Home Audience 5 Conception, pregnancy and childbirth with a saddle uterus. Saddle-shaped uterus: reasons, how to get pregnant, positions for conception, consequences

Conception, pregnancy and childbirth with a saddle uterus. Saddle-shaped uterus: reasons, how to get pregnant, positions for conception, consequences

Sometimes, during the first ultrasound after pregnancy, the doctor makes a strange diagnosis: a saddle uterus. And even less often, a diagnosis may be made: a bicornuate uterus. A woman is usually scared: what could this mean? Will this harm the pregnancy? Let's figure out together what a saddle-shaped and bicornuate uterus is, and whether it is dangerous for pregnancy and childbirth.

Saddle and bicornuate uteruses are rare, and approximately 0.1% of women are born with such uterine malformations, and many of them do not even suspect that their uterus is irregularly shaped. The saddle uterus is considered a type of bicornuate uterus, but is very different in shape. The saddle-shaped and bicornuate uterus are formed between the 10th and 14th weeks of intrauterine development of the fetus; doctors consider the saddle-shaped uterus to be a pathology of the development of the woman’s genital organs.

What does a bicornuate uterus look like?

First, let's figure out what a normal human uterus looks like and how it differs from the uterus of some representatives of the animal world.

The human uterus is shaped like an inverted pear. The part of the uterus that is located above is called the fundus, and below is the exit from the uterus: the cervix and vagina. It is so laid down by nature that there should be one child in the human uterus; its shape is intended specifically for bearing one fetus. Of course, multiple pregnancies do happen, and twin pregnancies are not uncommon, but such pregnancies are always the most difficult for the woman and her babies, since the uterus has to stretch more to accommodate two or even more children.

The uterus of many animals is structured completely differently. For example, the uterus of a cat or dog, which is destined by nature to bear several babies at once, is precisely bicornuate in shape. Instead of being pear-shaped like the human uterus, animal uteruses are divided in two, forming two “horns” on the right and left sides. During pregnancy, a cat's uterus can be felt from the sides, and the kittens are located in it, like peas in a pea pod, one after another. During pregnancy, the human uterus protrudes forward and is located in the middle of the abdomen. The same arrangement of the uterus can be found in apes, which also usually bear one young.

It is not difficult to guess that if there are abnormalities in the development of the uterus in humans, we will get a uterus similar in shape to the uterus of animals. This pathology of uterine development, such as a bicornuate uterus, occurs as a result of disturbances in the fusion of the Müllerian ducts during the period of intrauterine formation of the fetus. A double uterus is formed, having one outlet through the cervix and vagina, but fused with two cavities below.

Is it possible to get pregnant and carry a child to term normally with a bicornuate uterus?

It is possible, and often, pregnancy in women with a bicornuate uterus proceeds normally and without complications. However, we should not forget that pregnancy itself in a bicornuate uterus can begin unfavorably. For example, the fertilized egg will attach too low and placenta previa will occur.

The risk of placenta previa or its low location is very high with a bicornuate uterus. Sometimes it happens that a woman fails to get pregnant due to pathology of the uterus. It is also important to know that since one uterus is divided into two, each of these uteruses is smaller in size than a normal uterus, and accordingly, during pregnancy it can be stretched more, putting stress on the muscles and ligaments. All this is fraught with premature birth, premature rupture of amniotic fluid, as well as various anomalies of labor, for example, weakness of labor due to overstretching and fatigue of the uterine muscles. Also, doctors often have to resort to caesarean section, because there is a high risk of trauma to the uterus and fetus during childbirth.

If two eggs have been fertilized, and each of them has implanted in the horns of the uterus, then the pregnant woman must be under close medical supervision throughout the entire pregnancy.

It is easy to diagnose a bicornuate uterus using ultrasound. The only problem is that it is not always possible to identify this before pregnancy for the simple reason that not all women examine the internal genital organs before planning a pregnancy. Often, a bicornuate uterus can be discovered after a so-called habitual miscarriage - when a woman’s pregnancy repeatedly ends in early miscarriage. In such severe cases as the inability to implant the fertilized egg, or early miscarriages, the doctor may prescribe surgery to restore the uterine cavity. This surgical operation to sew together the uterine horns and restore the normal shape of the uterus is called laparotomy. After laparotomy, a woman can have children and has a chance of a normal pregnancy.

What is a saddle uterus?

