Double Cervix Research Articles

Bicervical Normal Uterus with Normal Vagina and Anteroposterior Disposition of the Double Cervix

We report a very uncommon uterine anomaly consisting on a normal uterus, a double cervix with an anteroposterior disposition, and absence of vaginal septum. A 36-years-old woman with one child and absence of past reproductive disorders was examined for a routine checkup. Clinical and transvaginal ultrasound examinations showed a normal uterus with a double cervix disposed in an anteroposterior fashion with the absence of vaginal septum. A review of the theories concerning müllerian fusion is done, and implications of this case in relation with these theories are discussed. This is the first case of a normal uterus with a double cervix situated in an anteroposterior fashion and absence of vaginal septum. This case is in concordance with theories that consider the fusion of the caudal part of Müllerian ducts to be the result of a complex process. It proves that at least in some cases the most caudal part of müllerian ducts is fused in an anteroposterior disposition.

Robotic Modified Jones Metroplasty for Uterine Unification

To show the feasibility of robotic metroplasty in the treatment of double uterus. Patients: The 36-year-old, Gravida 0 para 0, woman with primary infertility. She received IVF twice, but failed to conceive. Pelvic MRI revealed complete septated uterus with double cervix. However, uterine septum resection cannot be performed by hysteroscopy. Robotic metroplasty was performed by Da Vinci Si surgical system. The uterine septum should be surgically excised as a wedge. After the wedge has been removed, the uterus is closed in three layers with interrupted stitches: 2-0 non reactive suture on an atraumatic tapered needle is convenient.

Uterus didelphys in a buffalo heifer: a case report

Uterus didelphys or true double cervix is a congenital anatomical defect of the female genital tract of monotocous species, including cattle and humans (1). The defect is characterized by presence of completely separated cervices, each one leading to a separate uterine horn. The condition has been attributed to failure of fusion of the caudal portions of the paramesonephric ducts during embryonic development, resulting in a double cervix or a divided uterine funds (2). These cases could conceive normally, but may show dystocia due to a fetal limb entering each cervical canal (3). Case reports of uterus didelphys in cows are sporadic (4,5). Fig 1: A- Buffalo heifer reproductive tract showing two cervical canals, B- two cervical canals leading to separate uterine horns. In the present case and during routine collection of reproductive tracts from Mosul abattoir a uterus didelphys was diagnosed through the post mortem examination of the reproductive tract of a buffalo heifer. Macroscopically, the genital tract had two cervical canals without any connections between them; they were separately opened into separated uterine horns (Figure 1). This is the first record of such a case in buffalo cows.

Difficult Total Laparoscpoic Hysterectomy (TLH) for a Case with Double Uterus, Double Cervix and Double Vagina, with Severe Pelvic Endometriosis with Diffuse Pelvic Adhesion, with Previous Hemi-Subtotal Hysterectomy

Study Objective: Introduction: Total laparoscopic hysterectomy (TLH) for cases with Mullerian anomalies usually possess particular surgical difficulties. Congenital adhesion bands among bladder, rectum, and Mullerian duct may obscure the usual dissection plane. Concomitant deeply infiltrating endometriosis (DIE) will be another problem. For patient with previous incomplete surgical procedures, the situation becomes even worse. (distorted anatomy). Materials & Methods: The 42 y/o lady had Mullerian anomaly. (didelpyis uterus, double cervix, double vagina) She even received open LSO, and Lt subtotal hysterectomy. This time, severe adenomyosis (on Rt uterus), and posterior DIE were noted. Results: Total laparoscopic intervention (TLH+ adhesiolysis + radical excision of DIE lesions) was successfully performed, after complete development of bilateral retroperitoneal spaces, medial pararectal spaces and rectovaginal space. The double vagina lumens were clearly visible through laparoscopic view during the procedure. Conclusion: For patient with Mullerian anomaly associated with advanced endometriosis and severe pelvic adhesion, laparoscopic approach is feasible. Study Objective: Introduction: Total laparoscopic hysterectomy (TLH) for cases with Mullerian anomalies usually possess particular surgical difficulties. Congenital adhesion bands among bladder, rectum, and Mullerian duct may obscure the usual dissection plane. Concomitant deeply infiltrating endometriosis (DIE) will be another problem. For patient with previous incomplete surgical procedures, the situation becomes even worse. (distorted anatomy). Materials & Methods: The 42 y/o lady had Mullerian anomaly. (didelpyis uterus, double cervix, double vagina) She even received open LSO, and Lt subtotal hysterectomy. This time, severe adenomyosis (on Rt uterus), and posterior DIE were noted. Results: Total laparoscopic intervention (TLH+ adhesiolysis + radical excision of DIE lesions) was successfully performed, after complete development of bilateral retroperitoneal spaces, medial pararectal spaces and rectovaginal space. The double vagina lumens were clearly visible through laparoscopic view during the procedure. Conclusion: For patient with Mullerian anomaly associated with advanced endometriosis and severe pelvic adhesion, laparoscopic approach is feasible.

