Unicornuate Uterus Research Articles

Impact of Unicornuate Uterus on Third-Trimester Obstetric Outcomes in Nulliparous Women

Background: Pregnancies in women with a unicornuate uterus are associated with an increased risk for specific adverse pregnancy and obstetric outcomes. We sought to investigate the obstetric outcomes of singleton pregnancies in nulliparous women with a unicornuate uterus in the third-trimester and to determine safe and appropriate modes of delivery. Methods: This retrospective cohort study included 94 nulliparous women with singleton pregnancies and a unicornuate uterus, along with 278 matched controls with a normally shaped uterus, from March 2009 to March 2019. Results: A total of 124 patients were diagnosed with a unicornuate uterus in the obstetrics department after the 28th week of pregnancy, including 94 nulliparous women. Compared to pregnancies with normal uterine morphology, a unicornuate uterus is associated with an increased risk of preterm delivery (PTD), preterm prelabor rupture of membranes (PPROM), malpresentation, caesarean section (CS), intrauterine growth restriction (IUGR), and neonatal intensive care unit (NICU) admission. Additionally, pregnancies with unicornuate uterus show significantly lower gestational age at delivery, as well as lower rates of term delivery and vaginal delivery. No increased risk was observed for in-labor CS rates or labor duration. In total, 17 pregnant women in the unicornuate uterus group had vaginal deliveries, including 2 who had previously undergone rudimentary horn resection. Conclusions: The presence of a unicornuate uterus is associated with an increased risk of specific adverse obstetric outcomes compared to pregnancies in women with a normal uterus. However, vaginal delivery may be considered in in women with a unicornuate uterus thorough evaluation.

Hysterosalpingographic Pattern of Primary Sub-fertility and Secondary Sub-fertility in Women of Reproductive Age

Objective: To evaluate the structural abnormalities of uterus and fallopian tubes in women diagnosed with primary and Secondary Sub-fertility using hysterosalpingogram. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul to Nov 2019. Methodology: This study investigated potential anatomical causes of primary and secondary subfertility in women of reproductive age. A total of 500 participants, referred from Gynecology and Obstetrics Departments, underwent hysterosalpingography during the pre-proliferative phase following comprehensive medical history assessment. Results: Out 500 women, 340(68.0%) had Primary Sub-fertility while 160(32%) had Secondary Sub-fertility. Mean age of presentation was 31.5±3.5 years. Bilateral free peritoneal spill was recorded in 340(68%) patients. Unilateral tubal blockage was present in 50(10%) patients while bilateral tubal blockage was observed in 40(8.0%) patients. Bilateral hydrosalpinx was present in 15(3 %) women. Patients with uterine congenital anomalies were also examined, and bicornuate uterus was seen in 25(5%) women and unicornuate uterus was noted in the same number, that is, 25(5%) women. Conclusion: Hysterosalpingography is a baseline assessment test done for evaluation of patency of uterus and uterine tubes. Positive hysterosalpingography cases were more prevalent in Secondary Sub-fertility. Tubal abnormalities were more commonly observed as compared to uterine cavity pathologies. Secondary Sub-fertility was found to be more associated with older age groups.

Developmental uterovaginal anomalies and histologic findings in transgender patients receiving gender-affirming hysterectomies: A large case series.

To describe the incidence of uterovaginal anomalies and histologic findings in transgender and nonbinary (TGNB) patients seeking hysterectomies. All patients receiving gender-affirming hysterectomies between 2013 and 2023 were retrospectively reviewed. Primary outcomes included uterovaginal anomalies and histological findings. Multivariable logistic regressions were performed to evaluate relationships between variables of interest and whether they predict findings of uterovaginal anomalies, inactive endometrium, adenomyosis, leiomyoma, endometriosis, and cervical atrophy. 278 patients received hysterectomies at an average age of 29.2 ± 8.3 years. Seven patients (2.5%) were found to have a developmental anomaly, including two bicornuate uterus (0.7%), two unicornuate uterus (0.7%), one septate uterus (0.4%), and two vaginal septum (0.7%). 60 patients (21.6%) were found to have inactive endometrium and 26 patients (9.4%) had cervical atrophy. Although 262 patients (94.2%) were on testosterone therapy, hormone duration was not a significant predictor of any uterine findings. This study describes uterovaginal anomalies in a large cohort of patients receiving gender-affirming hysterectomies. Although long-term testosterone use is commonly believed to be associated with endometrial and cervical atrophy, this study shows no such association.

