Bicornuate Uterus: Infertility Treatment and Pregnancy Continuation without Cerclage: An Unusual Case

Abstract

Introduction: Uterine malformation in general population is around 7% - 8%. Abnormal fusion of the para-mesonephric duct (mullerian duct) during embryonic life results in a variety of congenital uterine malformations, such as uterus didelphys, uterus bicornis bicollis, uterus bicornis unicollis, uterus subseptae, uterus arcuatus, uterus unicornis. The bicornuate uterus accounts for approximately 10% of the mullerian anomalies. Women with bicornuate uterus have no extra uterine infertility issues. The uterine malformations are known to be associated with spontaneous miscarriages, intrauterine growth restriction, preterm deliveries, preterm prelabour rupture of membranes, breech presentation and increased rate of caesarean delivery. The rates of spontaneous abortion and premature delivery have been reported to reflect the degree of non fusion of the horns. The common complications and adverse reproductive outcomes associated with bicornuate uterus are recurrent pregnancy loss (25%), preterm birth (15% - 25%) and cervical insufficiency (38%). We reported a case of bicornuate unicollis pregnancy which was infertility treated and carried till 38 weeks and had a good outcome. Case Report: A 32-year-old nullipara presented to Infertility OPD at NIMS Medical College and Hospital with the chief complaint of inability to conceive in spite of having regular sexual intercourse for 12 years without using any contraception. Patient was then investigated, bicornuate uterus identified. Infertility treatment was done by Intrauterine Insemination (IUI). Patient conceived and pregnancy continued till term uneventfully. Discussion: The prevalence of uterine anomalies is 7% - 8%. And now because of better availability of diagnostic modalities, better detection of such anomalies is possible. Bicornuate uterus is a congenital uterine anomaly that results from defective lateral fusion of the paramesonephric ducts at about the tenth week of intrauterine life around the fundus. A bicornuate uterus consists of two symmetric cornua that are fused caudad, with communication of the endometrial cavities—most often at the level of the uterine isthmus. In a partial bicornuate unicollis uterus the intervening cleft is of variable length. Bicornuate uterus has been reported to have the highest prevalence of cervical incompetence among mullerian anomalies. Prophylactic placement of cervical cerclage in selected patients has been reported to increase fetal survival rates.