A Septated Uterus with Double Cervix and Double Vagina

A Septated Uterus with Double Cervix and Double Vagina

Reproductive outcome following resectoscope metroplasty in women having a complete uterine septum with double cervix and vagina

Objective To evaluate reproductive outcomes in women with complete uterine septum with double cervix and vagina following resectoscope metroplasty. Methods The pregnancy outcomes of 21 women who underwent vaginal and uterine septum resection were compared with those of 15 untreated women with similar clinical characteristics. The Fisher exact test and the Mann-Whitney test were used for statistical analysis. Results Cycle fecundity was better (33.4% ± 28.5% vs 12.2% ± 4.7%; P = 0.046), the rate of term delivery significantly increased ( P < 0.05), and the rate of spontaneous abortion decreased ( P < 0.05) in the treatment group. Conclusion Resectoscope metroplasty was found to improve the pregnancy outcomes of women having primary infertility or a history of pregnancy loss associated with a complete uterine septum with double cervix and vagina.

A normal uterus communicating with a double cervix and the vagina: a müllerian anomaly without any present classification

To report a rare uterine anomaly consisting of a normal uterus, a double cervix, and a double vagina. Case report. University hospital. A 28-year-old nulligravida patient referred for evaluation of primary infertility and a suspected müllerian anomaly. Clinical and surgical evaluation of the anomaly. Description and treatment for a rare uterine anomaly and a subsequent literature search. Successful resection of vaginal septum and subsequent pregnancy. This extremely rare anomaly is not explained by classic embryologic teachings, and it does not fit into the classification system currently used to describe müllerian anomalies.

Reproductive Outcome of Women with Rare Müllerian Anomaly: Report of 2 Cases

Two patients had a rare uterine anomaly characterized by longitudinal vaginal septum, double cervix, and incomplete septum of the uterus with normal fundus. This report is, to our knowledge, the third in the literature. There are some other works describing a similar anomaly, with a complete uterine septum. These cases challenge the classic unidirectional theory of müllerian development and support an alternative bidirectional hypothesis. After definitive diagnosis, the vaginal and uterine septa were successfully resected. Both patients conceived spontaneously and had an uneventful obstetric outcome. Surgical treatment might be an alternative treatment in the case of infertility or recurrent pregnancy loss in patients with such a rare müllerian anomaly. The hysteroscopic uterine reunification should be the preferable surgical method and can improve the poor reproductive outcome.

