Uterus atresia
Contents:
Description:
Uterus atresia – the anomaly of a neck or a body of the womb which is shown their fusion and impassability. The atresia of a uterus is characterized by a false amenorrhea, pains during the periods of estimated periods, development of a gematometra and hematosalpinx (in hard cases – a pyometra and a pyosalpinx). Diagnosis of an atresia of a uterus includes gynecologic inspection: survey, ultrasonography, MRT. Treatment of an atresia of a uterus operational, at an atresia of the cervical channel is made recovery of its passability by bougieurage or a laser rekanalization.
By origin atresias of a uterus are divided into the acquired and inborn, representing cases of an abnormal pre-natal bookmark and development of internal generative organs. On impassability localization the gynecology distinguishes an atresia of a neck and a body of the womb. The atresia of the cervical channel can be observed at the level of an outside or internal pharynx, sometimes – throughout the cervical channel. The uterus atresia quite often is followed by anomalies of development of urinary tract.
Uterus atresia reasons:
Inborn atresias of a uterus often result from influence of the teratogens operating during the embryonal or fetalis period. Normal the uterus and a proximal part of a vagina are formed as a result of merge of distal myullerovy channels. Depending on that site where there were no merge and the sewerage of channels, this or that type of an atresia of a uterus develops. As adverse exogenous factors infections of mother (herpes, clamidiosis, toxoplasmosis, syphilis, etc.), the ionizing radiation, medicines, the alimentary reasons causing disturbance of processes of cellular division and metabolism can serve.
The acquired atresias most often are caused by a rough scraping of a cavity of the uterus, cauterization of the cervical channel silver nitrate or electrothermic coagulation, an endocervicitis, endometritises, abortions (abortion), cancer of a neck of uterus. As a result of the injuring manipulations or the inflammatory phenomena the granulating surfaces adjoining among themselves are spliced, causing an atresia of a uterus or formation of intrauterine synechias (Asherman's syndrome). In certain cases leads hypertrophic scarring to an atresia of a uterus. At senile age the spontaneous atresia of the channel of a neck of uterus is occasionally observed.
Uterus atresia symptoms:
Inborn atresias receive clinical value during puberty. As the leading manifestation of an atresia of a uterus serves the false amenorrhea – i.e. absence of outside menstrual bleeding at monthly cyclic changes in an organism. Menstrual allocations, being late atresia zones are higher, lead to development of a gematometra – to accumulation of blood masses in a uterus with stretching of body.
Development of a gematometra at an atresia of a uterus is followed by the acute, cyclically repeating pain with which patients are quite often hospitalized in a surgical hospital. Pain at a gematometra has spastic character and is so expressed that can make sick, disturbance of functions of intestines and bladder, a loss of consciousness.
Blood from a cavity of the uterus can get into uterine tubes, promoting development of a hematosalpinx. Accession of consecutive infection promotes development of purulent process in a uterus and pipes – a pyometra and a pyosalpinx.
The atresia of a uterus is the reason of anatomic infertility.
Diagnosis:
At suspicion on a uterus atresia the qualified consultation of the gynecologist is necessary for the woman. Inspection consists in collecting the anamnesis, assessment of sexual and all-physical development, survey of generative organs. During gynecologic survey on a chair flattening of the vulval arches and smoothing of a neck of uterus is defined. The uterus is palpated in the form of painful spherical education. At a hematosalpinx on each side from a uterus slow-moving elastic painful educations – uterine tubes come to light.
The diagnosis of an atresia of the channel of a neck of uterus is confirmed during its sounding. By means of ultrasonography of bodies of a small pelvis and OUSE-gisterosalpingoskopii is documentary validated interpretations of data of survey. At ultrasonography uterus parameters, endometria thickness, existence of partitions, the sizes and thickness of walls of a gematometra authentically are defined.
In diagnosis of difficult and atypical atresias of a uterus preference is given to MRT in frontal, axial and sagittal projections.
Carrying out endourological researches (uretrotsistoskopiya) is shown at the combined urinogenital anomalies.
Usually this complex of researches happens enough for definition of an atresia of a uterus and the choice of a method of surgical intervention.
Treatment of an atresia of a uterus:
At an atresia of a uterus elimination of an anatomic obstacle and emptying of a gematometra is made.
Treatment of an atresia of the channel of a neck of uterus consists in its bougieurage or a laser rekanalization. Often recurrent atresias serve as the indication to installation of the alloplastichesky implant interfering contact of walls and fusion of the cervical channel. In some cases formation of an anastomosis of the cervical channel with a vagina is required.
At intrauterine unions (synechias) their section under control of the hysteroscope, laser reconstruction of a cavity of the uterus is made.
In case of a rupture of a gematometra and a hematosalpinx carrying out audit and drainage of an abdominal cavity is required, it is frequent – an extirpation, supravaginal amputation of a uterus or a panhysterectomy.
Prevention:
In gynecology the prevention of development of a secondary atresia of a uterus assumes prevention and timely treatment of inflammations of a uterus and the cervical channel, careful carrying out intrauterine manipulations (abortion, a diagnostic scraping), careful conducting childbirth, improvement of techniques of operations on a neck and a body of the womb.
Prevention of inborn atresias of a uterus includes attentive conducting pregnancy, an exception of adverse factors of influence on a fruit.
After elimination of an atresia of the cervical channel and preservation of a uterus pregnancy becomes possible.
