Bicornuate Research Articles

Ultrasound Imaging of a Bicornuate Uterus with a Pregnancy and an Intrauterine contraceptive device in different Horns: A Case Report from Zimbabwe

A bicornuate uterus is a congenital abnormality that results from the incomplete lateral fusion of the two müllerian ducts. The WHO eligibility criteria for contraceptive use, states that the use of intrauterine devices (IUCDs) is contraindicated for women with uterine abnormalities. However, in most cases, the presence of the bicornuate uterus is not known at the time of IUCD insertion. We herein report a case of a 41-year-old woman who had a bicornuate uterus with an IUCD in situ in the left horn and a live pregnancy in the right horn. The aim of this case report is to highlight the important role ultrasound imaging can play in the diagnosis of congenital uterine abnormalities in patients using IUCDs. Furthermore, the report also discusses the ultrasound imaging techniques that a diagnostician can adopt to optimize the diagnosis.

Ultrasound Imaging of a Bicornuate Uterus with a Pregnancy and an Intrauterine contraceptive device in different Horns: A Case Report from Zimbabwe

A bicornuate uterus is a congenital abnormality that results from the incomplete lateral fusion of the two müllerian ducts. The WHO eligibility criteria for contraceptive use, states that the use of intrauterine devices (IUCDs) is contraindicated for women with uterine abnormalities. However, in most cases, the presence of the bicornuate uterus is not known at the time of IUCD insertion. We herein report a case of a 41-year-old woman who had a bicornuate uterus with an IUCD in situ in the left horn and a live pregnancy in the right horn. The aim of this case report is to highlight the important role ultrasound imaging can play in the diagnosis of congenital uterine abnormalities in patients using IUCDs. Furthermore, the report also discusses the ultrasound imaging techniques that a diagnostician can adopt to optimize the diagnosis.

REPRODUCTIVE OUTCOME IN WOMEN HAVING CONGENITAL UTERINE ANOMALIES: A RETROSPECTIVE STUDY

Background: Congenital uterine anomalies result from failure of or incomplete development, fusion or canalisation of one or both Mullerian ducts during foetal life. [1] These anomalies are often asymptomatic and unrecognized, until menarche or starting of reproductive life. The spectrum of uterine anomalies ranges from an arcuate uterus, uterine didelphys , unicornuate , bicornuate, t-shaped and septate uterus.[3] Pregnancy occurs in many women despite these anomalies. The complication rates with pregnancy are considerably increased; complications include intrauterine fetal growth restriction, fetal malposition, preterm labor, preterm premature rupture of membrane and malpresentation (breech) [21]. Not surprisingly, the rate of caesarean delivery is markedly higher. [4] Thus we want to conduct a systematic review to evaluate the association between the different subtypes of uterine anomaly and various clinical presentations and reproductive outcomes. This study was carried out retrospectively in 52 patients Method: that were in the age group of 12-38 years and having congenital uterine anomalies and presenting with either primary or secondary infertility / amenorrhoea, bad obstetrical history, recurrent abortions, preterm deliveries and ectopic pregnancies using consecutive sampling. All patients were evaluated and investigated further including reproductive & perinatal outcome. Data were analyzed regarding type of uterine anomalies and their reproductive performance. Results & Conclusion: Results of study shows that patients with uterine anomalies have higher rates of reproductive loss, preterm deliveries, that increase obstetric intervention and perinatal mortality.

Double Trouble: Tips for Colpotomy and Vaginal Cuff Closure with Uterine Bicollis and Longitudinal Vaginal Septum