Hysteroscopic septum resection of complete septate uterus with cervical duplication, sparing the double cervix in patients with recurrent spontaneous abortions or infertility

To evaluate the safety and efficacy of hysteroscopic septum resection of the complete septate uterus with cervical duplication in patients with recurrent spontaneous abortions or infertility. Prospective consecutive clinical study. University hospital for obstetrics, gynecology, and reproductive medicine. Twenty-five patients with a complete septate uterus, cervical duplication, and history of recurrent spontaneous abortions (13 cases) or infertility (12 cases) were included. Hysteroscopic septum resection and sparing the double cervix using a bougie served as a means of orientation and blockage of internal cervical os. Intraoperative and postoperative complications, and postoperative anatomic identification of the uterus. No intraoperative and postoperative complications were encountered. Postoperatively, ultrasound revealed minor fundal septal remnants in 7 (31.8%) of 22 patients receiving the ultrasound detection, and no residual septum in the other 15 cases (68.2%). By using a bougie technique, hysteroscopic correction of complete septate uterus with cervical duplication and sparing the double cervix can be performed successfully.

Müllerian anomalies “without a classification”: from the didelphys-unicollis uterus to the bicervical uterus with or without septate vagina

To point out possible discrepancies in the classic hypothesis of Müllerian development and to present cases that support an alternative hypothesis. Case reports. University hospital. Six women with uterine malformation. Surgical, clinical, and outpatient evaluation of the anomalies. Assessment of the genital anomalies according to our embryologic investigations and embryologic-clinical classification and standard classifications for Müllerian malformations. We have included examples of cases presenting with didelphys uterus with normal cervix, didelphys uterus with septate cervix, and bicornuate (or didelphys) uterus with septate cervix and vagina versus septate uterus with double cervix and vagina, septate bicervical uterus with isthmic communication, and normal simplex uterus with septate cervix and vagina. These case reports prove that the fusion and reabsorption processes in the development of the Müllerian ducts can be affected to different degrees in the superior-convergent and inferior-divergent portions, thus resulting in atypical or transitional cases without a classification. Therefore, for a more appropriate classification of the uterine malformations, even if the same degrees of fusion, resorption, and development defects are used, a separate classification should be made for each superior and inferior uterine segment.

Leiomyoma on the septum of a septate uterus with double cervix and vaginal septum: a challenge to manage

To describe the first case of a leiomyoma localized in the septum of a septate uterus that had cervical duplication and a longitudinal vaginal septum. Case report. A university hospital. A 43-year-old patient with primary infertility and complaint of menorrhagia. Laparotomy, adhesiolysis, myomectomy, and resection of the vaginal septum in the first operation. Hysteroscopic resection of the complete uterine septum in the second operation. Magnetic resonance imaging findings and two-step repair of the anomaly. Cervical length at second trimester. Restoration of normal anatomy was achieved after correct diagnosis and a two-step operation procedure. A normal cervical length was measured at 26 weeks of gestation. Large leiomyoma at rare localizations in the presence of uterine anomalies is a diagnostic challenge, but with available diagnostic technology and appropriate operations, successful results can be obtained.

Septate uterus with cervical duplication and a longitudinal vaginal septum: a müllerian anomaly without a classification

To report a rare uterine anomaly of a septate uterus, double cervix, and double vagina. Case report. A university-based reproductive endocrinology center. A 20-year-old nulligravida with primary infertility. Clinical examination and surgical resection of a vaginal septum with hysteroscopic examination of both hemicavities. Description and treatment for a rare uterine anomaly and a subsequent literature search. Successful resection of vaginal septum and subsequent spontaneous pregnancy. This rare anomaly is not explained by classic embryologic teaching and is not described by the classification system currently used to describe müllerian anomalies.

