Blind-angled uterus: the bilateral renal tube development is better, but one side of the uterine horn does not communicate with the vagina, forming a blind uterus, menstrual cramps after puberty, periodic abdominal pain, and increasingly serious, long-term not being It is found that menstrual blood retention can cause uterine hemorrhage, blood in the fallopian tube, and even menstrual blood can flow into the abdominal cavity through the end of the fallopian tube, which can reach the growing mass in the lower abdomen. Some blind uterus itself has an incomplete vagina, but Does not communicate with the normal vagina, can be misdiagnosed as vaginal cyst after the formation of vaginal blood, treatment: through the orthopedic surgery to communicate the blind uterus with the contralateral uterine cavity or vaginal cavity.
4. Double uterus and repeated uterus (symmetric type): These two types of malformations are very similar. The former is completely uncooperative due to the development of the secondary renal tube. Each has a set of fallopian tubes, uterus, cervix and vagina. This is rare. The latter is also known as the double-horned double-necked double uterus. The sub-neural tube meets completely, but the septum is completely unabsorbed. The difference between the two is that the gap between the two uterus is larger than the latter, and the double uterus may or may not No vaginal mediastinum.
5. Double-horned uterus: The distal end of the renal tube on both sides has mostly met, and the terminal septum has been absorbed, so there is a cervix and a vagina; but it is equivalent to the incompleteness of the bottom of the uterus, resulting in a prominent angle on both sides of the uterus. It is called double-horned uterus, and the degree of malformation is lighter. The bottom of the uterus is inwardly depressed. According to different degrees, a so-called saddle-shaped uterus, a heart-shaped uterus, and a bow-shaped uterus, such as pregnancy, can cause abortion or abnormal fetal position.
6. Mediastinal uterus: After the bilateral renal tube meets, the mediastinum is not absorbed, and the uterus is divided into two halves, but the shape of the uterus is completely normal, sometimes the mediastinum is incomplete, resulting in two separate uterus - small passage between the cervix Therefore, it is said that the uterus is connected with the vaginal mediastinum. The channel is often located in the uterine isthmus. Sometimes the vaginal part of the uterus is partially blocked. The menstrual blood can be slowly flowed out to the contralateral side through the isthmus channel. Therefore, the patient may have old bloody secretion. The medicine flows out of the vagina and sees a doctor.
7. Saddle-shaped uterus: The bottom of the palace is concave, the degree can be different.
(3) After the secondary kidney tube meets, the pipeline is not connected:
The part of the uterus that forms the uterus after the middle kidney tube meets, and one or all of them do not penetrate to form a substantial uterus, and there is no endometrium. The uterus is smaller than the normal uterus, but has no menstruation.
(4) Congenital uterus ectopic:
One of the uterus or the double uterus can be like the ovary, the fallopian tube, and moved in the inguinal hernia. The uterus can also stay at a higher position in the embryonic period without falling into the pelvis.
Uterine prolapse can be seen in various periods after birth, often coexisting with the spine, and more often combined with pelvic floor muscle dysplasia.
(5) iatrogenic congenital uterus abnormalities:
Congenital uterine abnormalities can occur in some cases of paraneoplastic dysplasia, with diethylstilbestrol syndrome, affected by diethylstilbestrol during intrauterine development, leading to diethylstilbene syndrome or vaginal epithelial changes Of the patients, 82% of uterine salpingography was found to be abnormal. These abnormalities included uterine hypoplasia or uterine enlargement, T-shaped or arcuate uterus, fibromuscular narrowing or uterine horn in the uterine cavity, and narrowing of any part of the uterus or The lower part of the uterus is relatively wide, the edge of the uterine cavity is not neat or polypoid lesions, intrauterine adhesions and so on.
Second, the clinical manifestations of uterine dysplasia
Some patients with uterine malformations may have no symptoms, menstruation, sexual life, pregnancy, childbirth, etc., and no abnormal performance, even for life, or even found during physical examination, but some patients have different reproductive system functions. The degree of influence, when sexual maturity, after marriage, or during pregnancy, birth time, was discovered because of symptoms.
(1) abnormal menstruation: congenital absence of uterus or primordial uterus patients without menstruation, naive uterine patients may have no menstruation, but also have less menstruation, delayed, dysmenorrhea, menstrual irregularities, etc.; double uterus, double uterus Patients often have excessive menstrual flow and prolonged menstrual duration.
(B) infertility: no uterus, primordial uterus, naive uterus and other uterine dysplasia, often one of the main reasons for infertility.
(3) Pathological pregnancy: uterus with abnormal development often causes miscarriage after pregnancy, premature birth or abnormal fetal position, occasionally spontaneous uterine rupture during pregnancy, residual uterus such as fallopian tube patency, then pregnant eggs can be implanted in the uterus However, due to dysplasia of the myometrium, it often ruptures during pregnancy, and the symptoms are the same as ectopic pregnancy.
(4) Postpartum, postpartum pathology: the uterus of the developmental malformation often coexist with myometrial dysplasia, due to abnormal productivity, difficulty in cervical dilatation during labor, and dystocia or even uterine rupture, placental retention may occur through vaginal delivery, postpartum hemorrhage Or postpartum infection, after the pregnancy of the uterus, the uterus of the pregnancy develops and grows. The non-pregnant uterus is located in the uterus rectal fossa. It can cause obstructive dystocia during childbirth. Patients with double uterus, double-horned uterus or mediastinal uterus may be due to postpartum. Bleeding occurs in the uterine cavity of the gestational side.
Examine
Uterine dysplasia check
Gynecological examination, if necessary, use the probe to detect the size, direction, or hysterosalpingography of the uterus. Genital malformations often associated with urinary tract malformations or lower gastrointestinal malformations. If necessary, intravenous pyelography or barium enema examination. When urinary tract or lower gastrointestinal malformation is found, detailed examination of genital malformations, including uterine malformations, is also required. Inside.
Diagnosis
Diagnosis and differentiation of uterine dysplasia
diagnosis
If the patient has primary amenorrhea, dysmenorrhea, infertility, habitual abortion, fetal position in each pregnancy is not correct or dystocia, etc., should first think of the possibility of uterine malformation, further detailed history and gynecological examination, if necessary, use exploration Needle to detect the size, direction, or uterine fallopian tube angiography to confirm the diagnosis, genital malformation often combined with urinary system malformation or lower gastrointestinal malformation, if necessary, can be used for intravenous pyelography or barium enema examination, when the urinary tract or lower is found In the case of gastrointestinal malformations, detailed examination of genital malformations, including uterine malformations, is also required.
Differential diagnosis
Should be differentiated from uterine prolapse, uterine prolapse can be seen in various periods after birth, often coexist with spina bifida, and more combined with pelvic floor muscle dysplasia.