<h3>Study Objective</h3> To describe the laparoscopic technique for colpotomy, approach for laparoscopic excision of longitudinal vaginal septum, laparoscopic cuff closure with and without intact vaginal septum and considerations for uterine manipulation in patients with uterine bicollis and longitudinal vaginal septum. <h3>Design</h3> Two case reports. <h3>Setting</h3> Two laparoscopic cases at a single tertiary care center in the United States. <h3>Patients or Participants</h3> Two patients undergoing total laparoscopic hysterectomy (TLH) with uterine bicollis and longitudinal vaginal septa, one with a bicornuate uterus and one with uterine didelphys. <h3>Interventions</h3> The first patient with bicornuate uterus underwent TLH using a manipulator with small colpotomizer cup to accommodate the small caliber of the hemivagina and cervices. Colpotomy was performed by placing the manipulator first in the right cervix, then the left. Her vaginal septum left in situ as it was not bothersome. The septum was successfully integrated into the vaginal cuff. The second patient with uterine didelphys underwent TLH using a manipulator without a cup. The colpotomy was completed in a similar manner. Her septum was excised laparoscopically as it caused dyspareunia. The vaginal defect was repaired laparoscopically and cuff closed in the usual fashion. <h3>Measurements and Main Results</h3> Options for manipulation include a small manipulator cup, a manipulator without cup, vaginal devices such as sponge stick, vaginal/rectal probe or Briesky-Navratil retractor. Vaginal septa can be successfully incorporated into the vaginal cuff from a laparoscopic closure or excised laparoscopically. <h3>Conclusion</h3> Alternative means for uterine manipulation are often necessary in patients with uterine bicollis and longitudinal vaginal septa. Longitudinal vaginal septa can be successfully incorporated into the vaginal cuff for laparoscopic closure or excised and repaired laparoscopically.

Minimally Invasive Management of a Second Trimester Miscarriage in a Patient with a Non-Communicating Uterine Horn

<h3>Study Objective</h3> We present a rare case of an 18-week missed abortion in a patient with a previously undiagnosed non-communicating uterine horn. <h3>Design</h3> N/A. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> A patient with a history of suspected bicornuate uterus presented with missed abortion at 18 weeks gestation. <h3>Interventions</h3> Prior attempt at dilation and evacuation was unsuccessful and a diagnostic hysteroscopy confirmed no connection between the uterine cavity and the pregnancy. MRI imaging confirmed a unicornuate uterus with a non-communicating horn. Exploratory laparoscopy with hemi-hysterectomy and removal of uterine horn with fetus was performed. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Timely diagnosis of pregnancy within an unruptured non-communicating horn is exceedingly rare. With adequate workup including proper imaging, surgical planning, and technical expertise, safe laparoscopic removal of both the rudimentary horn and fetus is possible and should be offered to spare the patient the morbidity of laparotomy.

8397 Metroplasty; A Case of Bicornuate Uterus

<h3>Study Objective</h3> Video presentation showing laparoscopic metroplasty. <h3>Design</h3> Case presentation with showing procedural techniques in detail. <h3>Setting</h3> Tertiary academic teaching hospital. <h3>Patients or Participants</h3> 29-yo G3P0 with history of a 16 and an 18 weeks pregnancy losses leading to evaluation and diagnosis of bicornuate uterus with no other identifiable cause of recurrent second trimester loss. Her past medical history is significant for polycystic ovarian syndrome, otherwise healthy with no surgical history. US showed equal cavities in size and there is a small indentation about 2 cm at the top of the uterus. <h3>Interventions</h3> Hysteroscopy, followed by laparoscopic metroplasty. <h3>Measurements and Main Results</h3> Uncomplicated procedure with 3 months follow-up hysteroscopy showing normal cavity with no evidence of polyp, both ostia visualized, and secretory endometrium appreciated with no adhesions seen. <h3>Conclusion</h3> Surgical correction of bicornuate uterus is only recommended in patients with a history of poor pregnancy outcome after other potential causes have been ruled out. It is crucial to resect only the inter cavity segment to preserve normal size uterine cavity. Multi-layer myometrial closure is recommended.

What type of uterine anomalies had an additional effect on pregnancy outcomes, compared to other uterine anomalies? An evaluation of a large population database