ANATOMICAL AND PATHOLGICAL ABNORMALITIES OF FEMALE GENITALIA OF COWS

Genitalia of 405 local and cross breed cows were collected from Al- Ramadi abattoir, during the period from July, 1999 to Feb, 2000. The aim of the study was determined to know the anatomical and pathological abnormalities effected the female genitalia in cows. The percentage of pregnancy was 6.2% ( 25/465 ). The incidence of genital abnormalities was observed in 20.99 % (85/405) of the specim. The abnormalities were formed 0.99 % form pregnant genitalia, includes; ovarobusal adhesions 0.74 % and mummified fetus 0.25 %. The abnormalities of non-pregnant genitalia includes; paraovarian cyst ( 7.16% ), cystic C. L.( 0.99% ), ovarian hypoplasia ( 0.99% ) follicular cystic ovaries ( 0.25% ), Male-Pseudohermapherdite ( 0.25% ), patencey of the oviduct ( 0.49% ), metritis (1.98% ). Uterine aplasia ( 0.49% ), hydrometra ( 0.25% ) uterine abcess ( 0.25% ), infantile genitalia ( 0.25% ), double cervicalos ( 0.49% ) and Double cervix ( 0.25% ). It was concluded form this study that female genitalia showed high incidence of abnormalities which may affected fertility of the cow.

Hysteroscopic Metroplasty of the Complete Uterine Septum, Double Cervix, and Vaginal Septum. A Multicentric, Randomized Clinical Trial on the Section Vs. Preservation of the Cervical Septum

To determine whether sectioning of the cervical septum is associated with intra-operative bleeding, cervical incompetence, and secondary infertility. Multicentric, randomized, controlled clinical trial During the period of 7 years, 28 women with the diagnosis of complete uterine septum who had history of pregnancy wastsage or infertility were randomized into two groups. Group A underwent hysteroscopic metroplasty with section of the cervical septum while group B underwent the same procedure with preservation of the cervical septum. Operating time were 25+-9.74 min and 48+-22.6 min in group A and B respectively(P<0.05). Distending media deficit was 421+-186 ml in group A, while this value for group B was 782+-10 ml(P<0.05). Two cases of pulmonary edema and 3 cases of significant bleeding were seen in group B. Cesarean section rate was significantly higher in group B. There were no Significant differences in the rate of term and preterm delivery and abortion. Section of the cervical septum makes hysteroscopic metroplasty simpler, safer, and with lower complication rate than preservation. This procedure is recommended for the correction of compete uterine septum.

Double cervix and vagina with a normal uterus and blind cervical pouch: A rare müllerian anomaly

Objective To report a rare müllerian anomaly with a blind cervical pouch. Design Case report. Setting Private practice and community hospital. Patient(s) A 27-year-old nulliparous patient referred for evaluation of suspected müllerian anomaly. Intervention(s) Clinical and outpatient surgical evaluation of the anomaly. Main outcome measure(s) Assessment of the anomaly according to standard müllerian classification system and subsequent literature search. Result(s) A rare müllerian anomaly was found that did not fit within the standard classification system, which included a double cervix and vagina with a normal uterus and blind cervical pouch. This was found to have been described only once before after extensive review of the literature. Conclusion(s) The described anomaly is extremely rare, with no prior cases reported in the United States. The described anomalies in this case report are inconsistent with the generally accepted understanding of müllerian development and do not fit into the current classification system.

The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum

Objective This study was undertaken to evaluate the diagnostic management and the reproductive outcome after surgical repair of a rare reproductive malformation. Study design Sixteen women with a complete septate uterus, double cervix, and a longitudinal vaginal septum were referred for evaluation. Presenting complaints were chiefly pregnancy loss in parous women (n = 9) and dyspareunia in nulligravid women (n = 7). The combination of hysterosalpingography, ultrasonography, and/or magnetic resonance imaging was used to correctly identify the anomaly in 15 of the 16 cases. Both hysteroscopic (n = 11) and transabdominal (n = 5) surgical techniques were used to repair the uterine septum. Results In no case was the correct diagnosis made before referral; the uterus didelphys was the most common misdiagnosis. The preoperative pregnancy loss was 81%. Postoperatively, 12 women conceived for a total of 17 pregnancies; there were 14 term live births or ongoing pregnancies in the third trimester (82%), with a first trimester spontaneous abortion rate of 18%. In 9 women who conceived after hysteroscopic surgery, term live births occurred in 9 of 12 (75%) conceptions. A modified Tompkins metroplasty was performed in 5 women with subsequent term live births or ongoing third trimester pregnancies in 5 of 5 (100%) patients. Conclusion The identification of a duplicated cervix and a vaginal septum is consistent with several uterine malformations, which leads to frequent misdiagnosis and errors in management. Significant pregnancy wastage, obstetric complications, and dyspareunia are common, and surgical treatment is therefore advisable. Making the best choice between hysteroscopic or transabdominal metroplasty depends on the anatomic features of the cervix and the uterine cavity, but optimal patient management requires familiarity with both techniques.

