Overview

Uterine anomalies are structural abnormalities arising when the Müllerian ducts don't form or fuse correctly during foetal development. They affect ~5–7% of all women, rising to 25% in those with recurrent miscarriage.

Types

• Septate uterus — most common (35%); fibrous band divides the cavity; most associated with pregnancy loss
• Bicornuate uterus — two "horns"; linked to preterm birth
• Arcuate uterus — mild indentation; often a normal variant
• Unicornuate uterus — one side only; higher ectopic risk
• Didelphys uterus — two complete uteri and cervices
• Hypoplastic/absent uterus — e.g., MRKH syndrome

Symptoms

• Often no symptoms — discovered during fertility investigations
• Recurrent miscarriage, especially in second trimester
• Preterm labour or premature birth
• Abnormal foetal position (breech or transverse)

Diagnosis

• 3D transvaginal ultrasound — preferred initial tool
• MRI — most accurate for classification
• Hysteroscopy — direct visualisation and same-session treatment
• Renal ultrasound — to screen for associated kidney anomalies

Treatment

• Hysteroscopic septum resection — minimally invasive; significantly reduces miscarriage rates
• No treatment often needed — arcuate and bicornuate uteri may not require intervention
• Cervical cerclage — to reduce preterm birth risk in some cases
• Specialist obstetric monitoring throughout pregnancy

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