The saddle uterus is a peculiar type of bicornuate uterus, and it is also classified as a pathology of uterine development. The difference between the saddle-shaped and bicornuate uterus is that the saddle-shaped uterus is like an intermediate stage between the normal and bicornuate uterus. In the process of formation, the uterus initially looks like a bicornuate uterus, then the stage of its development turns into a saddle-shaped uterus, and only then the saddle-shaped uterus finally fuses and takes on the appearance of a normal pear-shaped uterus. If this process is disrupted, the uterus remains at one of these stages. Therefore, the saddle uterus is one uterus, but often has the shape of a saddle (a deflection in the fundus of the uterus), or a heart (not completely fused septa).

What are the features of pregnancy with a saddle uterus?

Pregnancies with a saddle uterus are known to have a number of complications, often due to abnormal fetal position. There is not as much space in a saddle-shaped uterus as in a normal-shaped uterus, which is why the baby sometimes chooses not a head-down position, but an oblique or transverse position, in which natural childbirth is dangerous or impossible. Very often, the saddle uterus has poor contractility in the postpartum period, which often results in hypotension or atony of the uterus, and uterine bleeding during or after childbirth.

The uterus with a septum should also be mentioned. Often, a septum is located inside the saddle uterus; this can lead to infertility or early miscarriage. Sometimes a saddle uterus with a septum is combined with isthmic-cervical insufficiency, which can cause a miscarriage, while the frequency of miscarriages in the early stages (in the first trimester of pregnancy) is 20-60%, and in the second trimester - already about 5%. Sometimes it happens that implantation of the embryo occurs not on the muscular body of the uterus, but on the septum, which cannot fully perform the function of the uterus, and the embryo cannot develop.

The septum in the uterus should be surgically removed in case of obvious signs of miscarriage and recurrent miscarriages. The septum is removed using hysteroscopic scissors or a laser. After removal of the septum, a woman has a chance for normal development and course of pregnancy.

The development of modern medicine every day makes it possible to discover new diseases and natural deviations in the development of the human body. Gynecology is no exception in diagnosing abnormalities of the reproductive system.

In particular, developmental disorders or abnormal shape of the uterus are observed in only a small percentage of women of childbearing age, with a bicornuate uterus in 62 percent of women, and a saddle uterus in 23 percent.

Types of uterine shape: normal and pathological condition

The uterus is pear-shaped, and the expanded side is turned upward. The upper part of the uterus is called the fundus, and the isthmus or lower region ends with the cervix; with the help of a canal, the uterine cavity is connected to the vagina (this is the only way sperm and all microorganisms can enter the uterine cavity).

The width of the uterus reaches 5 centimeters, its length can be 7-8 cm, and its approximate weight is up to 60 grams. The fallopian tubes, which look like tassels at the end (fimbriae), extend to the sides from the upper corners of the uterus. The flickering of the fimbriae allows the egg to pass from the ovary into the fallopian tube for further conception.

Deviations in the development of the uterus can be independent, or in combination with pathologies of the cervix or vagina. Against this background, one can distinguish a one-horned, double, two-horned uterus and other forms. The bicornuate uterus is divided into three types:

Complete - the division of the uterus into horns begins to occur instantly, at the level of the sacrouterine folds; such a case branches both horns at an angle in different directions.
Saddle-shaped bicornuate uterus - the organ expands in a transverse section; there may be a small depression in the fundus of the uterus, which in appearance resembles a saddle. The division of the uterus into two horns is not clearly expressed, since there is a fusion of the uterine horns without affecting the fundus.
Incomplete - the uterus is split into two horns only in the upper third of the organ, but the shape and size of the horns are the same.

The pear-shaped uterus was created by nature specifically for bearing only one child (an exception may be multiple pregnancies). The structure of the human uterus is very similar to the organs of animals (dogs or cats), it has a bicornuate shape and when palpating the side of the abdomen of a pregnant animal, you can feel the location of the fetuses, like in a pea pod.

Causes of the occurrence and development of pathology

The reason for the formation of the saddle-shaped uterus and the further development of abnormalities have not been accurately diagnosed at the moment. Doctors can only explain the process of development of uterine anomalies. As far as is known, before the 14th week of embryo development, the formation of female genital organs begins. As a result, two uterovaginal cavities are formed, which are separated by a sagittal septum.