Objective To compare pregnancy risks between different congenital uterine anomalies utilizing other congenital anomalies as a control group in a large population database. Design, setting, and sample A retrospective population-based cohort study from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) included 3,846,342 births (2010–2014). Of them, 6195 deliveries were to women with bicornuate uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with unicornuate uteri and 1404 with septate uteri. Main outcome measures and results After adjustment for confounders, women with bicornuate uteri were more likely to deliver vaginally (aOR 1.4, 95%CI: 1.1–1.9), p = .01), less likely to deliver by cesarean (CD) and had lower risk of small for gestational age (SGA) (aOR 0.8, 95%CI: 0.7–0.9, p = .03) when compared to the other anomalies (aOR 0.6, 95%CI: 0.5–0.6, p = .0001). Pregnant women with arcuate uterus had lower risks of preterm delivery (PTD) (aOR 0.6, 95%CI: 0.5–0.8, p = .0001), less chance of operative vaginal delivery (aOR 0.5, 95%CI: 0.2–0.9, p = .04), and higher risk for CD (aOR 1.6, 95%CI: 1.4–2, p = .0001). Pregnant women with didelphys uteri had higher risk of preterm premature rupture of membranes (PPROM) (aOR 1.6, 95%CI: 1.3–1.9, p = .0001), PTD (aOR 1.5, 95%CI: 1.3–1.6, p = .0001), CD (aOR 1.4, 95%CI: 1.2–1.5, p = .0001) and wound complications (aOR 1.6, 95%CI: 1.1–2.4, p = .02). Pregnant unicornuate uteri had increased risks of PTD (aOR 1.4, 95%CI: 1.1–1.6, p = .0001), CD (aOR 2, 95%CI: 1.6–2.5, p = .0001) and of SGA (aOR 1.8, 95%CI: 1.4–2.3, p = .0001). Pregnant septate uteri had higher risk of chorioamnionitis (aOR 1.5, 95%CI: 1.1–2.1, p = .048) and CD (aOR 1.4, 95%CI: 1.2–1.6, p = .0001). Conclusions We demonstrated that there are different risks for certain adverse pregnancy and neonatal outcomes in diverse uterine anomalies as compared to the other anomalies.

Diagnostic Value of Hysterosalpingography

Objective: Hysterosalpingography (HSG) is a contrast-enhanced, radiographic examination method of the internal female reproductive organs, which is used in the context of infertility diagnostics for the clarification of uterine malformations. The aim of this study was to investigate the significance of HSG as a diagnostic method in reproductive medicine. Methods: The results of HSG examinations from the Clinic for Reproductive Medicine and Andrology of the University Hospital Halle (Saale) between 2006 and 2020 were retrospectively examined. Results: Normal uterine findings were diagnosed by HSG in 151(51.01%) patients. The most common uterine malformation was uterus arcuatus, which was found in 46 patients (15.54%); 30(10.14%) patients had uterus bicornis unicollis. Uterus bicornis, unicornis, and subseptus were present in 5(1.69%) patients each. A duplex uterus was detected in 3(1.01%) patients, and malformations of a uterus arcuatum unicollis, uterus septus, bicornis subseptus, and uterus corpora in case of sectio bicornis were detected in 1(0.34%) patient each. A comparison of HSG findings with those from initial baseline diagnostics (gynecologic manual examination, sonography, etc.) revealed a correlation of findings in 105 cases (35.84%) and divergence of findings in 79 cases (26.96%). With the assistance of the HSG findings, further specification of the previously collected findings was achieved in 27 cases (9.22%). The diagnostic significance of HSG in reproductive medicine was demonstrated by the fact that findings were obtained and could not be detected in the preliminary examinations. In addition, basic diagnostic findings were confirmed by HSG, and conversely, previously collected findings could be further specified. HSG is a less invasive diagnostic imaging procedure with a short examination time. The fluoroscopy time is usually only a few seconds. Therefore, the radiation exposure is negligible. Conclusion: HSG is a method of radiologic examination that can be used to diagnose and specify uterine malformations. The diagnosis by HSG often opens up new therapeutic options to correct uterine malformations.

An Ultrasonographic Assessment to Document the Prevalence of Various Congenital Uterine Anomalies and their Probable Clinical Outcome in the Eastern Uttar Pradesh Region

Background: Uterine anomalies arise from abnormal fusion of paramesonephric ducts or failure of apoptosis of septum between two ducts leading to abnormal division of the uterine cavity. Initial dearth of universal standard diagnosis was the reason for the improper reporting of the data associated with prevalence of uterine developmental anomalies. But now various authors have reported the prevalence of uterine anomalies using standard diagnostic techniques. The objective of the study was to assess the prevalence of various uterine congenital anomalies among women of reproductive age (15–45 years) with no previous uterine pathology. Methodology: An ultrasound was utilized to take a transabdominal sonographs of both longitudinal and transverse planes from the supine position of participants who were made to consume 500–1000 mL of water to promote diuresis for the duration of the scan. Scans were then interpreted. Results: From a study of 200 participants whose mean age group fell around 30 ± 8 years, 140 of the women were parous and 60 were nulliparous. Twelve of the participants displayed anomalies that included bicornuate, arcuate, and septate. Five cases of the bicornuate uterus (2.5%), four arcuate uterus (2.0%), and three septate uterus (1.5%) were noted. Conclusion: From a sample size of 200, the occurrence of uterine anomalies is 6%, with no cases of uterine agenesis or a hypoplastic uterus.