The significance of hysteroscopic treatment of congenital uterine malformations

AbstractHysteroscopic surgery replaced abdominal metroplasty and is today the treatment of choice for congenital uterine malformations. This is not just because of its reproductive results, which are comparable to those achieved with the abdominal approach, but mainly because of several post-operative benefits (reduced morbidity, convalescence and costs, and no scar tissue on the abdominal and uterine walls), improved reproductive performance (no reduction in uterine volume, shorter interval to conception after operation) and the mode of delivery (avoiding Caesarean section). Decisions on when and how to treat uterine septa, in relation to the type of malformation, are discussed. In particular, indications for treatment have been broadened to include not only the septate uterus associated with adverse reproductive outcome, but also patients before any potential obstetric accidents, especially in those with declining fecundity (>35 years), with reproductive problems (unexplained infertility) and before assisted reproductive techniques, as well as in women with no actual desire of pregnancy. Two types of hysteroscopic treatment are available: resectoscopic and office hysteroscopic surgery. The indications for resectoscopic surgery are broad-based septa and complete septa with single or double cervix. The resectoscope allows an excellent continuous flow system, providing continuous washing of the uterine cavity and a clear view, removing bubbles and debris during the procedure. However, an exact measurement of fluid balance must be performed to avoid excessive fluid intravasation. Laparoscopic or sonographic monitoring is mandatory. Treatment of limited-based small septa whose apex is easily visible can be achieved with an outpatient approach using office minihysteroscopic surgery and the vaginoscopic technique. The intra-operative check of the fundus is performed by ultrasonography. No preparation of the endometrium is required, except for large, broad-based septa, and hormonal therapy and intrauterine devices are not utilized post-operatively. The post-operative follow-up consists of a hysteroscopic check performed 1–3 months after surgery.

Double cervix and vagina with septate uterus: an uncommon müllerian malformation

BACKGROUND: The case of an unusual müllerian anomaly is described. CASE: A nulligravida was found to have a septate uterus with double cervix and a vagina with partial longitudinal vaginal septum. The anomaly presented symptomatically, was suggested by clinical examination, and confirmed by magnetic resonance imaging and intraoperative visualization. Visualization of the anomaly was enhanced by magnetic resonance-based three-dimensional reconstruction techniques. CONCLUSION: Description of double cervix and vagina in the setting of an anatomically normal or simple septate uterus is uncommon. This anomaly is inconsistent with the generally accepted understanding of müllerian development but fits with an alternative hypothesis. Magnetic resonance imaging and magnetic resonance-based three-dimensional reconstruction was useful in aiding visualization of the anomaly.

Successful Pregnancy in an Adolescent Woman with a Communicating Double Uterine Anomaly

Background: Women with communicating double uterine anomalies are at increased risk for obstetric complications, including early pregnancy loss, preterm delivery, and breech presentation. We present the pregnancy of a woman with a previously diagnosed communicating double uterine anomaly. Case: An 18-yr-old white female with a previous diagnosis at age 11 of a communicating double uterus, double cervix, and obstructed left hemivagina was followed during the course of her pregnancy. She experienced no complications until 36 6/7 weeks, when she was found to have signs and symptoms of mild preeclampsia. The fetus was in a breech presentation and a cesarean section was performed. Two hemiuteri were identified intraoperatively. The communication was not visualized. A viable male infant was delivered without complications. Conclusion: This patient represents only the sixth report of successful pregnancy in a woman with a Toaff type 5A communicating uterine anomaly.

Double Cervix and Vagina With Septate Uterus

Double Cervix and Vagina With Septate Uterus