T-shaped uterus

The T-shaped malformation is commonly associated with in-utero exposure to diethylstilbestrol (the so-called "DES daughters"). It is also presented congenitally.{{cite journal| author=Pui MH| title=Imaging diagnosis of congenital uterine malformation. | journal=Comput Med Imaging Graph | year= 2004 | volume= 28 | issue= 7 | pages= 425–33 | doi=10.1016/j.compmedimag.2004.05.008 | pmid=15464882 }}

Women are often diagnosed with this condition after several failed pregnancies, proceeded by exploratory diagnostic procedures, such as magnetic resonance, sonography, and particularly hysterosalpingography.{{cite journal| author=Baramki TA| title=Hysterosalpingography. | journal=Fertil Steril | year= 2005 | volume= 83 | issue= 6 | pages= 1595–606 | doi=10.1016/j.fertnstert.2004.12.050 | pmid=15950625 | doi-access=free }}{{cite journal|last1=Viscomi|first1=G N|last2=Gonzalez|first2=R|last3=Taylor|first3=K J|title=Ultrasound detection of uterine abnormalities after diethylstilbestrol (DES) exposure.|journal=Radiology|volume=136|issue=3|year=1980|pages=733–735|issn=0033-8419|doi=10.1148/radiology.136.3.7403556|pmid=7403556}}{{cite journal|vauthors=van Gils AP, Tham RT, Falke TH, Peters AA | title=Abnormalities of the uterus and cervix after diethylstilbestrol exposure: correlation of findings on MR and hysterosalpingography. | journal=AJR Am J Roentgenol | year= 1989 | volume= 153 | issue= 6 | pages= 1235–8 | doi=10.2214/ajr.153.6.1235 | pmid=2816640 }} 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.{{cite journal|vauthors=Kaufman RH, Binder GL, Gray PM, Adam E | title=Upper genital tract changes associated with exposure in utero to diethylstilbestrol. | journal=Am J Obstet Gynecol | year= 1977 | volume= 128 | issue= 1 | pages= 51–9 | doi=10.1016/0002-9378(77)90294-0 | pmid=851159 }}

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.{{cite journal|vauthors=Katz Z, Ben-Arie A, Lurie S, Manor M, Insler V | title=Beneficial effect of hysteroscopic metroplasty on the reproductive outcome in a 'T-shaped' uterus. | journal=Gynecol Obstet Invest | year= 1996 | volume= 41 | issue= 1 | pages= 41–3 | doi= 10.1159/000292033| pmid=8821883 }}{{cite journal|vauthors=Berger MJ, Goldstein DP | title=Impaired reproductive performance in DES-exposed women. | journal=Obstet Gynecol | year= 1980 | volume= 55 | issue= 1 | pages= 25–7 | pmid=7352058 }}

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.{{cite journal|last1=Lin|first1=Paul C|last2=Bhatnagar|first2=Kunwar P|last3=Nettleton|first3=G.Stephen|last4=Nakajima|first4=Steven T|title=Female genital anomalies affecting reproduction|journal=Fertility and Sterility|volume=78|issue=5|year=2002|pages=899–915|issn=0015-0282|doi=10.1016/S0015-0282(02)03368-X|pmid=12413972 |doi-access=free}} 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.{{cite journal|vauthors=Noyes N, Liu HC, Sultan K, Rosenwaks Z | title=Endometrial pattern in diethylstilboestrol-exposed women undergoing in-vitro fertilization may be the most significant predictor of pregnancy outcome. | journal=Hum Reprod | year= 1996 | volume= 11 | issue= 12 | pages= 2719–23 | doi= 10.1093/oxfordjournals.humrep.a019197| pmid=9021378 | doi-access= free }}{{cite journal|vauthors=Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarini G | title=Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus. | journal=Gynecol Obstet Invest | year= 2011 | volume= 71 | issue= 3 | pages= 183–8 | doi=10.1159/000317266 | pmid=21150155 | s2cid=2313662 }}{{cite journal|vauthors=Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP | title=Obstetric outcome in women with congenital uterine malformations. | journal=J Reprod Med | year= 1992 | volume= 37 | issue= 3 | pages= 233–6 | pmid=1564709 }} However, risks after the procedure include placenta accreta, Asherman's syndrome and severe haemorrhage.{{cite journal|last1=Fernandez|first1=H.|last2=Garbin|first2=O.|last3=Castaigne|first3=V.|last4=Gervaise|first4=A.|last5=Levaillant|first5=J.-M.|title=Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus|journal=Human Reproduction|volume=26|issue=7|year=2011|pages=1730–1734|issn=0268-1161|doi=10.1093/humrep/der056|pmid=21398337|doi-access=free}}

• Vaginal adenosis

{{reflist}}

• {{cite journal| author=Kaufman RH| title=Structural changes of the genital tract associated with in utero exposure to diethylstilbestrol. | journal=Obstet Gynecol Annu | year= 1982 | volume= 11 | pages= 187–202 | pmid=7110645 }}
• {{cite journal|last1=Goldberg|first1=Jeffrey M|last2=Falcone|first2=Tommaso|title=Effect of diethylstilbestrol on reproductive function|journal=Fertility and Sterility|volume=72|issue=1|year=1999|pages=1–7|issn=0015-0282|doi=10.1016/S0015-0282(99)00153-3|pmid=10428139|doi-access=free}}
• 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).
• {{cite journal| author=Lin PC| title=Reproductive outcomes in women with uterine anomalies. | journal=J Womens Health (Larchmt) | year= 2004 | volume= 13 | issue= 1 | pages= 33–9 | doi=10.1089/154099904322836438 | pmid=15006276 }}

{{DEFAULTSORT:T-shaped uterus}}

Category:Mammal reproductive system

Category:Anatomical pathology

Category:Congenital disorders of female genital organs