Ectopic Pregnancy in the Outer Aspect of the Right Lobe of the Liver Coexisted with Unicornuate Uterus and Renal Agenesis

Ectopic Pregnancy in the Outer Aspect of the Right Lobe of the Liver Coexisted with Unicornuate Uterus and Renal Agenesis

The effect of unicornuate uterus on reproductive outcomes in infertile patients

ObjectiveUnicornuate uterus, which is a rare congenital anomaly, has been associated with obstetric and perinatal complications. The aim of this study is to evaluate the reproductive outcomes of patients with unicornuate uterus, and also to compare them with outcomes of infertile patients without a Müllerian anomaly. MethodsRetrospective analyses of the data of 18–40 year old infertile patients with unicornuate uterus diagnosed in between January 2012 and December 2022, and a control group with the same number of patients, with age and infertility durations matched were performed. Demographic data, cycle parameters and reproductive outcomes of the unicornuate uterus and control groups were compared. ResultsA total of 75 patients with unicornuate uterus and a control group of 75 infertile patients without a Müllerian anomaly were included in the study. Totally, 116 and 91 pregnancies were achieved at unicornuate uterus and the control groups, respectively. Ectopic pregnancy rates (10.3 % vs 2.2 %, OR = 5.53, 95 %CI [1.17–26.21]) and malpresentation rates (29 % vs 0 %, OR = 1.40, 95 %CI [1.12–1.76]) were significantly higher and newborn birth weights in singleton pregnancies were significantly lower in the unicornuate group (3000 g vs 3455 g, p = 0.005). No significant difference was found in other obstetric parameters. ConclusionUnicornuate uterus constitutes a small portion of all congenital uterine anomalies. Although increased ectopic pregnancy and malpresentation rates with diminished birth weights were found in the unicornuate group in our study, live birth rates and preterm deliveries did not differ significantly between the two groups. However, patients should be counseled on this issue both during the reproductive treatment process and during pregnancy, and should be followed closely.

Unicornuate uterus with a functional, non-communicating rudimentary cavity associated with ovarian endometriosis and ipsilateral renal agenesis

Introduction: Müllerian anomalies are rare developmental anomalies of the female reproductive tract, that are usually associated with renal abnormalities.Case Presentation: A 16-year-old Sri Lankan schoolgirl, presented with progressive dysmenorrhea and inter-menstrual lower abdominal pain for 2 years. There was recent lower abdominal distention over 6 months. Examination revealed a non-tender mass in the suprapubic area.A subsequent CT scan, followed by an ultrasound abdomen, revealed features of a right-sided unicornuate uterus with a non-communicating left-sided horn containing endometrium and a homogenous large cystic lesion between the non-communicating left horn and the uterine body, associated with ipsilateral renal agenesis.She underwent a laparotomy and resection of the left-side rudimentary horn of the uterus with a left-side ovarian cystectomy, as intra-operative findings suggested an endometrioma.Conclusion: Clinical presentations of Müllerian anomalies are largely non-specific. Early diagnosis and prompt treatment are useful in avoiding complications that arise as a consequence of Müllerian anomalies.

Surgical management of an ectopic pregnancy in the setting of an unexpected Müllerian anomaly: intraoperative and postoperative implications

