Abnormal Shaped Uterus

JaimeEC · 10-23-2007, 09:41 PM

I'm not sure if anyone else has had this. I just miscarried today and my specialist told me i had a abnormal shaped uterus. he said its supposed to be round but its shapped like bunny ears. Anyone else ever had this?

lovemychris · 10-24-2007, 12:55 AM

So sorry about your m/c...

Sounds like maybe a septated uterus. Usually this means that there is a septum that splits your uterus into two endometriums. This usually isn't a problem if the septum does not go all the way to the cervix. A lot of women have the septum removed which I hear is pretty easy and doesn't require an overnight stay in the hospital. One problem is when the egg implants on the septum and not the uterine wall; there isn't enough blood flow for it to grow.

I'm shocked to see that you had an HSG in July and your doctor didn't catch this?? It's very apparent on screen during a vaginal u/s.

Don't be discouraged, you can still get pg and carry a baby. It's important that you have an MRI or u/s to see what's going on (and how much of a septum you have).

If you want to google and see which uterine shape you may have, try these:
septated uterus, uterus didelphys, bicornuate uterus. They are all Mullerian Duct anomalies from when the fetus is still in the the womb.

Best wishes!!

Edit: here's a great link with pictures!

Nyksta · 10-24-2007, 10:35 AM

Hi there,

I was also going to suggest a septate/bicournuate uterus (although whenever I"ve heard this described is 'heart shapped' and not bunny eared lol!)...

I have a bicournuate uterus and my septum does run all the way from the top to the bottom and I also have a septaet vigana too...

I was given the option to have it removed by surgery IF it caused a problem (i.e. wait and see if you misscarry first) which I was crose about...however when discussing this further my consultant said he liked to avoid any kind of surgery unless copletely necessary and there were risks of scarring the tissue and causing further problems.

I opted not to have the op and I am the proud mommy of a 2 year old miracle daughter. I did have to have a c-section with her because the septum in my vagina would not stretch to let her through and again I've been offered surgery....but I feel that if I got pregnant once it will happen again - when its supposed to

I think your specialist should have given you more information, especially following your loss. Do you know how far along you were? {{hugs}}

As the pp said the main problem is that the egg implants on the septum which does not have a blood supply, causing misscarriage. Other problems depending on the size of the septum is that there is less room for baby to grow, causign IC and pre term labour. Thins which need to be monitored carefully.

I wish you luck for the future and hope that you specialist can give you some more info!!!

Nyk x

JaimeEC · 10-24-2007, 11:12 AM

Lovemychris: Thank you so much for the link. I'm not sure either why the dr. didnt catch it when he did the HSG. I am so upset right now. I just had a miscarriage and i heard this could be a reason of miscarriage.

Nyksta: The reason why i said "bunny eared" is because thats how my specialist explained it to me. I did have a miscarriage so i will have to talk to my regular gyn about it and see what he wants to do.

nasheajones · 11-25-2007, 04:45 PM

Sorry about your loss

I have a heart shaped uterus as well. I have had five pregnancies three full term live births, and two miscarriages. I think you should have an ultra sound to see how severe it is..you can sometimes elect to have surgery to fix it? I wonder if it caused my miscarriages?? Hope you get some answers..

Jane_smith · 11-26-2007, 04:44 PM

I have a bicornuate uterus but unlike yours my septum doesn't run all the way down. Mine's more like heart shaped...and you can't even tell it's not normal unti lI'm pregnant. then when I'm really pregnant and the two separate areas up top get bigger and bigger and the bottom dosen't keep up.

FYI, just because you have this problem doesn't mean that there isn't a blood supply to the septated area. I had to have special ultrasounds done when I was pregnant with my son but they showed that even though the septum grew (or stretched?) with the pregnancy there was a blood supply to it.

I ended up having two "sides" to my uterus while I was pregnant so the baby had a two room apartment instead of a studio. Although i did go into early labor a few times it is possible to have a healthy pregnancy that ends in live birth with this problem. My son was a bit of a preemie but he's healthy as a horse now. I just discussed this with my RE today and she said that it should not be a problem when/if I get pregnant again but that a C-section may be favored. While birthing last time my uterus wasn't able to contract normally so I had to do all of the pushing myself, good ole uterus didn't feel like doing it's part. Good luck! I'm sure you'll be able to work around this with or without surgery and have the family you want.

Danger Kitty · 11-26-2007, 06:41 PM

Jaime (and others with uterine anomalies!),

Hi - I'm a moderator on a group for women with mullerian anomalies ("MAs"). There tends to be quite a bit of confusion about MAs - a LOT of doctors really don't understand them, and even more are not able to really explain them to their pateints (I'm not talking about just GPs and obgyns - there are many REs out there that don't understand the fundamental differences between them!)

