Congenital Uterine Anomalies
How important are uterine anomalies?
All uterine anomalies are associated with an increased risk of miscarriage and preterm labour. The risk of early miscarriage is particularly high in women diagnosed with subseptate uterus.
How are uterine anomalies diagnosed?
Uterine anomalies can be diagnosed on routine two-dimensional ultrasound scan, MRI scan and during minimally invasive surgery such as hysteroscopy or laparoscopy. However, it has been generally accepted that three-dimensional ultrasound is the optimal method to diagnose uterine anomalies. Three-dimensional ultrasound provides clear images uterine anatomy and it is the simplest and the most effective method for the diagnosis of congenital uterine anomalies. The examination is best performed in the second half of the menstrual cycle and the diagnosis can be usually reached within a couple of minutes without the use of any medication or medical contrast media.
How are uterine anomalies treated?
Women who are not planning future pregnancy do not require any treatment. The only exception are women in whom the anomalies are partially or completely blocking menstrual flow. This causes severe period pain and surgery is required to remove the blockage. Women diagnosed with subseptate uteri who are planning to become pregnant are often advised to have the anomaly corrected. This involves introducing a fine telescope into the uterine cavity and cutting out the division of the uterine cavity. Surgery is not currently offered to women with bicornuate or double uteri, but they are advised that they are monitored closely in pregnancy to look for any signs of threatened miscarriage or early delivery.
Accessory Cavitated Uterine Malformation (ACUM)
Accessory Cavitated Uterine Malformation (ACUM) is a type of congenital uterine animally which has only recently been recognised as a separate clinical entity. This is a relatively rare condition which is an important cause severe menstrual and pelvic pain. Women with ACUM have an extra, completely enclosed uterine cavity within the uterine muscle. With every period there is build-up of blood in the closed cavity which causes pain. This anomaly is present from birth but only cause symptoms after girls start their periods. Due to the lack of awareness about this condition many women with ACUMs undergo years of fruitless investigations and treatment before they receive the correct diagnosis. Ultrasound is the best and the simplest method to diagnose this abnormality. We have particular expertise in diagnosing and managing ACUMs and have recently published the largest case series in the world, describing how to diagnose them as well as a variety of treatment options including hormonal medicines, ultrasound-guided ablation and laparoscopic excision.