At the final stage of the child's intrauterine life, this septum disappears and the uterus becomes single-cavity. The resulting bicornuate uterus becomes saddle-shaped by the end of pregnancy; with the onset of the birth of a girl, it takes on a pear-shaped appearance. However, the embryonic process can be influenced by negative factors, for example, incomplete union of the paramesonephric ducts, which determine the presence of abnormalities in the shape of the vagina or uterus. The following unfavorable factors are identified:

Chronic lack of oxygen (as a result of various obstetric abnormalities.
Poisoning of a woman’s body during pregnancy is the use of drugs, alcoholic beverages, smoking, certain medications, or working in hazardous industries.
Infectious diseases - herpes, influenza and others.
Lack of vitamins during pregnancy.
Cardiac dysfunction - the presence of heart failure can lead to chronic hypoxia in the child.
Stress.
Malfunctions of the endocrine system, including diabetes.

How can one suspect the presence of a saddle uterus?

Searching for clinical manifestations of this abnormal shape of the uterus can take quite a long time, namely until the woman begins to plan a pregnancy or becomes pregnant. Why is this so? The reason is that the saddle uterus does not have characteristic manifestations.

This anomaly can be present in an absolutely healthy woman who will not even be aware of the presence of a gynecological abnormality in her body. Palpation of the saddle uterus during an examination by a gynecologist will not reveal its presence, since the doctor’s hands are not equipped with x-rays. Even with an ultrasound of the pelvic organs, the saddle uterus may not be diagnosed, and only an ultrasound in a pregnant woman can detect an anomaly.

Progress of pregnancy

The saddle uterus during pregnancy makes itself felt quite clearly for a number of reasons:

The irregular shape of the uterine cavity can provoke a threat of pregnancy or constant miscarriages.
Very often there is an incorrect location of the placenta or other pathological processes. If the uterus of a pregnant patient has an uncharacteristic shape, the risk of miscarriage and abnormal placentation increases, in which the egg is attached in a place inconvenient for further growth. As pregnancy progresses, a pelvic or transverse one may form. Improper attachment of the placenta increases the likelihood of premature detachment, and, accordingly, bleeding.
Women with a saddle-shaped uterus are at greater risk of developing it than pregnant women with a normal organ shape.
During childbirth, the transmission of nerve impulses during contractions is interrupted, which causes complications of labor (weak labor, loss of coordination). Very often such births end in caesarean section.
During and after childbirth, there is a high risk of bleeding, which is explained by disturbances in uterine contractions.

However, the pathologies described above do not always occur; in approximately 50% of cases, pregnancy in women with a saddle uterus proceeds without complications.

Having problems conceiving

Most women are concerned that if they have a saddle-shaped uterus, they may have problems conceiving. This question can be answered very quickly, since this deviation in gynecology does not always end in infertility, and for a large number of women, the fertilization process occurs without problems. Difficulties during conception occur in women with a characteristically pronounced saddle-shaped uterus, who have experienced disturbances in the attachment of the fertilized egg. The presence of an intrauterine septum (with the exception of the saddle uterus) during pregnancy in most cases leads to miscarriages.

If women with a saddle uterus cannot become pregnant without any special symptoms, the cause of infertility often lies in other pathologies. However, it must be remembered that this gynecological defect is combined with other anomalies of the urogenital system (). In addition, not everyone has a normal hormonal state of the body or does not suffer from chronic diseases of the reproductive system (see).

Poses for conception with an irregularly shaped uterus

If we talk about favorable positions for conception with a saddle-shaped uterus, we can affirmatively say that there are no ideal or unsuitable positions for fertilization. Forums are popular on the Internet where there are active discussions of positions during sex that are most favorable for conception in various gynecological pathologies.

The essence of sexual intercourse, in addition to pleasure, is aimed at conceiving a child, regardless of the position. If a woman is healthy, conception will definitely occur, since sperm are very active and do not lose their viability for a long time.

If pregnancy still does not occur even if certain “favorable” positions are observed, you need to understand the possible psychological reasons for the woman herself, or check her partner.

The saddle uterus is not a pathology that prevents sperm from entering the uterine cavity and preventing conception. The most important thing in conception is the ability of a fertilized egg to attach to the wall of the uterus in the right place, and this is completely independent of position.

Diagnostic methods

To determine the presence of a saddle uterus, a woman needs to undergo a number of additional examinations.