The link that lovemychris provided is a good start.

A few things to keep in mind - a lot of docs use the terms "septate uterus" (a uterus with a septum, aka "SU"), "bicornuate uterus" (a uterus with 2 "horns" aka "BU") and "didelphyc uterus" (a duplicated uterus, or "uterus didelphys", aka "UD") interchangeably. THEY ARE NOT THE SAME THING, AND HAVE VERY DIFFERENT ISSUES IN TERMS OF BRINGING PREGNANCIES TO TERM.

An SU looks completely NORMAL from the outside of the uterus, but will appear to have a "split" on the interior of the uterus, caused by the septum. The septum can be partial (just a slight ridge, running from fron to back at the top of the uterus), to complete (a full "wall" of tissue running front to back from the top of the uterus all the way down to the cervix - and sometimes THROUGH the cervix and into the vag. canal. The septum is less vascular, and less muscular, than "normal" uterine wall tissue. It can not support an embryo that implants on it for very long (if at all), and can not expand like uterine muscle tissue (potentially causing the fetus to run out of room, especially if the septum is long). However, the septum may be resected / incised, and the uterus will look and act pretty much like a "normal" uterus. SU is result of a partial failure of the mullerian ducts to fuse while in utero.

A BU can also vary in severity - the exterior may show a very slight dip at the center, top of the uterus - think of a puffy, cartoon heart. Or, the dip can be very deep, and give rise to a classic "bunny ears" profile. The key with BU is that the interior chambers of the uterus are joined to one degree or another above the cervical opening. The interior cleft is composed of uterine muscle, and generally acts just like "normal" uterine wall tissue (well vascularized, capable of stretching). BU is OFTEN what docs are referring to when they say "heart shaped", but not always (because some docs are. . . confused!). BU is the result of a greater failure of the mullerian ducts to fuse while in utero.

(There is also the possibility - rare, but seen on occassion, of a "BU / SU combo platter" - where the INTERIOR separation is much more than the EXTERIOR separation. The portion of the interior separation that is not accounted for by the exterior separation is much more like a septum, and generally, can be surgically corrected just like a regular septum).

A UD is a near complete failure of the mullerian ducts to fuse while in utero. A woman with UD will have a left fallopian tube, connected to a left hemi-uterus (sort of banana shaped, veering off to the left), connected to a left cervix, and (typically) a left vag. canal (resulting from a septum in the vagina). She will also have a right fallopian tube, connected to a right hemi-utueri, connected to a right cervix, and a right vag. canal.

(A variation of UD is "unicornuate uterus" or "UU" - this is when only 1 side develops).

To the original poster: you need to find out what your doctor means by "bunny eared" - does she mean that only the INTERIOR contour appears bunny eared (SU)? or does she mean that both the interior AND EXTERIOR contours appear bunny eared (BU)? And to what degree? A small BU cleft is often considered within the "normal" range, and a small partial septum (under 1.5 cm from the fundus to end of the septum) is NOT generally considered to be problematic.

Unfortunately, lots and lots and lots of doctors rely ONLY on HSGs to make the determination of which anomaly you have, and many of them don't understand that HSGs are one of the WORST methods out there to distinguish between SU and say, BU or UD. They are fine when in the hands of a doctor that is REALLY, REALLY experienced with uterine anomalies, but most are not - and many docs rely on the report of the radiologist, who knows even LESS about uterine anomalies than the garden variety obgyn. The "gold standard" for diagnosing uterine anomalies is a combination laparoscopy / hysteroscopy - so that both the interior and the exterior contour of the uterus can be determined.

The board that I moderate has waaaaaay too many members that were mis-diagnosed as having BU or UD (not generally candidates for surgical correction, but also, not as great of a need for it), when they actually had SU (ideal candidate for surgical correction). These women could have had the corrective surgery earlier rather than later, and could have avoided multiple losses.

A BU generally has a pretty good chance of carrying to term or near term. There is some additional risk of 2nd tri issues, including incompetant cervix and preterm labor. However, it is thought that each subsequent pregnancy will go longer than the last, so if a woman with BU *does* experience a loss, she will eventually be able to carry to a point where the baby is viable. This also holds true for a woman with UD, with the caveat that each successive pregnancy IN THE SAME UTERUS will carry longer.

