Abnormalities of the female reproductive organs can cause infertility, miscarriage, premature birth (before 37 completed weeks of pregnancy) and other pregnancy complications. Reproductive tract abnormalities can be congenital (present at birth) or acquired (develop later in life).
Many women with reproductive tract abnormalities have no symptoms and do not know they have an abnormality. Some women with reproductive tract abnormalities are able to become pregnant and have normal, full-term pregnancies. Others may learn that they have a reproductive tract abnormality if they have difficulty becoming pregnant or develop pregnancy complications. In some cases, treatment can improve the chances for a healthy pregnancy.
What are congenital uterine abnormalities?
The uterus is a hollow muscular organ shaped like an upside-down pear. The narrow, lower end of the uterus is called the cervix. About 3 in 100 women are born with an abnormality in the size, shape or structure of the uterus (1). In the female embryo, the uterus is formed from two small tubes called Mullerian ducts. At about 10 weeks gestation, these two tubes come together and fuse, forming a single uterine cavity. When the Mullerian ducts do not fuse at all or fuse incompletely, a uterine abnormality can result.
Some women with a congenital uterine abnormality have normal, full-term pregnancies. However, these abnormalities can increase the risk of a number of reproductive problems, including:
The risk may be different for each one of these problems, depending on the specific uterine abnormality.
Congenital uterine abnormalities include:
How are congenital uterine abnormalities diagnosed?
Congenital uterine abnormalities usually are diagnosed using imaging tests. Sometimes more than one of these tests is needed to distinguish between uterine abnormalities. It is important to make the correct diagnosis because certain uterine abnormalities (such as septate and bicornate uterus) appear similar on some imaging tests but are treated differently. Imaging tests include (1, 3):
How are congenital uterine abnormalities treated?
Some congenital uterine abnormalities can be corrected with surgery. The provider may recommend surgery for a woman who has a congenital uterine abnormality and a history of miscarriage or premature birth. Surgery usually is not recommended if the woman has no history of pregnancy problems because some women with uterine abnormalities have normal, full-term pregnancies.
Studies suggest that more than 80 percent of women with septate uterus have successful pregnancies after surgical removal of the septum (1). Surgery for this abnormality generally can be done during hysteroscopy. In a hysteroscopy, the provider inserts a thin, telescope-like instrument through the vagina and cervix into the uterus to see inside the uterine cavity. The provider inserts a small instrument through the hysteroscope to remove the septum. Surgery to correct bicornate uterus and other congenital uterine abnormalities involves more extensive surgery through an incision (cut) in the abdomen.
What are acquired uterine abnormalities?
Acquired uterine abnormalities are those that develop later in life. Acquired uterine abnormalities that affect pregnancy include:
What are fibroids?
Fibroids are benign (non-cancerous) growths made up of muscle tissue. They range from pea-size to 5 to 6 inches across. About 20 to 40 percent of women develop fibroids during their reproductive years, most frequently in their 30s and 40s (4). Many women with fibroids have no symptoms, while others have symptoms such as (5):
The health care provider may first detect fibroids during a routine pelvic exam. The diagnosis can be confirmed with one or more imaging tests.
Do fibroids cause pregnancy complications?
Small fibroids usually do not cause problems during pregnancy and usually require no treatment. However, fibroids occasionally break down during pregnancy, resulting in abdominal pain and low-grade fever. Treatment includes bedrest and pain medication. Multiple or large fibroids may need to be surgically removed, generally before pregnancy, to avoid potential complications associated with pregnancy. Due to pregnancy hormones, fibroids sometimes grow larger during pregnancy. Rarely, large fibroids may block the uterine opening, making a cesarean birth necessary.
Most women with fibroids have healthy pregnancies. However, fibroids can increase the risk of certain pregnancy complications, including (2, 5):
If the health care provider determines that a woman’s infertility or repeated pregnancy losses are probably caused by fibroids, he may recommend surgery to remove the fibroids. This surgery is called a myomectomy. In some cases, myomectomy can be done during hysteroscopy.
What are uterine adhesions?
Uterine adhesions, sometimes called Asherman syndrome, are scar tissue that can damage the uterine lining (endometrium). The damage may range from mild to severe. Causes of uterine adhesions can include (2, 6):
Some women have no symptoms, while others may have light or infrequent menstrual periods. Adhesions can contribute to infertility, repeat miscarriage and premature birth (2, 6). Imaging tests and hysteroscopy can diagnose adhesions. Adhesions can be removed during hysteroscopy, improving the chances of a normal pregnancy (2).
What are cervical insufficiency and short cervix?
Cervical insufficiency (sometimes called incompetent cervix) refers to a cervix that opens too early during pregnancy, usually without pain and contractions. This usually occurs in the second or early third trimester of pregnancy, resulting in late miscarriage or premature birth. A woman may be diagnosed with cervical insufficiency based largely on this history. There is no specific diagnostic test.
