T-shaped uterus

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.

T-shaped uterus
Hysterosalpingography of a T-shaped uterus.
Specialty	Urology

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]

See also

• Vaginal adenosis