How do bicornuate uteri alter pregnancy, intra-partum and neonatal risks? A population based study of more than three million deliveries and more than 6000 bicornuate uteri.

To explore maternal and neonatal outcomes in pregnant women with bicornuate uteri. Retrospective population-based cohort study utilizing data from the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2010 to 2014. There were 3,846,342 births between 2010 and 2014, included in the study. Six thousand and 195 deliveries were to women with bicornuate uterus. The remaining deliveries without other uterine anomalies were categorized as the reference group (n=3,840,147). Pregnant women with bicornuate uterus were older and more likely to be obese (p=0.0001) with previous cesarean deliveries (CD) (31 vs. 17.1%, p=0.0001). After adjustment for confounders, they were more likely to experience pregnancy-induced hypertension (HTN) (aOR 1.21, 95%CI: 1.1-1.3), p=0.0001), preeclampsia (aOR 1.4, 95%CI: 1.2-1.6, p=0.0001) and placenta previa (aOR 1.7, 95%CI: 1.3-2.2, p=0.0001). Moreover, they were more likely to deliver preterm (aOR 2.8, 95%CI: 2.6-3.1, p=0.0001), deliver by CD (aOR 5, 95%CI: 3.1-4.1, p=0.0001), experience preterm pre-labor rupture of membranes (PPROM) (aOR 3.5, 95%CI: 2.6-3.1, p=0.0001), and have a placental abruption (aOR 3.0, 95%CI: 2.5-3.5, p=0.0001). There were increased risks of PPH (aOR 1.4, 95%CI: 1.2-1.6, p=0.0001), wound-complications (aOR 2.0, 95%CI: 1.5-2.7, p=0.0001), hysterectomy (aOR 2.6, 95%CI: 1.6-4.1, p=0.0001), blood-transfusion (aOR 1.7, 95%CI: 1.5-2.1, p=0.0001), and DIC (aOR 1.6, 95%CI: 1.1-2.5), p=0.014) in the group with bicornuate uteri. Also there was higher risk of SGA (aOR 2.9, 95%CI: 2.6-3.2, p=0.0001) and IUFD (aOR 2.5, 95%CI: 1.8-3.3, p=0.0001). Bicornuate uteri can increase risks in pregnancy by many folds. Particularly risks of: premature delivery, CD, PPROM, placental abruption, hysterectomy, SGA and IUFD were increased 250-500%.

Prospective study of Feto maternal outcome in pregnancies with reproductive tract anomalies

Introduction: Congenital uterine anomalies are common but their effect on reproductive outcome is unclear. Congenital uterine anomalies result from abnormal formation, fusion or resorption of mullerian ducts during fetal life. The overall frequency of uterine or mullerian anomalies is 4%. In general fertile population the frequency of mullerian anomalies is 5%, in infertile population 3%. Recurrent miscarriages occur in 5-10% of cases. Materials and methods:A hospital based cross-sectional analytical study was conducted among the pregnant women with uncorrected reproductive tract anomalies in the Shaheed NirmalMahto Medical College, Dhanbad, Jharkhand. All the pregnant women with uncorrected uterine anomalies, diagnosed by transvaginal ultrasound and/or hysterosalpingography admitted through emergency or OPD basis. The study was conducted for a period of two years from September 2018 to August 2020. Results: A total of 31 pregnant women with uterine anomalies were included in the study. Bicornuate uterus was the most common uterine anomaly (45.2%) followed by arcuate uterus (19.3%). Cesarean section was conducted in 72.6% of the pregnant women and its major indication was fetal malpresentation (breech). Maternal complications were present in 55% of the pregnancies and fetal complications in 52% of the newborns.

