Submitted by Amer Hussien, M.D & Hesham Al-Inany M.D
A) During pregnancy and labor
Abnormal fetal presentation : are treated in the same way as they are encountered in a normal uterus . Attempts at external version are less likely to be successful and mat prove dangerous .
Uterine dysfunction : it is unwise to stimulate those defective uteri with oxytocin . CS is safer , but unfortunately the diagnosis is often unexpected .
- Therapeutic and prophylactic cervical cerclage are indicated in women with uterine didelphys and unicornuate or bicornuate uteri.
- Transabdominal cerclage offers the best hope of successful pregnancy outcome in women with partial cervical atresia or cervical hypoplasia but modified Shirodkar cerclage that closes the internal os without resorting to an abdominal procedure was described . This procedure was performed in women with short or lacerated cervices and in women with previous McDonald cerclage failures . The results obtained were similar to those achieved with a Shirodkar procedure , but operative time and blood loss were less . Importantly the cerclage could be removed with less difficulty
- In DES-exposed women with hypoplastic cervices , transvaginal cervical cerclage was used successfully .
- There appears to be no reason for cerclage with an arcuate uterus .
- Cerclage should not be needed after successful resection of a uterine septum, but probably should still still be used following abdominal metroplasties for uterine didelphys and bicornuate uterus.
- Whether to place a suture in both cervices of a uterine didelphys is controversial .
- To prolong gestation has been used either acutely or chronically .
- Their efficay has not been established in these situations .
? Mode of delivery of a pregnacy following metroplasty :
Uterine scar following metroplasty is as strong as , if not stronger than, that following CS as the biological conditons in which healing occurs are entirely different . Despite evidence that metroplasty scar heals securely CS is recommended except hysteroscopic resection of a uterine septum .
B) In between pregnancies
? Anomalies are treated accordingly .
- All other factors for reproductive loss should be corrected before metroplasty . Correcting other factors first may indeed correct the problem before metroplasty .
- Similarly a full infertility investigation is needed to rule other causes of infertility before the anomalous uterus is blamed . Even then, if no other cause for infertility is found and the uterus is septate or bicornuate , than the physician may not have a proper indication for metroplasty .
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