OBLIQUITY OF THE UTERUS.
The longitudinal axis of the . - .
womb is not coincident with that of the pelvis, so that the vaginal portion deviates to one and the fundus deviates to the other side, together with defective development of one half of the womb. One side and one cornu are less than the other side and the other cornu. Thus the uterus is ap parently displaced upon its vertical axis.
There is in quite a number of cases no other explanation possible than that one Miillerian duct has been insufficiently developed, without, how ever, being prevented from uniting with the opposite duct. Perhaps also an unsymmetrical position of the two halves may have something to do with it; one duct may be situated lower than the other, and thus asymmetry ensue when the two halves unite. The cause may either be in the uterus itself, or it may come from without. One ligarnentum latum may be too short, as indeed Kussmaul found in a case of obliquity of the uterus in a new-born infant. Fcetal inflammations, and abnormal growth and size of neighboring organs, bladder and rectum, may not unlikely be influential factors also.
Deficient development of ono half of the organ is almost always marked by obliquity. This condition is the transition stage to latero flexion, where the body is bent upon the cervix, or body and cervix to gether are bent. Most often a, fault in the uterine rudiments or inflam matory shortening of the broad and round ligaments will be the active causes.
Sterility not infrequently occurs with obliquity of this kind, and prob ably the bending of the organ has more to do with it than any partial. de ficient development. The obliquity seen in the highly gravid uterus probably depends upon slight original obliquity of this kind, heightened and increased by the great mobility of the organ of conception at that time. On the other hand, the results ascribed to the obliquity of the
uterus are really due to other causes, Nevertheless, it is not impossible that the changes of the lower segment of the uterus, inter gravidilatem, in latero-position, may occur here.
The anomaly could be mistaken during life for a uterus unicornis on account of the lateral implantation of the vaginal portion and the oblique position of the womb. But the well-developed uterine body, and the lig. rotunda, tubes, and ovaries present on both sides, ought to render diagnosis easy. The only treatment that may possibly be necessary is the mechanical means for the relief of the sterility and the dysmenorrlicea.
I have recently had an opportunity to demonstrate in the clinic here a case of this kind during labor, and in a primiparous woman. The bead was deep down in the pelvis, and the cervix was widely dilated. The more developed. half was markedly deflected to the right, so that the somewhat cystic and dilated cornu reached almost to the kidney region. 'The atrophied side projected only a hand's breadth beyond the median line; its cornu was more deeply seated and turned anteriorly, so that its round ligament could be very plainly recognized. The fundus showed a slight depression. Labor was normal, save for a slight perineal rupture, but after delivery very little of the original form of the uterus could be recognized.
If the unilateral atrophy, and bettding is but little marked, we can regard the case as one of simple latero-version of the uterus; a condition which probably occurs in a similar manner to the corresponding flexion.