Ultrasound of the uterus and its appendages

It is not always possible to detect a saddle uterus using ultrasound. Significant pronounced deformation of the uterus during a transverse scan reveals an increase in the fundus of the uterus to 68 mm in width, the thickness of the muscular layer of the uterus to 10-14 mm, and growth of the myometrium into the uterine cavity is also noted. The most optimal method for detecting a saddle uterus is to conduct an ultrasound examination with a vaginal probe, and this is best done in the second half of the menstrual cycle, since during this period the endometrium is at its greatest thickness.

MRI

Magnetic resonance imaging involves observing and recording the condition of the genital organs.

Hysterography

This method of examining and diagnosing gynecological anomalies involves injecting an X-ray contrast agent into the uterus, after which photographs are taken. The presence of a saddle-shaped depression of the uterus is a sign of saddleback.

Hysteroscopy

Hysteroscopy is carried out by introducing an optical device into the uterine cavity, with the help of which various urological pathologies are examined and detected.

Treatment methods

Treatment of the saddle uterus is carried out exclusively in the absence of a woman’s ability to become pregnant or in the case of regular miscarriages. Hysteroscopy is used to reconstruct the uterus (plastic surgery), meaning there are no visible incisions and no prolonged anesthesia. Upon completion of the surgical intervention, the ability to conceive and bear a child increases 10 times or more.

Pregnant women with this pathology may experience various complications (chronic fetal hypoxia, risk of miscarriage), so patients are prescribed the necessary treatment: hormonal drugs (,), bed rest, tocolytics and antispasmodics. To improve uteroplacental blood flow, it is recommended to take drugs that normalize blood clotting and metabolic processes (Essential-Forte, Troxevasin, Curantil and others).

Gynecological problems are sometimes congenital. Such pathologies include such a feature as a saddle-shaped uterus - this is a kind of organ defect when the uterus has a split saddle-shaped shape.

Usually a woman learns about this type of reproductive system from a gynecologist, since other signs of pathology are rare: we will talk about this and other features of the saddle uterus in our article.

ICD-10 code

Q51 Congenital anomalies [malformations] of the body and cervix

Epidemiology

Uterine defects (improper configuration or other defects) are diagnosed in 0.2-0.4% of women of reproductive age.

In this case, the diagnosis of a bicornuate uterus is established in 60% of these cases, and the diagnosis of a saddle uterus is established in 23%.

Causes of saddle uterus

The formation of the saddle uterus occurs in the fetus approximately from 10 to 14 weeks of embryogenesis. During the period of active development of the embryo, the uterine cavity initially consists of two vaginal-uterine cavities, which are divided between each other by a central sagittal membrane.

Before the birth of a child - a girl - the membrane gradually dissolves, and the uterus takes on its normal shape with one full cavity. If the intrauterine formation of the uterus occurred with disturbances, then a slight “indentation” of the bottom of the organ remains, which is a developmental defect - a saddle-shaped uterus. In addition to the split depressed fundus, the pathology is always accompanied by an increase in the uterus in transverse size.

Pathogenesis

The pathogenesis of abnormal formation of the uterus is due to certain provoking factors:

intoxication during pregnancy caused by alcohol, nicotine, drugs, medications, chemicals;
acute lack of vitamins or minerals in the body of the expectant mother;
severe stress during pregnancy;
endocrine system disorders (diabetes, endemic goiter);
heart defect in the expectant mother.

In addition, infectious diseases of the woman during pregnancy, severe toxicosis, and prolonged fetal hypoxia can play a decisive role in the development of the defect.

Symptoms of a saddle uterus

Usually a woman does not even suspect that she has this feature of the shape of the uterus. Most often, the defect is discovered by consulting a doctor when planning a pregnancy or during an existing pregnancy.

Thus, it can be argued that the saddle uterus is asymptomatic. And only the fact that a woman cannot get pregnant for a long time, or suffers from recurrent miscarriage, can indirectly indicate pathology.

Saddle uterus and IVF

The saddle uterus is a difference between the organ and the usual normal configuration. But this difference is not considered a direct barrier to pregnancy. Inability to become pregnant is present only in some cases if the anatomical changes are clinically significant.

What worries doctors is not so much the difficulty of getting pregnant with a saddle-shaped uterus, but the greater danger of complications during pregnancy.

So, do women diagnosed with a saddle uterus need IVF?

The altered saddle-shaped shape of the uterine organ does not affect the entry of sperm into the tubes, their meeting with the egg and directly fertilization.