An SU has a MUCH higher chance of loss, occurring anywhere from immediately after implantation of the embryo (if it implants on the septum, which can not provide adequate nourishment to the growing embryo), through to 2nd tri (preterm labor, and/or catastrophically preterm birth, due to the fetus running out of space or incompetant cervix). The longer the septum, the higher the risk of loss. This isn't to say that EVERY woman with SU will have problems, but that there is a higher probability that she will. I always tell women who have had a successful pregnancy with an intact septum that they are VERY lucky and blessed.

One study has shown that for women with a complete septum, there is as high as a 90% chance of loss. Another study, looking at things a bit differently, found that 100% of women with a complete septum have had at least 1 loss DUE TO THE SEPTUM (ranging in time of occurence from just after implantation, to late second trimester).

The situation with SU sounds dire, I know - but there is a VERY SIMPLE surgical fix for it. It requires general anesthesia, but you are in and out of the hospital in a few hours. It's done through the cervix, and does NOT generally require an abdominal incision. Most women are fully recovered in a matter of days, and TTCing can begin again within 1-3 months (depending on their surgeon's preference). Most women who undergo this surgery have a simultaneous laparoscopy ("belly button" incision) to confirm the exterior shape of their uterus, and also deal with any other issues - i.e., endometriosis, adhesions, ovarian issues, etc.

Sorry if this is an overwhelming amount of information - hope that some of what I've written is helpful. I've had a string of REALLY bad doctors (before FINALLY finding one who actually knew what he was doing), and am quite passionate about the issue. I'm quite happy to answer any questions that you might have - I'm an "MA Survivor" myself, had a complete (top of uterus to bottom of vagina) septum, had a very successful surgery to remove the septum, and am now 23 weeks pregnant with no (knock on wood) complications to date.

best,

ann

Nyksta · 11-26-2007, 07:55 PM

Hi Danger Kitty,

THanks very much for all of that information - its amazing what doctors don't know......... I've always been confused over whether I have a bicournuate or septate uterus and think it stems back to where one of my doctors called it one then the other.... I then found out they wern't the same thing lol.........

I'm going to come back and re read the info you posted - its quite a lot to digest in one sitting!!

But thanks again - its great to have someone with some inside info lol

Nyk xx

Danger Kitty · 11-26-2007, 08:52 PM

Quote:

Originally Posted by Nyksta

I'm going to come back and re read the info you posted - its quite a lot to digest in one sitting!!

Sorry - I know it's really long (I'm impressed you made it through the whole thing ONCE, let alone that you're going to go back and do it again!

)

I would guess from your prior post that you have SU. It seems to be more common for women to have a vaginal septum with SU than with BU (don't know why). Also, while there IS a surgical procedure available to unite BU, it is MAJOR surgery, involving an abdominal incision, and has a recovery similar to that of a c-section. It's a surgery of last resort.

Once upon a time, surgery to correct SU was also done abdominally, so there really had to be strong evidence calling for the need to do it. Surgery to correct SU is now sooooo simple, and many doctors are now discarding the "you have to have a miscarriage before we'll consider surgery" approach because it is so simple.

Skilled reproductive surgeons very rarely encounter complications with trans-cervical correction of SU. A lot of docs who are NOT familiar with the surgery focus way too much on the doom-and-gloom aspects of the surgery. However, the real incidence of complications (ranging from uterine perforation during the procedure to scarring after the procedure) are very, very low in the hands of an experienced reproductive surgeon. The best way to put it is that - for a woman with a complete septum in particular - the risk of complication from DOING the procedure is vastly outnumbered by the risk of loss from NOT DOING the procedure.

The one thing that you MIGHT want to consider regardless is to have surgery JUST TO RESECT THE VAGINAL SEPTUM. In addition to making a vaginal delivery possible, it also helps in other ways - like being able to use tampons (a SINGLE tampon), and may aid with conception (let me know if you need visuals with *that*

). As a teen ager (and long before I found out I had redundant parts down there!) I could never figure out why my girl friends insisted that tampons were sooooo much better than pads. They never worked for me! (duh). It can also make the process of bd'ing a bit easier - I used to have this terrible "bump/slip" sensation every now and again that was NOT comfortable for either party!

hth,

ann

Nyksta · 11-28-2007, 08:07 AM

Wow, thanks, you've given me a lot to think about and discuss with my consultant next time I see him again.

Regarding surgery to remove the septum...I was told to 'wait and see' if it was a problem.... and I was so so cross about that to begin with but then the Dr started telling me about scarring and not wanting to cause more problems and I suppose as he was a Dr I jsut went with it - and now I do have a beautiful little miracle and although I was warned about potential problems during pregnancy - pre term labour, IC etc I was actually the healthiest I've ever been and had a completely problem free pregnancy (wasn't even sick once!)....
However, I have sometimes wondered if it is possible for me to miscarry so early on that its more like a late period - if the egg trys to attach tot he septum.... I don't know enough to be able to say...