ObjectiveTo describe the intraoperative and postoperative implications arising from the unexpected diagnosis of a Müllerian anomaly during the surgical management of an ectopic pregnancy. DesignVideo article. SettingAcademic Center. Subject(s)A 39-year-old nulligravid woman with anovulation and irregular menstrual cycles presented to the office. Her urine pregnancy test was incidentally positive; serum β-human chorionic gonadotropin (β-hCG) level was 5,644 mIU/mL. Outpatient transvaginal ultrasonography (TVUS) demonstrated a 2.1 x 1.7 x 2.2-cm thick-walled structure in the left adnexa without an intrauterine pregnancy. These findings were highly suspicious for a left tubal ectopic pregnancy. The patient was consented for laparoscopy with planned left salpingectomy. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. InterventionDiagnostic laparoscopy did not show an obvious left tubal ectopic pregnancy. Instead, a right unicornuate uterus with a dilated rudimentary left uterine horn was seen. Both fallopian tubes and ovaries appeared normal. These laparoscopic findings were consistent with an ectopic pregnancy in the rudimentary horn. However, in the absence of informed consent for a hemi-hysterectomy and no evidence of ectopic rupture or bleeding within the pelvis, we decided to proceed with excision of the ectopic pregnancy from the uterine horn. An incision was made over the anterior surface of the uterine horn, and the pregnancy sac was dissected from the underlying myometrium and excised in its entirety. Left salpingectomy was also performed. The patient was discharged home the same day, and her β-hCG levels decreased to <5 mIU/mL within 28 days of surgery. Main Outcome MeasuresComplete resolution of a left rudimentary uterine horn ectopic pregnancy through surgical excision of the pregnancy sac without hemi-hysterectomy. ResultsPostoperative hysterosalpingography (HSG) demonstrated a right unicornuate uterus with normal fill and spill of the right fallopian tube. Magnetic resonance imaging (MRI) of the pelvis confirmed the findings of a right unicornuate uterus with a non-communicating left rudimentary uterine horn that did not contain any endometrial tissue. Thus, the patient did not require an interval hemihysterectomy. She underwent letrozole and intrauterine insemination treatment 5 months after the initial surgery, which resulted in a clinical intrauterine pregnancy. However, this pregnancy was terminated in the early second trimester due to findings of trisomy 18. She conceived naturally one year later, and this pregnancy resulted in a full-term vaginal birth at 39 weeks gestation. ConclusionUndiagnosed or unexpected Müllerian anomalies can impact the standard intraoperative and postoperative management of ectopic pregnancies.

A misleading case of Müllerian anomaly: fibroid degeneration and growth involving nonfunctional, noncommunicating rudimentary horn

ObjectiveTo report a rare, misleading fibroid degeneration involving a non-functional, non-communicating horn in a woman with a unicornuate uterus. While the presence of a functional rudimentary horn may lead to signs and symptoms that recommend its removal, non-functional cases are rarely reported, and due to their apparent functional inactivity, the need for their removal has never been reported. No previous report showed the possibility of a degenerative process in a non-functional rudimentary horn causing patient discomfort. DesignThis is a step-by-step narrated video showing a unique case of fibroid degeneration and growth of a non-functional, non-communicating rudimentary horn in a unicornuate uterus (ASRM classification 2021) and its surgical management. SettingUniversity Academic Hospital ‘‘A.O.U. delle Marche – Università Politecnica delle Marche” Ancona, Italy. SubjectA 48-year-old Caucasian nulliparous premenopausal woman was referred to our institution because of abdominal pain and an enlarging adnexal mass. Her personal history showed primary infertility with a previous diagnosis of unicornuate uterus. Given the possibility of ectopic ureters in these occurrences, a complete computed tomography scan was performed, and no genitourinary alterations were found. Pre-operative imaging (ultrasound evaluation, computed tomography, and magnetic resonance) provided a provisional diagnosis of a suspicious ovarian fibroma. InterventionsConsidering the patient’s age, lack of desire for pregnancy, and volumetric increase of the adnexal mass, a laparoscopic intervention to perform mass removal and prophylactic bilateral salpingectomy was planned. The patient was counseled about the low risk of an underlying malignant transformation. Therefore, the decision to remove the intact mass via a mini-laparotomy at the end of the surgery was shared.Once the abdominal cavity was entered, the right unicornuate uterus was found in anatomical continuity with the ipsilateral broad ligament, fallopian tube, and ovary. These structures were wholly attached to the right pelvic wall.On the other side, cranially compared to the right hemi-uterus, a roundish myoma-like mass was detected in direct connection with the left broad ligament, fallopian tube, and ovary.In light of a changed intraoperative finding, the amputation of the left rudimentary horn and prophylactic bilateral salpingectomy were performed. Main outcome measuresShowing the fibroid degeneration and growth of a non-functional, non-communicating rudimentary horn in a unicornuate uterus (ASRM classification 2021) treated laparoscopically. ResultsLaparoscopic removal of the uterine horn was successful, and no intra- and postoperative complications occurred. The patient was in good health at the six-month follow-up visit. The histopathological examination confirmed the fibroid degeneration and the absence of endometrium. ConclusionThe lack of symptomatic cases of rudimentary non-functional horns reported in the literature led gynecologists to consider them a silent Mullerian anomaly. This unique case demonstrates that even non-functional rudimentary horns can undergo symptomatic transformation processes requiring surgery. This information may be helpful for more comprehensive counseling of women and for considering the possibility of this occurrence in the diagnostic work-up of misleading Müllerian anomalies. With this in mind, surgical treatment can also be better planned as the technical aspects change compared to what is expected for an adnexal pathology.

