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Pelvis » Female Pelvis (Gynecology)
T-shaped uterus
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Presentation A 25 year old woman presents with a history of repeated spontaneous first trimester abortions. An ultrasound and sonohysterography were performed.
 
 
 
Caption: Sonohysterographic image of the endometrium
Description: The endometrial cavity is distended with fluid and shows an irregular T-shaped outline.
 
 
 
Caption: Sonohysterographic image
Description: The endometrial cavity in the fundal region again shows a characteristic T-shape. The echogenic material seen floating within the distended endometrial canal represent blood clots.
 
 
 
Caption: Transverse sonohysterographic view
Description: The characteristic T-shape of the endometrium is again noted. The blood clots in the endometrial cavity are more prominent in this view.
 
Differential Diagnosis T-shaped uterus vs. other uterine anomaly
 
Final Diagnosis T-shaped uterus with blood clots in the endometrial cavity. This woman had in-utero exposure to diethylstilbestrol.
 
Discussion An overview of congenital anomalies of the uterus is available [here]

A T-shaped endometrial cavity classically occurs due to diethylstilbestrol [DES] exposure. DES is a synthetic form of estrogen that was given to women in the past few decades to prevent certain complications of pregnancy, namely premature deliveries and spontaneous abortions. However, many utero-tubal and other malformations were noted in the female off-springs of DES exposed women. These included the characteristic T-shaped uterus, cervico-isthmic anatomic anomalies, cornual restriction bands, lower uterine segment dilatation, pretubal bulges, short and narrow tubes and anomalies of the vaginal epithelium.

According to one study, amongst all the congenital anomalies, a T-shaped uterus is associated with the highest rate of first trimester spontaneous abortions and the lowest rate of term deliveries.  It is, therefore, important to recognise this condition because of its influence on predicted obstetric outcome. Due to the anatomic configuration of this anomaly conventional radiographic or sonohysterosalpingography is required for a definitive diagnosis. 
 
Case References 1. Golan A, Langer R, et al. Obstetric outcome in women with congenital uterine malformations. J Reprod Med. 1992 Mar; 37(3):233-6.
2. Drapier E. Fertility disorders attributable to the use of diethylstilbestrol during intrauterine life. Rev Fr Gynecol Obstet. 1984 Apr; 79(4):297-300, 303-5.
3. Petrozza J, et al. Hysteroscopy. http://www.emedicine.com/med/topic3314.htm
4. Kaufman RH, Binder GL, Gray PM Jr, Adam E. Upper genital tract changes associated with exposure in utero to diethylstilbestrol. Am J Obstet Gynecol. 1977 May 1;128(1):51-9.
 
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