Difficulty may occur during implantation of the embryo into the uterine wall and throughout pregnancy. In addition, the saddle uterus is often accompanied by other congenital pathologies of the genital area, which can interfere with normal conception. Thus, in patients with a saddle-shaped uterus, uterine bending, polyposis, etc. are often diagnosed.

One of the options for successful conception can be IVF - but only with the condition of complete preliminary diagnosis and treatment.

Position for conception with a saddle uterus

A diagnosis of “saddle uterus” is not a reason to give up conception. In most cases, the patient is able to become pregnant on her own, using certain positions during sexual intercourse.

There is no point in trying different "extreme" poses, as they will most likely be ineffective. The main condition when choosing the right position is to ensure that the sperm enters the uterus, so the position should prevent the seed from flowing out. It is for this reason that experts advise a woman after sexual intercourse to turn on her stomach, placing a small pillow under the pelvic area, and lie in this position for at least half an hour.

If we talk about choosing the right posture, then you should pay attention to the knee-elbow position. This position promotes deeper penetration of sperm.

The second suitable pose is considered to be one in which a woman, lying on her back, throws her legs back as high as possible (you can bend them at the knees). After ejaculation, the woman brings her legs to her chest, holding them with her hands, and remains in this position, if possible, for up to half an hour.

Saddle uterus during pregnancy

The likelihood of a successful conception is directly dependent on the degree of concavity of the uterine fundus, therefore it is believed that a bicornuate uterus is most unfavorable for pregnancy.

With a saddle uterus, an important condition for the normal development of pregnancy is the presence of sufficient intrauterine space, as well as normal stretching of the uterine walls for a comfortable stay and growth of the fetus.

As pregnancy progresses, the risk that the baby will take an incorrect intrauterine position increases. In addition, premature placental abruption may occur, accompanied by varying degrees of bleeding. In such a situation, there is a threat of miscarriage, and not only that: the woman herself is also in danger. Therefore, if the saddle uterus bleeds during pregnancy, and even with slight bleeding from the vagina, the pregnant woman should immediately see a doctor.

In a large number of cases, in women with a saddle uterus who managed to carry a pregnancy to term, the baby is born ahead of schedule.

Does a saddle uterus affect the fetus?

The saddle-shaped configuration of the uterus does not cause any discomfort or inconvenience to the baby who is developing in utero. Apart from a certain degree of threat of miscarriage and some other possible complications, the saddle uterus does not pose any other threats. This pathology will not affect the physical or intellectual development of the baby.

Forms

A saddle uterus may be the only defect of a woman’s reproductive system, or it may be combined with defects of the cervix or vaginal walls.

In general, experts distinguish such varieties of uterine forms as one-horned, two-horned, double uterus, etc.

A bicornuate uterus can also occur in three variants:

A complete bicornuate uterus is an organ divided into two “horns” at the sacrouterine folds.
An incomplete bicornuate uterus is an organ that also has two “horns”, identical only in the upper 1/3.
The saddle-shaped uterus is an expansion of the size of the organ in the transverse segment, with a characteristic depression in the fundus area (visually similar to a saddle). The splitting of the horns is weakly expressed.

Complications and consequences

A saddle uterus may be accompanied by problems with conception, but these problems may not be the only problems a woman has. In some cases, the implantation of the egg occurs in the lower segment of the placenta, which significantly complicates the further development of pregnancy.

In addition, during pregnancy, improper attachment of the placenta or placental abruption often occurs.

It is not uncommon to have a consequence of a saddle uterus, such as uncoordinated labor, in which the independent birth of a fetus is considered impossible - the doctor has to resort to an emergency cesarean section.

Thus, with a saddle-shaped uterus, the main difficulties occur not so much with conception, but with carrying a pregnancy. Therefore, patients with this problem should be given increased attention and all necessary measures should be taken to preserve the fetus.

Diagnosis of the saddle uterus

The diagnosis of a saddle uterus cannot be made either after a gynecological examination or after palpation of a woman. Even on ultrasound, the true shape of the uterus becomes visible only during pregnancy or in the second phase of the monthly cycle.

Urine and blood tests in this case are also uninformative and can only be prescribed to clarify the general condition of the body.

Instrumental diagnosis of the saddle uterus is most often carried out using the following procedures:

intravaginal and abdominal ultrasound;
hysterosalpingography (one of the x-ray methods);
hysteroscopy (introduction of a specific device – a hysteroscope) into the uterine cavity;
magnetic resonance imaging.