Bicornuate uterus with second trimester fetal demise in a rudimentary horn

Bicornuate uterus is a congenital uterine anomaly associated with reproductive complications such as recurrent pregnancy loss, preterm birth, cervical insufficiency and uterine rupture. A bicornuate uterus occurs owing to failure of septal resorption after fusion of the paramesonephric ducts during organogenesis, resulting in a uterus divided into two horns. Most cases are only identified once reproductive difficulty is experienced or as an incidental finding in patients with a normal obstetric history. Here we present a patient who had two previous normal vaginal deliveries at term who was incidentally found to have a bicornuate uterus with second trimester fetal demise in the rudimentary horn. A hysterotomy and bilateral tubal ligation was performed, and the patient was discharged in good health after 48 hours.

P-718 How do bicornuate uteri alter pregnancy, intra-partum and neonatal risks? A population based study of more than 3-million deliveries and more than 6000 bicornuate uteri

Abstract Study question What are the obstetrical outcomes in the third-trimester in women with bicornuate uteri based on analysis of the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample(HCUP-NIS)database? Summary answer Bicornuate uteri increased risks in pregnancy. Notably risks of premature-delivery, Cesareans, PPROM, placental-abruption, hysterectomy, SGA and IUFD were increased 250%-500%. What is known already Bicornuate uterus is the most frequent uterine malformation. Previous individual studies were mostly small and yielded conflicting results regarding the effect of bicornuate uterus on pregnancy outcomes. In a recent systematic review of all congenital anomalies, 124 pregnancies with bicornuate uteri were included, and it was associated with increased rates of first-trimester miscarriage preterm birth, and fetal malpresentation. Study design, size, duration This retrospective population-based cohort study utilizing data from the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2010 to 2014, inclusive. There were 3,846,342 births between 2010 and 2014, included in the study. Six thousand and one hundred ninety five deliveries were to women with bicornuate uterus, and the remaining deliveries without other uterine anomalies were categorized as the reference group (n = 3,840,147). Participants/materials, setting, methods HCUP-NIS is the largest inpatient database in the USA and is comprised of hospitalizations throughout the USA. It provides information relating to seven-million inpatient stays yearly, includes 20% of admissions, and represents over 96% of the Americans. Multivariate logistic regression, was conducted to explore associations between bicornuate uteri and delivery outcomes and control for confounding effects. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Pregnant women with bicornuate uteri were older and more likely to be obese (P = 0.0001) with previous CD (31% vs. 17.1%, P = 0.0001). After adjustment for confounders, they were more likely to experience pregnancy-induced HTN (aOR 1.21, 95%CI: 1.1-1.3, P = 0.0001), preeclampsia (aOR 1.4, 95%CI: 1.2-1.6, P = 0.0001) and placenta previa (aOR 1.7, 95%CI: 1.3-2.2, P = 0.0001). Moreover, women with bicornuate uterus were more likely to deliver preterm (aOR 2.8, 95%CI: 2.6-3.1, P = 0.0001), deliver by CD (aOR 5, 95%CI: 3.1-4.1, P = 0.0001), experience PPROM (aOR 3.5, 95%CI: 2.6-3.1,P=0.0001), and have a placental abruption (aOR 3.0, 95%CI: 2.5-3.5, P = 0.0001). There were increased risks of PPH (aOR 1.4, 95%CI: 1.2-1.6, P = 0.0001), wound-complications (aOR 2.0, 95%CI: 1.5-2.7, P = 0.0001), hysterectomy (aOR 2.6, 95%CI: 1.6-4.1, P = 0.0001), blood-transfusion (aOR 1.7, 95%CI: 1.5-2.1, P = 0.0001), and DIC(aOR 1.6, 95%CI: 1.1-2.5), P = 0.014) in the group with bicornuate uteri. Pregnant women with bicornuate uterus had a higher risk of SGA (aOR 2.9, 95%CI: 2.6-3.2, P = 0.0001) and IUFD (aOR 2.5, 95%CI: 1.8-3.3, P = 0.0001). There was no increased risk for chorioamnionitis (P = 0.47) or maternal infection (P = 0.8) in women with bicornuate uteri. Limitations, reasons for caution This is a retrospective analysis utilizing an administrative database that relies on data coding accuracy and consistency. Wider implications of the findings The present study demonstrates that women with bicornuate uteri tend to deliver preterm, by CD, and with increased probability of PPROM or abruption placenta. Neonatal outcomes were also worse in women with bicornuate uteri including a 250%-300% increase in the risk of SGA and IUFD. Trial registration number Not Applicable

P-749 How do different uterine anomalies compare for pregnancy complications? An evaluation of a large American population database