A Pregnancy in a Ruptured Non-communicating Rudimentary Horn: A Case Report

The rudimentary horn is a Müllerian duct anomaly. In instances of pregnancy within a non-communicating rudimentary horn, timely diagnosis is imperative to prevent life-threatening complications. Ultrasound only demonstrates 26-33% sensitivity, leading to misdiagnoses for tubal, intrauterine, or abdominal pregnancies. We present a case of a 20-year-old female, gravida 2 para 1 (G2P1), who conceived spontaneously while experiencing constant mild lower abdominal pain throughout the earlier stages of pregnancy. Pregnancy in non-communicating rudimentary horns advanced to twenty weeks of gestation. The diagnosis was made when the horn ruptured, resulting in hemoperitoneum and hemodynamic instability. An emergency exploratory laparotomy was performed, uncovering a complete rupture of the pregnant rudimentary horn, leading to hemi-hysterectomy and removal of the left fallopian tube. The rudimentary horn was completely ruptured and lacked direct communication with the right unicornuate uterus cavity. The diagnostic and management challenges associated with rudimentary uterine horn highlight the need for heightened vigilance to prevent associated morbidity.

P-737 Congenital tubal anomalies: exploring its relationship with tubal factor infertility: observational-descriptive study

Abstract Study question Is there any relation between congenital Fallopian tube anomalies and tubal factor infertility in subset of infertile women? Summary answer Nearly 15% of women who underwent diagnostic laparoscopy revealed congential tubal anomaly (15%), including total or partial agenesis of tubes. What is known already The fallopian tubes play a crucial role in the reproductive process. These structures are 10-12 cm in length, consists of four parts from proximal to distal side: intramural, isthmic, ampullary and fimbrial [1]. Any abnormalities in their development or structure can severely affect fertility. Fallopian tube agenesis, whether partial or complete, constitutes one such anomaly. While there have been numerous advances in the understanding and management of fallopian tube disorders, partial or complete fallopian tube agenesis remains an enigmatic entity with unknown prevalance in the general population. Study design, size, duration Observational study was conducted between 2020 and 2023. All couples with primary infertility were evaluated in an outpatient clinic using basic hormone analysis, semen analysis, sonography and hysterosalpingogram as a standard of care. All women with suspected tubal pathology were offered to have diagnostic laparoscopy (LS) in order to confirm the anomaly. When tubal and/or Mullerian anomalies were detected, urinary system was examined by intravenous pyelography. Other suspected pathologies were examined by abdominopelvic CT x-ray. Participants/materials, setting, methods All women with suspected tubal pathology were offered to have diagnostic laparoscopy in order to confirm the anomaly. Surgeries was performed by two experienced surgeons, after having informed consent. When tubal and/or Mullerian anomalies were detected, urinary system was examined by intravenous pyelography. Other suspected pathologies were examined by abdominopelvic CT x-ray imaging. All anomalies have been reported in an electronic database. Main results and the role of chance A total of 4230 infertile couples were admitted to clinics. Mean age of women in the study population is 30±2.3 years. Overall duration of infertility is 1.2±0.6 years. Among them, 895 women were diagnosed to have suspected tubal pathology after HSG examination (21%). Diagnostic LS was performed to 220 women. Flowchart of the patients is given in figure-1. Among them, 113 (51,3%) women revealed tubal pathologies/anomalies and 107 (49,7%) revealed normal findings. Total of 34 women revealed congenital proximal and/or distal tubal anomaly. Half of these cases (17/34) were complete agenesis and remaning were either with proximal or mid-distal portion agenesis. Majority of women 32/34 (94 %) with tubal pathology revealed at least 1 uterine anomaly as well. Among them, 19 (55.9 %) of these patients was confirmed to have unicornuate uterus, 6 (17.6 %) had uterus didelphys, 4 (11.8 %) had bicornuate uterus, and 3 (8.8%) had uterine septum. No uterine anomaly was observed in 2 (5.9 %) patients. Total of 16 women (14%) were diagnosed to have other system anomalies. Limitations, reasons for caution Lack of a control group in normal population in order to compare incidences. Secondly, our sample size is not enough to precisely conclude on exact prevalances. Third, we did not report fertility data following LS. Wider implications of the findings Tubal factor infertility is one of the major etiologic factor among primary infertility cases and congenital tubal anomalies were reported to be relatively higher (15%) in these younger women contrary to general expectations. Second important finding is high congenital uterine anomaly incidence in women with congenital tubal anomalies. Trial registration number not applicable