The saddle uterus on ultrasound has virtually no characteristic differences from the normal uterus. The exception is cases in which a transverse scan of the uterine fundus reveals its expansion and the presence of two M-echoes in the area of the tubal corners. Echo signs of a saddle uterus can be determined as follows:

presence of M-echo discrepancy in the uterine fundus area;
the index of depression of the myometrium into the uterine cavity ranges from 10 to 14 mm.

Differential diagnosis

Differential diagnosis is carried out with a normal and complete bicornuate uterus.

	Length	Thickness	Width	M-echo difference in the fundus of the uterus	Myometrial thickness of the uterine fundus	Myometrial thickness in the right corner of the uterus	Thickness of the myometrium in the left corner of the uterus
Normal uterus
Saddle uterus

Treatment of saddle uterus

Surgery for a saddle uterus is rarely performed - only in cases where attempts to get pregnant end unsuccessfully, and the reason for this is precisely the incorrect configuration of the uterine fundus. Most often, surgery is used for a bicornuate uterus, when it is necessary to remove the uterine septum (membrane).

Surgical treatment involves the use of the hysteroscopic method, a minimally invasive technology that allows surgery to be performed without blood or incisions.

Recovery after surgery occurs quickly, sometimes even without disrupting the cyclicity of menstruation.

Metroplastic surgery is performed laparoscopically, with puncture in several places of the abdominal wall. This operation is also considered minimally invasive. The patient stays in the inpatient department for a maximum of two days, and the postoperative period is short and relatively easy.

The listed surgical interventions almost always proceed without complications. At the same time, a woman’s chances of pregnancy increase many times.

After the operation, a woman diagnosed with a saddle uterus should be observed by a doctor throughout the child planning stage.

Saddle uterus and childbirth

A woman with a saddle uterus is constantly in danger during pregnancy. But even after overcoming them, you may encounter difficulties during childbirth.

Most often, such a woman’s baby will be born earlier than expected.

Moreover, during labor, the nervous innervation during contractions is often disrupted, which affects the quality of labor. For example, a woman’s water may have already broken, but contractions are weak or not at all. In such a situation, they talk about the weakness of labor: most often the problem is solved by performing a caesarean section.

The danger of bleeding with a saddle uterus exists not only during pregnancy, but also immediately after childbirth, since the saddle uterus cannot always contract normally. The doctor takes all these points into account, so he takes all possible measures to preserve the life and health of the child and mother.

It is worth noting that problems in women diagnosed with a “saddle uterus” do not always occur, so you should not “tune” yourself to the negative - such women should simply be aware of possible difficulties on the path to motherhood.

Prevention

Prevention of the development of a saddle uterus in a child is carried out by his mother, even before the start of pregnancy. Prevention measures include:

A doctor who is caring for the pregnancy of a woman with a saddle uterus must constantly take measures to prevent miscarriage and placental abruption.

A cesarean section may be used if there is a threat of miscarriage in the third trimester.

Surgical intervention for patients diagnosed with a saddle uterus can reduce the risk of miscarriage to 30%.

This is a pathologically formed uterus, which is a variation of the bicornuate uterus. With this defect, the fundus of the uterus is literally formed in the form of a saddle. There are different degrees of splitting of the body of the uterus into two horns, but in almost all cases the shape of the uterus when cut is visually similar to a saddle. The saddle uterus may not have any external manifestations, but it often makes itself felt during pregnancy in the form of complications such as incoordination and weakness of labor, premature birth, the threat of miscarriage and postpartum hemorrhage. Often the saddle uterus is combined with other developmental pathologies. Detection of the saddle uterus often occurs accidentally during routine ultrasound examination, nuclear MRI, and hysteroscopy. If there is a threat of pregnancy failure, surgical correction of the uterus is recommended.

The saddle uterus is considered not a very complex pathology of uterine development, and pregnancy prognosis is often favorable. In a healthy woman, the uterus develops in the shape of a pear, narrowed below and expanded above.

The saddle uterus is a particular manifestation of a bicornuate uterus. Bicornuate and saddle uterus are very rare pathologies of uterine development that occur in approximately 0.1% of women. The formation of the saddle uterus occurs at approximately 10-14 weeks of fetal development.

