A t-shaped uterus is a type of
uterine malformation wherein the uterus is shaped resembling the letter T.[1] This is typically observed in
DES-exposed women.[2] It is recognised in the
ESHRE/ESGE classification,[3] and is associated with failed
implantation, increased risk of
ectopic pregnancy,
miscarriage and preterm delivery. There is a surgical procedure to correct the malformation.[4]
A T-shaped uterus with circular constriction noted around the proximal portion of the marker. The lower uterus appears tapered and narrow.
Causes
The T-shaped malformation is commonly associated with in-utero exposure to diethylstilbestrol (the so-called "
DES daughters"). It is also presented
congenitally.[5]
Diagnosis
Women are often diagnosed with this condition after several failed pregnancies, proceeded by exploratory diagnostic procedures, such as
magnetic resonance,
sonography, and particularly
hysterosalpingography.[6][7][8] In such studies, a widening of the
interstitial and
isthmus of uterine tube is observed, as well as constrictions or narrowing of the uterus as a whole, especially the lower and lateral portions, hence the "t" denomination. The uterus might be simultaneously reduced in volume, and other abnormalities might be concomitantly present.[9]
Prognosis
Although fertility is impaired, T-shaped uterus sufferers can bear children. However, they carry a greater risk of complications, such as miscarriages, reduced fertility and preterm births, both before and after any treatment.[10][11]
The current surgical procedure to treat this malformation, termed a
hysteroscopic correction or
metroplasty, is undertaken by performing a lateral
incision of the uterine walls, and can return the organ to a normal morphology, while improving the patient's former reproductive performance.[4][10][12] It is considered a low-risk procedure, and can also improve
term delivery rate by up to 10-fold, as long as the
endometrium is considered to be in good condition.[13][14][15] However, risks after the procedure include
placenta accreta,
Asherman's syndrome and severe
haemorrhage.[4][16]
^van Gils AP, Tham RT, Falke TH, Peters AA (1989). "Abnormalities of the uterus and cervix after diethylstilbestrol exposure: correlation of findings on MR and hysterosalpingography". AJR Am J Roentgenol. 153 (6): 1235–8.
doi:
10.2214/ajr.153.6.1235.
PMID2816640.
^Kaufman RH, Binder GL, Gray PM, Adam E (1977). "Upper genital tract changes associated with exposure in utero to diethylstilbestrol". Am J Obstet Gynecol. 128 (1): 51–9.
doi:
10.1016/0002-9378(77)90294-0.
PMID851159.
^
abKatz Z, Ben-Arie A, Lurie S, Manor M, Insler V (1996). "Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus". Gynecol Obstet Invest. 41 (1): 41–3.
doi:
10.1159/000292033.
PMID8821883.
^Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarini G (2011). "Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus". Gynecol Obstet Invest. 71 (3): 183–8.
doi:
10.1159/000317266.
PMID21150155.
S2CID2313662.
^Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP (1992). "Obstetric outcome in women with congenital uterine malformations". J Reprod Med. 37 (3): 233–6.
PMID1564709.
Kaufman RH (1982). "Structural changes of the genital tract associated with in utero exposure to diethylstilbestrol". Obstet Gynecol Annu. 11: 187–202.
PMID7110645.
KALTFMANL, RAYMOND H., MD ERVIN ADAM, and Gary L. Binder. "Upper genital tract changes and pregnancy outcome in offspring exposed in utero to diethylstilbestrol." (1980).