PREGNANCY

 

 

INTRODUCTION

 

          For pregnancy and labour to be achieved with minimal difficulty, a woman must have normal reproductive anatomy.  When structural abnormality of the pelvic organs exists, problems arise which can place an extra burden on mother and fetus.  Dystocia may result from malformations and displacement.

 

 

DEFINITION

 

          Uterine malformations is defined as the malformations and displacement of the body of uterus caused by the persistence to a greater or lesser extend of the septum between the mullarian duct.

 

 

TYPES OF UTERINE MALFORMATIONS

 

They are:-

1.     Arcuate Uterus

2.     Uterus didelphys

3.     Uterus bicornis

4.     Uterus unicornis

5.     DES – Related abnormality

 

 

1) Arcuate Uterus

          The corneal part of the uterus remains separated.  The uterine fundus looks concave with heart shaped cavity outline.

 

2) Uterus didelphys

          There is a complete look of fusion of the mullarian ducts with a double uterus, double cervix and a double vagina.

 

3) Uterus bicornis

          This is of varying degree of fusion of the muscle walls of the two ducts.

1.    Uterus bicornis bicollis

There are 2 uterine cavities with double cervix with or without vaginal septum.

2.    Uterine bicornis unicollis

There are 2 uterine cavities with one cervix.  The horns may be equal or one horn may be rudimentary and have no communication with development horn.

3.    Septate Uterus

The two mullarian ducts fused together but there is persistence of septum in between the two either partially (sub-septable) or completely.

 

6.     Uterus unicornis

Failure of development of one mullarian ducts

 

7.     DES – Related abnormality

If it is due to DES exposure during intrauterine life varieties of malformations are included.

Eg: Hypoplasia Uterus ‘T’ shaped uterus and cervical hypoplasia.

CLINICAL FEATURES

          They are classified into gynaecological and obstetrical.

 

1. Gynaecological

1.    Infertility and dyspareunia.

2.    Dysmenorrhoea.

3.    Menorrhagia

2.  Obstetrical

1.    Mid trimester abortion

2.    Cornual pregnancy with inevitable rupture around 16^th week.

3.    Increased incidence of malpresentation

4.    Preterm labour

5.    Prolonged labour

6.    Obstructed labour

7.    Retained placenta and PPH.

 

 

Effect of Uterine Malformations on Pregnancy

          If their insufficient hypertrophy the possible difficulties are

·        Abortion

·        Pre-mature labour

·        Abnormal lie of the fetus

·        In labour there will be poor uterine function may be experienced.

·        Occasionally problems arise when  a fetus is accommodated in one horn of this double uterus and the empty of the horn has filled the pelvic cavity.

 

Diagnostic Evaluation

1.    Internal Examination reveals separate vagina and two cervix.

2.    Hysterography

3.    Hysteroscopy

4.    Ultrasonography

5.    MRI

6.    Laproscopy

MANAGEMENT

a) Surgical Management

1.    Strassman Utriculoplasty Operation

2.    Jonis Wedge Metroplasty

3.    Tomkins operation

4.    Hysteroscopic Ressection

 

NUSRING MANAGEMENT

·        The nurse should give psychological support to the patient.

·        Send the blood and urine for routine examination.

·        Check the vital signs every 4^th hrly.

·        Assess for any systemic diseases such as DM, HTN, TB etc.

·        Obtain consent for operation.

·        Mother should be kept nil by mouth.

·        Pre-operative medication should be given such as Inj-TT.

·        Prophylactic antibiotics such as cephalosporins to reduce the risk of infection.

·        Preparation of the part should be done with antiseptic solutions.

POST-OPERATIVE CARE

 

·        Provide comfortable position i.e., supine position.

·        Give foot end elevation.

·        Monitor the vital signs.

·        Observe the patient for any signs of infection.

·        Assess the incision site for bleeding.

·        Maintain aseptic techniques in all procedure.

·        Administer antibiotics to prevent the infection.

·        Administer analgesics to relieve pain.

·        Change the soiled dressings at least twice a day.

·        Provide calm and quit environment.

 

 

CONCLUSION

 

          Malformations can cause dystocia.  Malformations may be congenital or may be acquired.  This can be managed by surgical intervention.

 

BIBLIOGRAPHY

1.    Howkin and Bourne Shaw’s “Text Book of Gynaecology”, V.G.Pudubidri Shirish N Buftaly 13^th Edition, Page No.91-94.

2.    A.L.Mudaliar’s “Clinical Obstetrics” Published by Orient Longman Ltd., 9^th Edition, Page No.102.

3.    D.C.Dutta “Text Book of Obstetrics Including Perinatology and Contraception”, 16^th Edition, Pg.No.162-164.