The normal uterine or womb cavity is triangular in shape and spacious. Such a normal triangular cavity is a prerequisite for attachment of embryo and carrying the pregnancy for 9 months. In a T shaped uterus this normal triangular cavity is replaced with a cavity resembling English alphabet ‘T’, i.e. the cavity is broader at the top and narrow tube like below. Such a cavity is not spacious enough and may lead to infertility, abortions and preterm delivery.
Normal triangular uterine cavity T- shaped uterine cavity
However some women may have normal pregnancy with T- shaped uterus. It can be considered as a variant of normal shape.
What are the symptoms of T-shaped uterus?
As such women with T-shaped uterus do not have any symptoms. They may have less bleeding during menstrual cycle. They are usually diagnosed and treated as they may have associated infertility, previous abortions or preterm delivery.
What are the causes of T-shaped uterus?
Many a time a definite cause cannot be found. T-shaped uterus could be congenital (from birth) or may be related to pelvic infections. For example, Tuberculosis of the pelvis may cause scarring and narrowing of the cavity making the uterus T-shaped.
How is the diagnosis made?
Diagnosis is usually made on ultrasonography of the pelvis. Also these women do not have well developed endometrium (lining) as evident on ultrasound. The lining usually remains thin inspite of medicinal support. Endometrial volume measured with help of ultrasound is less than 2 cubic mm done on 10-14 day of periods is also confirmative. A 3 D ultrasound can also be helpful in case of any doubts.
Other useful means of diagnosis is with Hysterosalpingogram, where an X-ray of pelvis is taken after injecting a dye. Many a times diagnosis is made while doing a routine diagnostic hysteroscopy.
Normal Uterine cavity on HSG
T-shaped Uterine cavity on HSG
What is the treatment?
The treatment is surgical.
Hysterocopic adhesiolysis is the surgery which needs to be performed. In this a special knife mounted on resectoscope is used through which electric current is passed. This knife is used to cut the narrow walls of the uterine cavity and make the cavity broad. As the entire procedure is done under hysteroscopic guidance, it is very safe and equally effective.
Video of lat metroplasty:
A balloon may be kept in the uterine cavity for one week to keep the cavity distended and to prevent scar formation. Also some medications may be given for the lining to grow over the cut portion. Follow up may be scheduled after 7 days, when the balloon is removed. The growth of lining and response to surgery is monitored for the next one month or more. A Hysterosalpingogram done 4 weeks after surgery may show improvement in the cavity size.
Can I be sure of a pregnancy after this surgery?
Hysteroscopic adhesiolysis of grade 1 adhesions have shown to improve pregnancy rates and reduce abortion rates. Studies have shown that this decreases the abortion rates from 88% to 12.5% and term delivery rates improved from 3% to 87%. A cervical stitch may be required in some women who have undergone this to prevent preterm delivery.