Saddle uterus and conception

The saddle uterus and conception do not always work together in the best way. If there are problems with conception due to the development of a saddle uterus and if the pregnancy does not carry to term, surgical treatment is indicated. Most often, there is no need for radical interventions and reconstruction of the uterus occurs without incisions, through natural pathways during hysteroscopy. After a successful operation, the chances of getting pregnant and giving birth to a healthy child increase significantly. Plastic surgery of the uterine cavity is the most optimal solution to the problem, so it is important for a woman with a saddle uterus to be psychologically prepared in advance.

Saddle uterus and pregnancy

Saddle uterus and pregnancy: if a woman managed to safely carry a child and give birth to offspring normally, then in the future there are no threats to the development of the fetus and the health of the mother, the main thing is to undergo routine medical examinations and observations on time.

Pregnant women with a saddle uterus must be under medical supervision, regardless of the stage of pregnancy, and at the slightest suspicion they must be hospitalized in a hospital.

If pregnancy complications occur, a patient with a saddle uterus should adhere to bed rest. Drug therapy includes antispasmodic drugs, sedatives of herbal origin, gestagens (duphaston, utrozhestan), Esenseale-Forte, Actovegin.

The form of labor management in patients with a saddle uterus should be discussed and determined in advance, it is worthwhile to psychologically prepare the patient and explain possible difficulties and completion options.

Causes of saddle uterus

During embryogenesis, the mesonephric ducts merge, which is the reason for the formation of the saddle uterus. During embryonic development, the uterine cavity is initially divided into two parts by the sagittal septum. This septum dissolves by the time the fetus is born, so the bicornuate uterus initially acquires a saddle-shaped shape, and then a normal, single-band, pear-shaped shape. If by the time a girl is born the process of uterine formation has not yet completed, a developmental defect occurs, which is called the “saddle uterus.” Also characteristic of the saddle uterus is its expansion in diameter.

The reasons for the development of a saddle uterus can be a variety of disturbing and damaging factors during pregnancy: endocrinopathies (diabetes mellitus, thyrotoxicosis), stress, vitamin deficiencies, heart defects, maternal intoxication (chemical, drug, narcotic, alcohol, nicotine), radiation.

Infectious diseases are considered especially dangerous for the fetus - rubella, measles, syphilis, influenza, toxoplasmosis and others. Also, pregnant women suffering from prolonged toxicosis are a risk factor for carrying a fetus with this pathology, which can cause chronic fetal hypoxia.

Many women, having heard this diagnosis, decide that this is a death sentence, but there is no need to panic; first you need to understand the very essence and definition of the diagnosis. The degree of severity depends on the magnitude of the deformation of the uterine body.

Symptoms of a saddle uterus

A woman may not be aware that she has a saddle uterus until she becomes pregnant. If the deformation of the uterus is not significant, complications during pregnancy and childbirth may not occur.

With pronounced changes in the uterus, there is a risk of developing pathology of the placenta (premature abruption, accompanied by bleeding, low or lateral location of the placenta, placenta previa), pelvic or transverse presentation of the fetus, premature birth.

During childbirth, the saddle uterus often causes abnormal labor: incoordination and weakness. Often, in the presence of a saddle uterus during childbirth, it is necessary to resort to radical methods of delivery - a caesarean section.

If a pregnant woman is not adequately monitored, the risk of perinatal mortality may increase. If the uterus is very deformed, women may be diagnosed with primary infertility.

The main methods for diagnosing the saddle uterus are instrumental studies: ultrasound diagnostics, hysteroscopy, magnetic resonance imaging, hysterosalpingography, ultrasound examination. The use of a standard gynecological examination for a saddle uterus will not be effective.

It is not always possible to detect a saddle uterus during pelvic ultrasound. If the deformation of the uterus is significant, at the time of transverse scanning it is possible to determine the thickening of the muscular layer of the uterine fundus up to 10-14 mm, its protrusion into the uterine cavity, and also an increase in the width of the uterine fundus up to 68 mm. It is better to determine the saddle uterus using ultrasound in the second phase of the pregnancy cycle, using a vaginal sensor.

Hysterosalpingography is the most reliable method for diagnosing a saddle uterus: the images in the area of the uterine fundus clearly show a depression that flows into the uterine cavity, similar to a saddle, and two orifices are visible in the fallopian tubes. The same signs are observed during magnetic resonance imaging.

During pregnancy, women with a saddle uterus undergo Dopplerography of the uteroplacental blood flow, phonocardiography and fetal cardiography.