Hysteroscopic Surgery for Intrauterine Scar Adhesions after Laparoscopic Metroplasty in a Patient with a Unicornuate Uterus and a Functional Noncommunicating Rudimentary Horn.

Hysteroscopic Surgery for Intrauterine Scar Adhesions after Laparoscopic Metroplasty in a Patient with a Unicornuate Uterus and a Functional Noncommunicating Rudimentary Horn.

Assessment of the Incidence of Müllerian Anomalies in Central Illinois

Introduction: Müllerian anomalies include a spectrum of malformations resulting from the underdevelopment of the Müllerian duct during embryological development. This results in a malformed vagina, uterus or both. Complete agenesis of one or both of these structures in a subset of these cases is known as Mayer‐Rokitansky‐Küster‐Hauser (MRKH) syndrome. There are two types of Müllerian agenesis: Type I MRKH only affects the upper vagina, cervix and uterus, whereas Type II MRKH has associated malformations affecting the renal, auditory and skeletal systems. The reported prevalence is approximately 1 in 5,000 for MRKH syndrome and ~5.5 in 100 for all Müllerian anomalies; however, there is a broad range in the described incidence rates. Purpose: We hypothesized the patient population served by the Department of Ob/Gyn, Division of Reproduction, Endocrinology and Infertility (REI) at Southern Illinois University (SIU) School of Medicine has a higher incidence of Müllerian anomalies and MRKH. Our objective was to assess the incidence of these Müllerian anomalies and describe the types of anomalies that affect women in Central Illinois. Methods: All patients receiving care at SIU Ob/Gyn, Division of REI from 01/1/2010-07/31/2021 were queried using specific ICD-9 and 10 codes and further screened to verify eligibility. A retrospective review (IRB# 21-893) was then conducted on all eligible subjects and relevant health information was extracted from the electronic health record. Continuous variables were measured by central tendency (mean or median) and dispersion (standard deviation or range). Categorical variables were described using frequencies and percentages. Results: The initial query identified 282 individuals of which 81 were deemed eligible (i.e., confirmed Müllerian anomaly). The total number of unique patients who underwent an ultrasound at REI during that time of study approval was 697. Based on these data, the calculated incidence of Müllerian anomalies in the REI patient population is ~11.6% and the incidence of MRKH is 57 in 5000. Demographics included: 74 subjects were White (91.4%), two Black or African American (2.5%), one Asian (1.2%) and 4 declined to report their race or identified as more than one race (4.9%); two subjects were of Hispanic ethnicity (2.5%). Mean ages at menarche and diagnosis were 12.7 ± 1.7 and 27.8 ± 6.4 years, respectively. Eight subjects diagnosed with MRKH had Type I MRKH. The specific type of anomalies identified included: uterine septum (29.1%), arcuate uterus (25.3%), unicornuate uterus (19.0%), agenesis (10.1%), bicornuate uterus (6.3%), uterus didelphys (6.3%) and 3.8% had another type of anomaly. The majority of patients underwent surgery within approximately one year of diagnosis (74%). Postoperative complications were rare (~7%) and included mild constipation, urinary retention and bleeding from the incision site. Pregnancy outcomes were as follows: prior to diagnosis, 3 (30%) infants were preterm vs. 7 (70%) term and those were spontaneous conceptions; after diagnosis 4 (30%) infants were preterm vs 9 (70%) term deliveries and the most common methods of conception were spontaneous and ovulation induction; post-surgery 11 (31%) infants were born preterm vs 24 (69%) term deliveries, and the most common methods of conception were ovulation induction and in-vitro fertilization. Conclusions: From this initial investigation, we found the incidence of Müllerian anomalies in the SIU Ob/Gyn, REI population is higher than the wide range of reported values. As expected, the vast majority of these patients underwent surgical management with little or no complications. We aim to further study what factors/exposures may be impacting the development of female fetuses resulting in Müllerian anomalies.

