Author:Sa Jie (Attending Physician of Obstetrics and Gynecology)
If someone says that he was born with two tintins, and both are 25.4 centimeters long, and they can still be used normally, will you not be able to control the desire to hurry up and "see is believe"?
The day before yesterday, Sister Sa saw an article by her old friend Lilac Garden, telling everyone a story about the "three-gun shooting case", this disease about multiple tintins - "penis repetition" Diphallia, is a kind of penile deformity, for an extremely rare developmental abnormality, the patient has multiple dings as soon as he is born.
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This article reminds me of a real experience I had before, a pregnant woman I met who had a double vagina and a double uterus.
It is also surprising that the sister did not know that she had this problem before she became pregnant, because she had been menstruating like others, and every month she came to walk normally, the same room was also normal, and the pregnancy was also normally pregnant, and as a result, she was pregnant with a test, and the doctor found:
Why is there a womb next to this?
Check again: No, the vagina is also two!
In the case of double Dingqi in men, in women, the double uterus is also a repetitive malformation of the reproductive structure, and during the development of the fetus, if the fusion of the two Miao le tubes fails, it will lead to a double uterus.
But we don't know exactly why these two tubes fail to fuse, and women with this type of deformity, like men with multiple tintins, often have normal karyotypes.
In general, this repetition is limited to the uterus and cervix, that is, the double uterus and the double cervix, but this repetition can also occur in the vulva, bladder, urethra, vagina and anus, such as the pregnant woman I have seen, that is, the double uterus and double vagina, but from the vulva, no obvious abnormalities are found.
In women with this reproductive structure, 15% to 20% of women with a double uterus may also have unilateral deformities, such as concomitant obstructive hemivaginal, and ipsilateral renal loss, of which 65% of cases have malformations on the right side.
The double uterus is not difficult to diagnose, and can be seen on a supernatural examination in general. B-ultrasound is not only relatively inexpensive, but also relatively simple to operate.
Congenital uterine malformations are also divided into many types, in addition to the double uterus, the common mediastinal uterus and the bicorne uterus, in the ultrasound examination, in addition to assessing the external contour of the uterine floor, it is also necessary to assess whether the kidneys have related abnormalities.
If you want to look at others, then other tests, such as hysterosalpingogram (HSG), can show whether the fallopian tubes are patency, as well as the size and structure of the uterine cavity. Saline perfusion of hysterosynography and HSG both show the morphology of the uterine cavity well.
For the double uterus, under the ultrasound image, 2 distant uterine horns can be found, with a deep depression of the uterine floor, and the doctor can find 2 cervixes through speculum examination. However, if it is difficult, then MRI may be needed to better show complex deformities;
Vaginal ultrasound is relatively clearer to probe, and MRI may be considered for young women who cannot tolerate or reject the diagnosis of three-dimensional ultrasound with vaginal probes.
What is the effect of a double uterus on fertility?
Yes, first of all, from the perspective of pregnancy, although the pregnancy itself may not have as much effect, however, there are reports that the spontaneous abortion rate in patients with double uterus is 32%, and the preterm birth rate is 28%.
In this case, the risk of fetal growth restriction is also elevated. In fact, it is not difficult to understand, after all, there is only one piece of land, only build a house that is a luxury villa, build two buildings at most is a villa level, the resources enjoyed are not the same, and another kind of longitudinal uterus is also similar.
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For women with double uterus to live, it is also rare to have two vaginas that are completely separated, as about 75% of cases have a vaginal septum.
The vaginal septum is like the middle of the original four-lane road, giving you a guardrail, and the width of the road is greatly reduced, which may not only affect the outflow of menstrual blood, but also have difficulty in intercourse or vaginal delivery.
Many people did not find it when they were young, but when they tried to have intercourse in adulthood, they found this problem and went to the hospital to check it out.
Will there be a great aunt again?
Answer: Yes.
Even women with vaginal obstruction on one side and loss of the same kidney on the same side can still have regular menstruation, because menstrual blood from one uterus can still be discharged through the unobstructed side of the cervix and one side of the vagina.
However, because the distance is often not so smooth, such patients may often have a vaginal obstruction side, resulting in the accumulation of blood, resulting in periodic pain.
Another effect is that if there is a "tiny through" between the patency side of the vagina and the obstructive side, it can lead to infection on the obstructive side. Bilateral complete obstruction may also occur, so that menstruation cannot flow out, manifesting as primary amenorrhea.
In terms of treatment methods, the most common and effective method is to choose to remove the vaginal septum. Treatment often involves removal of the obstructive vaginal wall and subsequent establishment of a single vaginal vault, but hysteroplasty should also be considered in women with pelvic pain, repeated spontaneous abortions, or previous preterm births.
The available data are not enough to support the opening of the abdomen to repair the double uterus to improve the pregnancy outcome, if the double uterus situation does not have an impact on life, then the original normal life can be maintained first.
For example, the sister who met Sister Sa, even if she is more lucky, because it is a relatively complete set of structures that are separated, usually the aunt is still normal, and she is lucky to be pregnant to full term, after childbirth, the review did not find a problem, and she went home with the child.
Still, when she was discharged from the hospital, we asked her a few words.
What do you want to do?
You think, others are a set of "equipment", she is two sets, the child is born and will not say, then if you do not want to have a child, on the issue of contraception, you need to consider it.
What is different is that these two sets of equipment should be taken into account, because they may have normal functions, it is possible to alternate ovulation, and at the same time alternate to the big aunt, in case only one set of coping plans is prepared, one accidentally enters the wrong door, and the other set still has an output function, it may still be an accident.
So at this time, if you say that you take the way of intrauterine contraception ring contraception, it is not too suitable. The last one, she needs to go to the two, the cost is higher, not to mention, in case there is no adaptation, such as irregular vaginal bleeding, it may also be two.
So at this time, it may be better for men to take the method.
After all, another source of braking is also the solution. It's like the factory resumed work, even if there are two sets of equipment working at the same time, there is no channel to supply raw materials, forgive you will not be normal output!
Image source: Stand Cool Helo
bibliography:
[1] Grimbizis GF, Camus M, Tarlatzis BC, et al. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update 2001; 7:161.
[2] Venetis CA, Papadopoulos SP, Campo R, et al. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod Biomed Online 2014; 29:665.
[3] Ludmir J, Samuels P, Brooks S, Mennuti MT. Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high-risk obstetric setting. Obstet Gynecol 1990; 75:906.
[4] Vercellini P, Daguati R, Somigliana E, et al. Asymmetric lateral distribution of obstructed hemivagina and renal agenesis in women with uterus didelphys: institutional case series and a systematic literature review. Fertil Steril 2007; 87:719.
[5] Smith NA, Laufer MR. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome: management and follow-up. Fertil Steril 2007; 87:918.
[6] Stassart JP, Nagel TC, Prem KA, Phipps WR. Uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis: the University of Minnesota experience. Fertil Steril 1992; 57:756.
* This article is reprinted with permission from the WeChat public account Doctor Girl Zhengchuan.