Regarding surgery to remove the vaginal septum...I was offered the surgery for this but declined because I didn't feel it effected our sex life enough to put my body through surgery and I am happy to have another c-section (at least I will be given a date so arranging care for Georgie will be easy!!) ....but upon reading your reply regarding the 'bump slip' sensation lmfao (couldn't have described it better!) and also you mentioned aiding conception.... sometimes sex is very difficult - especially in certain positions and especially to bein with....again you've given me moer food for though and more to think about when I next see my consultant.

however, saying all of this, I do have proof that it can all happen without surgery etc - I fell with my daughter naturally and carried to full term (well she was 2 weeks early but I think they got my edd wrong).

Very intersting reading though - thank you for being so helpful..... is there any other visuals which would help me get my head around the differences??

(to the OP sorry for hijacking your thread - I hope you are finding this all helpful too!!)

Nyk x

SandySam · 11-28-2007, 02:11 PM

(((((HUGS)))))

Did your doc just find this out? I dont think he's a very good doc if he just figured it out???
He never did a ultra sound when you were DX with PCOS? Or after you were PG?

Danger Kitty · 11-28-2007, 03:46 PM

Quote:

Originally Posted by Nyksta

however, saying all of this, I do have proof that it can all happen without surgery etc - I fell with my daughter naturally and carried to full term (well she was 2 weeks early but I think they got my edd wrong).

Very intersting reading though - thank you for being so helpful..... is there any other visuals which would help me get my head around the differences??

You're very blessed!

One way to think of it is that *if* you have a complete septum (that reaches all the way to, and in some cases, through, the cervix), carrying a singleton on one side is comparable to a "normal" uterus carrying twins. It can definitely happen, and it can happen without complications. In the cases where there *are* complications, though, it's very, very sad.

The majority of septum issues happen in the first trimester - embryo attaches on or very close to the septum, and quickly outstrips the nourishment that the septal tissue can provide. By means of a single example among hundreds of members on the group, I know one woman with a partial septum that endured 4 losses between 5 and 7 weeks, and a subsequent loss at 14 weeks. The last 4 losses all occurred after she was diagnosed as having a septum, and all tested as being genetically normal (the first was chalked up to being "just a fluke", and was not tested). Close examination of her pregnancy ultrasounds revealed that the embryos had all attached on or close to the septum. She had the septum resected earlier this summer, and is 20 weeks pregnant with a completely complication free pregnancy.

It is rarer, but still happens with sad frequency, that the baby just doesn't have enough space. Think of a normal uterus as a round rubber balloon. As the baby grows, the whole thing (all the rubber surface) expands. A uterus with a complete or near complete septum is like gluing one side of the balloon to a piece of cardboard - as the baby grows, only PART of the ballon can expand, as the remainder is stuck at the same size. In some cases, the uterus can expand enough to accomodate the growing baby, but in others, it simply can't. If the cervix has ANY susceptability to being incompetant, the stress from grwoing BABY + not growing enough UTERUS can cause a problem.

To carry the analogy further, in a BU, the balloon itself would be shaped like a heart - all of the balloon surface is rubber, and can thus, stretch. Going with the case of an extreme BU, the rubber heart has a very deep "V", the two horns are each smaller than the top of a "normal" balloon, and can't individually stretch as much as the top of a normal balloon. However, they can still stretch. Also, there is a single, united bottom to the heart balloon that can also stretch relatively normally.

In the case of UD, the 2 uteri are shaped more like 2 banana shaped balloons - again, the entire "rubber" surface can stretch. Perhaps each balloon can't obtain the same volume as a big round balloon, but they can still stretch pretty far, because they are all rubber. UU would be the same situation, but with a single banana balloon.

HTH!

ann

Swtnrs · 12-28-2008, 02:56 PM

Thanks Ann for the wealmth of information! Much appreciated.

Ms. Bunny · 01-13-2009, 05:27 AM

I feel your pain.

After 3 miscarriages and a year and a half for TTC, I had a hysterosalpingogram so I could start Clomid.

The technician who did the procedure said that it looked like my uterus was rotting away (i don't think that they should be able to say any of their opinions to patients because all they do is scare the ba-geezus out of you), come to find out my actual doctor said that i have a large septum, and instead of the uterus being shaped like an upside-down rounded out triangle, mine looks more like a heart.

I am told that women with septums, although it is more difficult to carry to terms it still happens. Hopefully I am one of those cases.