Pregnancy with placenta accreta on a unicornuate uterus with rudimentary horn: a case report

The unicornuate uterus with rudimentary communicating horn is a rare uterine malformation, wich occurs several maternal-fetal complications. Pregnancy on the rudimentary uterine horn of a unicornuate uterus is an uncommon phenomenon, and the diagnosis of pregnancies on a rudimentary uterine horn is difficult. Early diagnosis in the first trimester can be made by endovaginal ultrasound. The treatment of rudimentary horns in unicornuate uterus is based on hemihysterectomy, ideally performed before the pregnancy.

Obstetric outcomes of women with congenital uterine anomalies in the United States

BackgroundDue to the rarity, congenital uterine anomaly type-specific evaluation of pregnant women has been relatively understudied. ObjectiveTo describe national-level obstetric outcomes in women with congenital uterine anomalies. Study DesignThis cross-sectional study queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Pregnant women with diagnosis of congenital uterine anomalies who had hospital delivery between 2016 and 2019 were examined. The World Health Organization's International Classification of Disease, 10th revision coding was used to delineate type of congenital uterine anomaly, diagnoses, and procedures performed during the index admission. Primary outcomes included pregnancy outcome, which was classified as full-term live birth, preterm live birth, abortion/stillbirth, or ectopic pregnancy. Secondary outcomes included obstetric comorbidities and severe maternal morbidity, which were compared between different subtypes of congenital uterine anomalies with multivariable logistic regression model. ResultsA total of 50,180 pregnant women with congenital uterine anomalies were identified. Bicornuate was the most common subtype (73.5%), followed by arcuate (13.5%) and unicornuate (10.0%). 70.6% of women with congenital uterine anomalies had a full-term live birth, 26.8% had a preterm live birth, 2.1% had an abortion or stillbirth, and 0.4% had an ectopic pregnancy. 61.8% of preterm births occurred between 33 and 36 weeks, 16.9% between 30 and 32 weeks, and 21.3% at <30 weeks. There were 1,440 (2.9%) periviable births. The preterm (34.5%) and periviable (6.9%) birth rates were highest in the uterine didelphys group. Overall, two-thirds (65.7%) of patients with congenital uterine anomalies were delivered via cesarean section. When compared to arcuate uterus, risk of severe maternal morbidity in septate uterus (4.8% vs 2.6%, adjusted-odds ratio [aOR] 2.60, 95% confidence interval [CI] 1.49-4.52) was increased, including hemorrhage (14.5% vs 7.7%, aOR 2.16, 95% CI 1.51-3.07). This was followed by uterine didelphys (4.2% vs 2.6%, aOR 1.75, 95% CI 1.24-2.47), unicornuate uterus (3.8% vs 2.6%, aOR 1.61, 95% CI 1.29-2.01), and bicornuate uterus (3.0% vs 2.6%, aOR 1.23, 95% CI 1.04-1.47). ConclusionWhile the majority of patients with congenital uterine anomalies result in full-term viable deliveries, each subtype of congenital uterine anomalies confers different obstetric risks. Uterine didelphys was associated with the highest risk of preterm birth, while septate uterus was associated with the highest risk of severe maternal morbidity. While this hospital delivery dataset likely overrepresents bicornuate uteri, this populational data may help inform patients with congenital anomalies considering pregnancy.El resumen está disponible en Español al final del artículo.

Multimodality imaging of acute gynecological emergencies-a pictorial essay.