Even without a medical education, after seeing pictures from various diagnostic methods, you can see a saddle-shaped pattern.

Every woman dreams of happy motherhood, filled with endless, but such pleasant chores. The diagnosis of a “saddle uterus” made by a specialist can make both a very young girl and a more experienced young woman panic. Don't get upset right away! The saddle uterus and pregnancy are compatible things, so there are many options for resolving the problem.

Read in this article

Uterine deformation: physiological features, causes

A well-known fact is that the saddle-shaped uterus - a type of bicornuate - is a congenital pathology in which the bottom of such an important organ in the female reproductive system is changed and resembles the shape of a saddle. The reasons should be sought in the period when the expectant mother, without complying with some requirements and advice from specialists, programmed deviations in the structure of her daughter’s uterus. Such violations of recommendations include:

intoxication of various origins (due to poor lifestyle or chemical poisoning);
disturbance of the general psychological background (stress);
lack of necessary substances in the body (vitaminosis);
certain diseases (heart disease, infectious lesions such as toxoplasmosis, measles and influenza).

Violation of the structure of the female genital organ in the unborn child provokes and, which many consider a common occurrence in the first and last trimester of pregnancy. But in fact, it is a formidable factor in identifying all kinds of abnormalities in fetal development in the future.

Manifestations of pathology: symptoms and diagnosis

The insidiousness of this deformation of muscle tissue lies in the fact that a woman can only find out about it during or during examination by specialists for the reason, and other factors indicating malfunctions occurring in the female body. With a slight change in the fundus of the uterus, there may be no symptoms: conception, pregnancy, and childbirth occur within the established norm and do not bother the expectant mother.

If there are changes in the structure of a larger formation, then it is worth thinking about the existing threat and turning to specialists. In this case, the fertilized egg will not be able to enter the uterine cavity. Possible consequences of conception may include:

miscarriage at any stage of pregnancy;
placenta located abnormally low;
position of the fetus in transverse or oblique presentation.

All these factors negatively affect the course of pregnancy and the health of the unborn baby.

Ways to solve the problem of conception with a saddle uterus

What does the diagnosis of a saddle uterus mean, how to get pregnant, what is necessary for the long-awaited conception to occur - all these questions are of interest to women who are faced with the problem. Experts say that if changes in muscle tissue are not subject to pronounced pathology, then the woman will not have any difficulties: fertilization and pregnancy will take place according to established standards and without harm to the unborn child.

In case of more pronounced deformation, it is worth remembering that there are both medicinal options for solving the problem, as well as nuances in terms of rational choice of positions during unprotected sexual intercourse.

Correct positions for conception

Before using radical measures regarding taking medications of various pharmacological groups, it should be remembered that the knee-elbow position for this form of the uterus is the most appropriate. However, it is also important to remember that the sincere feelings of partners and pleasure in the process can work wonders.

According to gynecologists, this change in a woman’s body implies any posture so that sexual intercourse ends in the long-awaited conception. The main thing is regular sex life with immunological compatibility of partners.

Surgical intervention

How to get pregnant with a saddle uterus if all attempts have not brought the desired result? The intervention of specialist surgeons is necessary only if it is impossible to conceive for no apparent reason. The reason for this can also be miscarriages, which are repeated and have no explanation from the point of view of the physiological structure of a woman. The surgical intervention is performed using hysteroscopy under general anesthesia, which increases the patient’s chances of conceiving a child in the future.

Pregnancy and childbirth with a saddle-shaped uterus

The long-awaited pregnancy with a congenital anomaly of the uterus has arrived, and the expectant mother begins to worry that everything proceeds within the established norms and does not harm the baby. The abnormal structure of the main organ of the female reproductive system will not affect the development of the baby in any way. In rare cases, this can lead to premature birth.

In case of pregnancy, which occurs with some complications, it is recommended to rest in bed, antispasmodics, homeopathy in the form of herbal sedatives, as well as gestagens - analogues of sex hormones, the main one of which is progesterone.

However, it is worth remembering that with this development of pregnancy, the best solution would be a caesarean section in order to avoid unforeseen and extreme situations during childbirth.

A saddle-shaped uterus, the correct position for conception, timely diagnosis of the pelvic organs - all this will help a woman in solving her problem. Congenital transformations of the uterus in the form of a saddle shape are not a reason to deprive yourself of the happiness of becoming the mother of the best and most desirable baby in the world.