Abstract Study question What type of uterine anomalies cause alterations in pregnancy complications, compared to other anomalies, based on analysis of the Healthcare-Cost and Utilization-Project-Nationwide Inpatient Sample(HCUP-NIS) database? Summary answer After controlling for confounders, bicornuate uteri had lower risks and arcuate uteri had increased risks of cesareans and mostly similar risks of other outcomes. What is known already Women with mullerian anomalies are known to have increased risks of adverse obstetrical outcomes. Comparison of different adverse obstetrics outcomes between women with different type of uterine anomalies has minimally been studied. Study design, size, duration This retrospective population-based cohort study utilized data from the HCUP-NIS from 2010-2014, inclusively. A cohort of all deliveries during the study period was created. Within this group, Six thousand and one hundred ninety-five deliveries were to women with bicornuate uteri, 798 were to women with arcuate uteri, 2255 were in women with didelphys uteri, 802 were from women with unicornuate uteri and 1404 were deliveries to women with septate uteri. Participants/materials, setting, methods HCUP-NIS is the largest inpatient sample database in the USA and is comprised of hospital stays throughout the country. It provides information relating to seven million inpatient stays yearly, includes 20% of admissions, and represents over 96% of the American population. Multivariate logistic regression was conducted to explore associations between uterine anomalies and delivery outcomes. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance After adjustment for confounders, women with bicornuate uteri had less risk for chorioamnionitis(aOR:0.6, 95%CI:0.5-0.8-P=0.003), were more likely to deliver vaginally or by operative vaginal delivery(aOR:1.4, 95%CI:1.1-1.9-P=0.01), and less likely to deliver by CD when compared to the other anomalies(aOR:0.6, 95%CI:0.5-0.6-P=0.0001). They had lower risk of SGA (small for gestational age)(aOR:0.8, 95%CI:0.7-0.9-P=0.03). Pregnant women with arcuate uterus had lower risk of preterm delivery compared to the other anomalies(aOR:0.6, 95%CI:0.5-0.8-P=0.0001), less chance of having delivered by an operative vaginal delivery(aOR:0.5, 95%CI:0.2-0.9-P=0.04), and were at higher risk of having a CD(aOR:1.6, 95%CI:1.4-2-P=0.0001). Pregnant women with didelphys uteri had higher risk of PPROM(aOR:1.6, 95%CI:1.3-1.9-P=0.0001), preterm delivery(aOR:1.5, 95%CI:1.3-1.6-P=0.0001), CD(aOR:1.4, 95%CI:1.2-1.5-P=0.0001) and wound complications(aOR:1.6, 95%CI:1.1-2.4-P=0.02) compared to the other anomalies. However, they had less risk for placenta abruptia(aOR:0.6, 95%CI:0.5-0.9-P=0.02). Pregnant women with unicornuate uteri had increased risks of preterm delivery(aOR:1.4, 95%CI:1.1-1.6-P=0.0001), CD(aOR:3.0, 95%%CI:1.6-2.5-P=0.0001) and SGA(aOR:1.8, 95%CI:1.4-2.3-P=0.0001) with lower risk of placenta abruptia(aOR:0.5, 95%CI:0.3-0.9-P=0.03). Pregnant women with septate uteri had higher risk of chorioamnionitis(aOR:1.5, 95%CI:1.1-2.1-P=0.048) and CD(aOR:1.4, 95%CI: 1.2-1.6-P=0.0001). Other pregnancy complications studied which included PPH, the need for hysterectomy, and IUFD had similar rates between the groups(p &amp;gt; 0.05 all). Limitations, reasons for caution This is a retrospective analysis utilizing an administrative database that relies on data coding accuracy and consistency Wider implications of the findings There are different risks for certain adverse pregnancy and neonatal outcomes in different uterine anomalies as compared to the other anomalies. Although, regarding many pregnancy complications, risks were similar with different anomalies. Arcuate uterus mostly responds in a similar manner in terms of pregnancy complications as other anomalies. Trial registration number NA

Incidental Finding of Bicornuate Uterus in a patient posted for Medical termination of pregnancy and Tubal Ligation

Incidental Finding of Bicornuate Uterus in a patient posted for Medical termination of pregnancy and Tubal Ligation