Gynecological emergencies can often present with a myriad of non-specific signs and symptoms, posing a diagnostic challenge to the clinician. They can be grossly divided into uterine or adnexal pathologies. Uterine pathologies can be secondary to intracavitary accumulation of blood [like in patients with transverse vaginal septum, Robert's uterus, accessory and cavitated uterine mass, unicornuate uterus with contralateral non-communicating functional horn], bleeding per vaginum [like in patients with retained products of conception, enhanced myometrial vascularity], pyometra [secondary to pelvic inflammatory disease, cervical obstruction secondary to benign and malignant causes] or complications of fibroids [like red degeneration, torsion of subserosal fibroid]. The adnexal pathologies can range from ectopic pregnancy in a urine pregnancy test (UPT) positive patient to haemorrhagic ovarian cyst, ovarian torsion, ruptured dermoid cyst and tubo-ovarian abscess in a UPT negative patient. Multimodality imaging including ultrasound (USG), computed tomography (CT) scan and magnetic resonance imaging (MRI) can narrow down the differentials and help in formulating an accurate diagnosis. The objective of this article is to familiarize the readers with multimodality imaging findings in common as well as uncommon acute gynecological emergencies and provide an algorithmic imaging approach for acute gynecological emergencies. USG is typically used as the first line diagnostic modality in diagnosis of acute gynecological emergencies. CT scan & MRI are helpful as a problem-solving tool in acute gynecological emergencies when USG findings are indeterminate.

Concomitant extragenital malformations of female reproductive tract anomalies: analysis of 444 cases in Peking Union Medical College Hospital

Objective: To analyze the incidence and clinical phenotype of the concomitant extragenital malformations in the patients with female reproductive tract anomalies. Methods: A retrospective study was conducted using clinical data of hospitalized patients diagnosed with uterine, cervical, or vaginal malformations from January 2003 to December 2022 in Peking Union Medical College Hospital. The malformations were classified according to American Society for Reproductive Medicine müllerian anomalies classification 2021, and in each type, the incidence and specific manifestations of concomitant extragnital malformations were analyzed. Results: A total of 444 patients were included. The overall incidence of concomitant extragenital malformations was 43.5% (193/444), including urinary system, skeletal system, and other system malformations. Renal malformations on the obstructed side were present in all patients with oblique vaginal septum syndrome (100.0%, 78/78). The total incidence of concomitant extragnital malformations was as high as 8/11 in uterus didelphys, 43.5% (10/23) in unicornuate uterus, 33.6% (79/235) in Mayer-Rokitansky-Küster-Hauser syndrome, 18.8% (6/32) in septate uterus and 18.5% (12/65) in cervical agenesis. Urinary system malformations (30.6%, 136/444) and skeletal system malformations (13.5%, 60/444) were the most common concomitant malformations in all types, in which, unilateral renal agenesis and scoliosis were the most common. Conclusions: Urinary and skeletal system malformations are important features of female reproductive tract anomalies. Urologic ultrasonography and spinal roentgenogram are recommended for all patients with female reproductive tract anomalies.

A case report on rare co-occurrence of invasive ovarian mucinous adenocarcinoma, unilateral renal agenesis, and bicornuate uterus: is it a new triad?

BackgroundConcomitant invasive ovarian mucinous adenocarcinoma, unilateral renal agenesis and bicornuate uterus is a rare combination. Unilateral renal agenesis has been associated with genital anomalies, such as unicornuate and bicornuate uterus. Furthermore, a wealth of studies has reported the association between unicornuate uterus and ovarian anomalies, such as the absence of an ovary or ectopic ovaries, but rarely has there been a combination of the three to the best of our knowledge. The present case report is the first case presentation with a combination of the three syndromes: ovarian mucinous tumor, unilateral renal agenesis, and bicornuate uterus.Case presentationWe report the case of a 17-year-old who presented with abdominal distension. On examination, a CT scan revealed a large multicystic abdominal mass on the right side, with an absence of the right kidney while the left kidney was normal in size, appearance, and position. Intraoperatively, massive blood-stained ascitic fluid was evacuated. Additionally, a large whitish polycystic intra-abdominal mass with mucus-like materials and solid areas was attached to the midpoint of the colon and the right ovary, with visible metastasis to the omentum. The uterus was bicornuate. The mass and omentum were taken for histopathology and a diagnosis of invasive ovarian mucinous cystadenocarcinoma with metastasis to the colon and omentum was made after a pathological report.ConclusionsThe presence of these conditions in the same individual could potentially complicate medical management and fertility considerations. Thus, a need for a multidisciplinary medical team, including gynecologists, urologists, and oncologists, to address their unique needs and provide appropriate treatment and guidance. Further research and case studies are needed to better understand the possible association and implications of these rare co-occurring conditions.

