Miscarriage & Disease

Uterine Malfomation: Uterine Septum, Bicornuate Uterus,Uterus Didelphys

Diagnosis of uterine malformation: If the patient has history of primary amenorrhoea, dysmenorrhea, infertility, ectopic pregnancy, recurrent spontaneous abortion (RSA)/ miscarriages, malposition or obstructed labor, etc., the first possibility of uterine malformation should be considered, and further detailed medical history should be asked and gynecological examination should be performed. Dynamic digital hysterosalpingography (HSG), vaginal 4D color Doppler ultrasound and electronic stereoscopic hysteroscopy-laparoscopy (Hsc-Lsc) examination could confirm the diagnosis. Genital malformations are often associated with urinary system malformations or lower gastrointestinal malformations, if necessary, intravenous pyelography or barium enema examination can be used. When a urinary tract or lower gastrointestinal malformation is found, detailed examination of genital malformations, including uterine malformations is also required. 
 


Treatment measures [bicornuate uterus, Antai uterus fusion surgery of uterus didelphys]
The most common and best indication for uterine malformation repair surgery is the symmetric bicornuate uterus. Patients with recurrent spontaneous abortion (RSA)/ miscarriages should be treated early. Make a transverse incision from the side of the cornua to the opposite side of the cornua in two separated cornua, cut the muscle wall in half, and sew the left and right incisions together. Postoperative delivery of live infants can reach 60% to 85%.  
 
[Rudimentary horn of uterus excision] When hematocele in the rudimentary horn of the uterus causes clinical symptoms, the residual angle can be removed.
Pregnant patients after surgical treatment of uterine malformations should be taken care to avoid miscarriage, and should be closely observed to prevent spontaneous rupture of the uterus. At the time of delivery, the mode of delivery should be chosen depending on the position of the fetus and the progress of labor. Because the size of the uterine incision scar is several times larger than that of the original cesarean section, the indication for cesarean section should be greatly expanded. Care should be taken to prevent postpartum bleeding and puerperal infections. Be alert to the retention of the placenta during vaginal delivery.   
 
[Uterine mediastinum, saddle uterus Antai Hysteroscopy-laparoscopy combined with mediastinal cold knife separation]
After the advent of hysteroscopy, the uterus mediastinum was removed by hysteroscopy under laparoscopic monitoring. The laparoscopic light source is darkened during surgery, so that the assistant can observe the hysteroscopic light source from the bottom of the palace to guide the operation. The surgeon first observed the shape of the uterine cavity and mediastinum through hysteroscopy, and then began to sharply separate from the midpoint of the mediastinum until the uterine fallopian tube taper was seen. The cutting edge should be kept in the midline level and cannot be backed to avoid perforation. When the mediastinum is separated, a well-proportioned uterine cavity can be seen at the inner cervix. In order to understand whether the mediastinal incision width is sufficient, the laparoscopic light source can be turned off during surgery, and attention is paid to whether the light of the hysteroscope is interrupted from the side of one side of the palace to the middle of the other side. It is currently the preferred method for treating the uterine mediastinum. 

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