V06-12 LAPAROSCOPIC MITROFANOFF APPENDICOVESICOSTOMY: AN OPTION IN COMPLEX ADULT PATIENT TO ACCESS TO THE BLADDER

You have accessJournal of UrologyCME1 May 2022V06-12 LAPAROSCOPIC MITROFANOFF APPENDICOVESICOSTOMY: AN OPTION IN COMPLEX ADULT PATIENT TO ACCESS TO THE BLADDER Roberto Hugo Martinez Rodriguez, Cristina Gutierrez Ruiz, Leire Portilla Maediavilla, Fatima Castroviejo, and Jose H. Amon Sesmero Roberto Hugo Martinez RodriguezRoberto Hugo Martinez Rodriguez More articles by this author , Cristina Gutierrez RuizCristina Gutierrez Ruiz More articles by this author , Leire Portilla MaediavillaLeire Portilla Maediavilla More articles by this author , Fatima CastroviejoFatima Castroviejo More articles by this author , and Jose H. Amon SesmeroJose H. Amon Sesmero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Mitrofanoff principle was originally described in paediatric population as a method to provide an alternative access to the bladder. It creates a conduit to the bladder through which patients with a sensitive, absent or traumatized urethra can perform clean intermittent catheterization (CIC) easily. We report our experience with complete laparoscopic approach in an adult patient with complex urogenital malformation and multiple previous surgeries. METHODS: 39 years old female patient born with urogenital sinus plus anorectal atresia and bicornuate uterus with several reconstructive surgeries during neonatal and infant period. Previous to the surgery, the patient was performing several CIC per day with increasing difficulty, pain and urethrorrhagia. The patient was incontinent due to elevate post-voiding residue due to an ineffective evacuation by catheter. Low bladder pressure was confirmed by urodynamics. Pelvic MRI showed atypical morphology of the bladder after previous surgery plus cystic image in the right iliac fossa related to anexial cyst without visualizing the anal sphincter complex. RESULTS: A 4 port transperitoneal approach was used :2 of 10 mm laparoscopic ports and 2 of 5 mm ports. The 10 mm camera port was placed trough the umbilicus and the rest in the midline and lateral to the edge of the rectus abdominis muscle. After liberation of several abdominal adherences, we found the appendix and right hemicolon medially and cranially displaced. The appendix was harvested with preservation of the vascular supply and ligated at its base. The appendix was assessed to determine whether the length was adequate to reach the anterior abdominal wall. The bladder was filled with saline and a 3 cm vertical seromuscular incision was made in the right posterior wall of the bladder down to the mucosa. Appendicovesical anastomosis was then performed, and seromuscular layer of the bladder was closed creating a tunnel for the appendix. The tightness of the bladder anastomosis was tested by bladder filling. Care was taken to ensure absence of twisting or tension on the appendiceal mesentery. The appendix was then brought up to the abdominal wall and a catheterizable stoma was created with 8 Fr catheter left through the appendix. The operative time was 300 min and estimated blood loss was 120 cc. The patient was discharged at eighth day. CONCLUSIONS: Pure laparoscopic Mitrofanoff appendicovesicostomy is feasible in adult patients even with previous and complicated surgeries. Pure laparoscopic Mitrofanoff is associated with reasonable outcome, early recovery and good cosmesis. The main disadvantage is the long operative time due to anatomical challenges. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e568 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Hugo Martinez Rodriguez More articles by this author Cristina Gutierrez Ruiz More articles by this author Leire Portilla Maediavilla More articles by this author Fatima Castroviejo More articles by this author Jose H. Amon Sesmero More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Rare Case of Spontaneous Uterine Rupture in Second Trimester Pregnancy with Bicornuate Uterus: A Case Report

Eighteen weeks gestation of 34 years-old-woman with abdominal pain in the last 12 hours because of uterine rupture. Abdominal pregnancy was found with 2D ultrasound. On laparotomy exploration, bicornuate uterus was found with uterine rupture and an unviable fetus. Supravaginal hysterectomy was performed to control haemorrhage. Uterine anomaly is rare. However, the complications that occur will be an obstetric emergency. Screening uterine anomalies at premarital or early antenatal care is needed for predicting the risk of maternal mortality.