Commentary: Three-dimensional transvaginal ultrasound diagnosis of interstitial ectopic pregnancy in a unicornuate uterus: A case report

A rare case of unicornuate uterus with interstitial ectopic pregnancy (IEP) was diagnosed using three-dimensional transvaginal ultrasound (3D-TVUS). The ultrasound revealed a "lancet-shaped" endometrial corona, a gestational sac near the uterus base extending towards the uterine serosa, and visible interstitial lines. The patient underwent laparoscopic surgery for a lesion in the right fallopian tube. 3D-TVUS was crucial in precisely locating the gestational sac, aiding in effective treatment. Interstitial ectopic pregnancies risk severe hemorrhaging upon rupture. Rapid, accurate diagnosis is vital for lifesaving treatment and preventing critical complications.

Laparoscopic Approach for Ectopic Pregnancy in a Rudimentary Horn: Stepwise Demonstration of Surgical Technique

ObjectiveTo provide a comprehensive, step-by-step presentation of the laparoscopic resolution of ectopic pregnancy within a rudimentary uterine horn. DesignA detailed demonstration of the laparoscopic technique presented through narrated video footage. SettingPregnancy occurring in the rudimentary horn of a unicornuate uterus represents a rare form of ectopic pregnancy [1]. This condition is associated with a high risk of uterine rupture. Early detection is crucial for effective management and prevention of potential complications [2,3]. In this manuscript, we present a case study of a patient diagnosed with ectopic pregnancy in a rudimentary horn, who underwent successful laparoscopic resection. InterventionsTen main steps were identified and described in detail during the laparoscopic resection: Step 1: identification of the anatomy; Step 2: uterine mobilization; Step 3: Open retroperitoneum; Step 4: Coagulation and section of left round ligament; Step 5: Bladder dissection; Step 6: Identification of vessels; Step 7: Coagulation and section of left utero-ovarian vessels; Step 8: Coagulation and section of uterine vessels; Step 9: Section of uterine septum; Step 10: Specimen removed. ConclusionThis publication offers a detailed and instructive account of the laparoscopic resection of ectopic pregnancy within a rudimentary uterine horn. The stepwise approach demonstrated in the accompanying video contributes to a deeper understanding of this complex surgical technique. Video Abstract [Display omitted]

Spontaneous Fistula and Abdominal Wall Endometriosis Due to Occult Existence of Unicornuate Right Uterus with Rudimentary Non-Communicating Functioning Left Horn.

Accurate diagnosis of Müllerian duct anomalies (MDA) remains a clinical challenge even by direct surgical inspection. Although obstetrical complications are more frequent in women with MDA, some subtypes allow normal reproduction, further delaying the diagnosis. Unicornuate uterus with a rudimentary non-communicating functioning horn is a rare form of MDA, susceptible to many gynecologic and obstetric complications such as miscarriages, premature birth, hematosalpinx, endometriosis, and chronic pelvic pain. We present an entire case pictorial assay including preoperative imaging as well as the surgical correction of the uterine anomaly and the associated complication of an occult unicornuate right uterus with rudimentary non-communicating functioning left horn (Class U4aC0V0/ European Society of Human Reproduction and Embryology/European Society of Gastrointestinal Endoscopy Classification) and its natural evolution following a previous incomplete surgical treatment. The patient had an emergency left adnexectomy for hematosalpinx and ovarian endometrioma at her local county hospital. After five years, the patient presented with severe dysmenorrhea and abdominal endometriosis due to blocked retrograde menstruation from a rudimentary, non-communicating functioning horn. Surgical treatment with the resection of the rudimentary uterine horn, together with the abdominal wall endometriosis lesions, was carried out with good outcomes.