Medical experts do not always know why cervical insufficiency occurs. Factors that may contribute include (7):
Miscarriage and premature birth due to cervical insufficiency frequently happens again in another pregnancy. These problems can sometimes be prevented with a procedure called cerclage, in which the provider places a stitch in the cervix to keep it from opening too early. The provider removes the stitch when the woman is ready to give birth.
It is not always clear which women will benefit from cerclage. This is because there is no specific test for cervical insufficiency, and many women who have had a late miscarriage or early premature birth go on to have normal pregnancies without treatment. Some studies suggest that cerclage is most likely to be beneficial in women who have had three or more late miscarriages or premature births (7). In some cases, providers may monitor a woman suspected of having cervical insufficiency with repeated vaginal ultrasounds to see if her cervix is shortening or showing other signs that she may give birth soon. The provider may recommend cerclage if these changes occur.
Some women learn that they have a short cervix during a routine ultrasound. Most of these women do not end up having a premature birth. However, short cervix, especially a very short cervix (less than 15 millimeters), does increase her risk of premature birth (8, 9). Studies suggest that treatment with the hormone progesterone may help reduce the risk of premature birth in women with a very short cervix (8, 9). According to the American College of Obstetricians and Gynecologists (ACOG), progesterone treatment may be considered for these women (8). However, ACOG does not recommend routine cervical-length screening for low-risk women.
Does a retroverted (tipped) uterus pose pregnancy risks?
Almost never. About 20 percent of women have a uterus that tips slightly backward (10). This is considered a normal variant of uterine positioning in most women, though some women may develop a retroverted uterus due to fibroids or scar tissue in the pelvis. Generally, the uterus straightens by early in the second trimester and does not contribute to pregnancy complications.
At about 12 weeks of pregnancy, the top of the uterus normally extends past the pelvic cavity. Rarely, a retroverted uterus may become trapped in the pelvis. This is called uterine incarceration and can cause pain and difficulty passing urine (10). An ultrasound can diagnose retroverted uterus in women with these symptoms. Simple treatments, including bladder drainage, positioning exercises the woman can do at home, or gentle manipulation by the health care provider, usually can restore the uterus to its normal position. Occasionally, an untreated incarcerated uterus may contribute to second-trimester miscarriage.
What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS) is a condition that affects a woman’s hormones and ovaries. PCOS affects up to 7 percent of women of childbearing age and is the leading cause of female infertility (12). Some women learn they have PCOS when they have problems becoming pregnant.
Women with PCOS have high levels of male hormones (androgens), which may interfere with normal ovarian function. Affected women often do not ovulate regularly. PCOS also affects other bodily systems, increasing a woman’s risk for diabetes and heart disease (11, 12). Signs and symptoms of PCOS include (11, 12):
How is PCOS diagnosed?
There is no specific diagnostic test for PCOS. Diagnosis is usually based on:
How is PCOS treated?
Women with PCOS who are overweight or obese should attempt to lose weight. Women who lose even 10 percent of their body weight can improve menstrual irregularities, lower androgen levels and reduce the risk of diabetes (11, 12). Weight loss also can improve fertility (11).
Women who do not wish to become pregnant right away can be treated with birth control pills. This treatment often helps regulate menstrual cycles and reduce androgen levels. In some cases, the woman may be treated with an oral diabetes drug called metformin (Glucophage), instead of or in addition to birth control pills. Metformin also helps reduce androgen levels and may help with weight loss.
Women who are having difficulty conceiving can be treated with medications that stimulate ovulation, usually starting with clomiphene citrate (Clomid, Serophene). If clomiphene treatment is not successful, the woman can be treated with injected fertility drugs (gonadotropins) or in vitro fertilization (IVF). In IVF, eggs are combined with sperm in the laboratory to create embryos which are transferred into the woman’s uterus. All fertility treatments increase the risk of multiple gestation (twins, etc.), which increases the risk for premature birth and other complications.
Does PCOS increase the risk of pregnancy complications?
Studies suggest that women with PCOS are at increased risk of gestational diabetes, preeclampsia (a pregnancy-related form of high blood pressure) and premature birth (11, 12, 13). Obesity also can increase the risk of these complications, so women with PCOS may be able to reduce their risk by reaching a healthy weight before they become pregnant. Women with PCOS should see their health care provider before pregnancy to make sure any health problems, such as diabetes, are under control, and that any medications they take are safe in pregnancy. When they become pregnant, they should go to all their prenatal appointments so that any complications can be diagnosed and managed before they become serious.
Does the March of Dimes support research on uterine and ovarian abnormalities and pregnancy?
The March of Dimes supports a number of grants on uterine and ovarian abnormalities and the pregnancy complications they may cause. One grantee is seeking to identify cell-to-cell signaling pathways that may help trigger shortening of the cervix before labor, in order to develop new treatments aimed at preventing premature birth. Another is studying the role of androgens in normal ovarian growth and fertility, in order to develop improved fertility treatments for PCOS.
Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.
You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:
If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.
There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.
The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.
If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.
If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.
Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.
Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.