A \u201ccluster\u201d of ten uterine anomalies observed in a single center over a short period of 4\xa0weeks: a case series

BackgroundUterine anomalies occur because of Müllerian duct maldevelopment. Few of them are associated with adverse obstetric outcome (Reyes-Muñoz et al. in Diagnostics. 2019;9:4. https://doi.org/10.3390/diagnostics9040149). Genital outflow tract obstructive uterine anomalies invariably present in the adolescent age group.Case detailsWe report a case series of uterine anomalies. Ten such cases presented like a “cluster” within a short span of just one month. Eight of these ten cases were diagnosed intraoperatively during cesarean section. One case was diagnosed during laparoscopic sterilization, and the other case was diagnosed before doing manual vacuum aspiration. There were four cases of bicornuate uterus, two cases each of unicornuate uterus and uterine didelphys, and one case each of septate uterus and arcuate uterus. All eight babies were healthy and without any obvious congenital anomalies. To the best of the authors’ knowledge, literature regarding these anomalies has been mentioned mostly as case reports (Bruand et al. in Cureus. 2020;12:3. https://doi.org/10.7759/cureus.7191) and a few case series (Ross et al. in BMJ Case Rep. 2018. https://doi.org/10.1136/bcr-2017-221815). All women were of Kannadiga ethnicity and in the age range of 19–35 years. They were from places nearby to our institute within a range of approximately 250 km.ConclusionWe describe herein almost all types of uterine anomalies. These rare uterine anomalies presented in a short span of just four weeks like a “cluster”. This incidental finding is unusual. We need to design studies to understand the reasons for clustering of such cases in our clinical practice.

Incidental Diagnosis of Bicornuate Uterus in a Lady of 48 Years - A Case Report

Congenital anomalies of uterus are not very uncommon. Quite a number of women with these anomalies can be totally asymptomatic. In some women, anomalies may be first detected during pregnancy or delivery. Here a case of incidentally diagnosed bicornuate uterus is reported in a lady of 48 years while being treated for breast carcinoma. The patient attended with a lump in her left breast at Delta Medical College Hospital, Dhaka, Bangladesh. She was totally asymptomatic previously and her three children were born preterm without any difficulty. Along with other investigations, abdominal ultrasonogram was done which showed two separate fundal and uterine cavities with single cervix. Bicornuate uterus was confirmed by endovaginal ultrasonogram. Breast carcinoma was treated accordingly.&#x0D; Delta Med Col J. Jul 2020 8(1): 46-50

A unique case of coexisting intrauterine and abdominal pregnancy which progress to term with a positive birth outcome

BackgroundThe term heterotopic pregnancy is defined as a uterine pregnancy coexisting with a second pregnancy in an extrauterine location. Spontaneous, full-term heterotopic pregnancy with alive birth is very rare. The diagnosis and management of such exceptionally unique case is difficult. When the patient presented with an advanced labor with no antenatal care follow up and with no risk factors is even more challenging for poorly equipped facilities like ours.Case presentationA 25 years old gravida 3, para 2 (both are alive) mother presented to the labor and delivery ward of Bele Primary Hospital, Southern Ethiopia with the complaint of pushing down pain of 18 h duration. Immediately after arrival, she gave birth to a 3300gm female neonate spontaneously. After delivery, an abdominal mass was recognized and manual exploration of the uterus was done to look for the presence of after coming second twin but the uterus was empty. On ultrasound examination, there was an alive fetus in transverse lie outside the uterus. With the impression of 2nd twin in a separate horn of bicornuate uterus and to rule out abdominal pregnancy, laparotomy was done. On laparotomy, there was abdominal pregnancy in the Pouch of Douglas with an intact amniotic sac. The sac was attached with the left broad ligament, left ovary, small bowel mesentery, and posterior wall of the uterus. The sac opened, a 1600gm alive female neonate with features of fetal growth restriction and left club foot was delivered. The placenta was detached spontaneously and removed without any complication.ConclusionsThe coexistence of spontaneous full-term intrauterine with advanced abdominal ectopic pregnancy is one of the rarest forms of heterotopic pregnancy. Every health professional should bear in mind that intrauterine and extrauterine pregnancy may happen simultaneously and it can progress to term without any symptoms. Ultrasound is the diagnostic method of choice but the existence of an intra-uterine pregnancy cannot rule out ectopic pregnancy. The life-threatening complication of abdominal ectopic pregnancy is bleeding from the detached placental site. Therefore, the decision to remove the placenta should be individualized.