Unicornuate Uterus Research Articles

Magnetic resonance imaging of uterovaginal lesions associated with female infertility

Abstract Objective To study the mandatory indications and accuracy of magnetic resonance (MR) imaging for the diagnosis of uterovaginal lesions associated with female infertility. Design Prospective cross sectional study. Main outcome measures Indications and accuracy of MR imaging for the diagnosis of uterovaginal lesions. Materials and methods 423 infertile women were investigated by hysterosalpingography (HSG) and transvaginal ultrasonography (TVUS). In 54 women having uterovaginal lesions and 76 women with tubo-ovarian lesions, the diagnosis was not conclusive by HSG and TVUS and consequently they were examined by MR imaging. The present study was devoted for infertile women suffering from uterovaginal lesions. Results MR imaging confirmed the diagnosis of agenesis of the uterus and the vagina (1 case), unicornuate uterus (2 cases, functioning rudimentary horn connected to the dominant horn in 1 case), uterus didelphys (1 case), bicornuate uterus (5 cases), septate and subseptate uteri (10 cases). Eighteen patients had multiple corporeal leiomyomas, 8 subserous and 10 intramural, diffuse adenomyosis, 14 cases and localized adenomyoma, 3 cases. Intramural leiomyomas showed enhancement on T2-weighted imaging suggesting a good response to uterine artery embolization (UAE). The size, number and location of myomas were precisely demonstrated on MR imaging, information necessary for myomectomy and UAE. The findings of MR imaging were compared with the final diagnosis after laparoscopy or surgical intervention and histopathological study. The accuracy, sensitivity, specificity, and positive and negative predictive values of MR imaging for diagnosing uterovaginal lesions associated with infertility were 100%. Conclusion The present study proved that MR imaging was the method of choice for precise diagnosis of uterovaginal lesions associated with infertility, when the diagnosis was not conclusive on HSG and TVUS. MR imaging was mandatory for conclusive diagnosis of mullerian duct anomalies, adenomyosis uteri and multiple uterine leiomyomas destined to myomectomy or uterine artery embolization. The accuracy, sensitivity, specificity and positive and negative predictive values of MR imaging for diagnosis of these lesions were 100%.

LAPAROSCOPIC EXCISION OF RUPTURED NON-COMMUNICATING RUDIMENTARY HORN PREGNANCY [Rüptüre Non-Komminikan Rudimenter Horn Gebeliğinin Laparoskopik Eksizyonu

Unicornuate uterus with rudimentary horn occurs due to failure of complete development of one of the mullerian ducts and incomplete fusion with the contralateral side. Pregnancy in a non-communicating rudimentary horn is extremely rare and usually terminates in rupture during first or second trimester of pregnancy. Diagnosis of rudimentary horn pregnancy and its rupture in a woman with prior vaginal delivery is difficult. It can be undiagnosed in routine ultrasound scan and in majority of cases it is detected after rupture. We report a case of G2 P1 with ruptured rudimentary horn pregnancy at 9 weeks of gestation which was misdiagnosed as tubal ectopic pregnancy. Key words: non-communicating rudimentary horn pregnancy, laparoscopy, unicornuate uterus

English

BACKGROUND: Rare case of the patient having multiple developmental variations of mullerian duct: unicornuate uterus with non-communicating rudimentary horn, cervical agenesis and transverse vaginal septum with cryptomenorrhoea. AIMS: Restoration of menstrual function and restoration of reproductive function. METHODS AND MATERIAL: Patient was examined and then surgical repair of reproductiove organs was done. RESULTS AND CONCLUSIONS: Patients responded well in post-operative period. She started having normal menses without any complaints. Patients with cryptomenorrhea must be thoroughly evaluated and appropriate surgical correction of underlying congenital anamoly provides good results.

A systematic approach to the magnetic resonance imaging-based differential diagnosis of congenital Müllerian duct anomalies and their mimics.

Müllerian duct anomalies (MDAs) represent a wide spectrum of developmental abnormalities related to various gynecologic and obstetric complications, including primary amenorrhea, infertility, and endometriosis. The use of diverse imaging modalities, in conjunction with clinical information, provide important clues to the diagnosis of MDAs. Diagnostic imaging work-up for MDAs often begins with hysterosalpingography (HSG) and/or ultrasonography (US). Although HSG and/or US may suffice to detect the presence of a uterine abnormality, magnetic resonance (MR) imaging is generally needed to classify the abnormality into a specific MDA category. MR imaging has been gaining in popularity for use in evaluating MDAs, by virtue of its noninvasiveness, lack of ionizing radiation, and capability for multiplanar imaging and soft tissue characterization. Abnormalities in the external uterine fundal contour are readily recognized with MR imaging, allowing for clear differentiation between a fusion anomaly, such as a uterus didelphys or a bicornuate uterus, and a resorption anomaly, such as a septate uterus. Furthermore, MR imaging enables clear depiction of a rudimentary uterine horn in a unicornuate uterus. Accurate differential diagnosis of MDAs on the basis of their characteristic MR imaging findings is crucial, because the rates of gynecologic and obstetric complications vary considerably among MDAs. The diagnostic accuracy may be enhanced by adopting a systematic approach to MR imaging-based differential diagnosis.

Coring-type laparoscopic resection of a cavitated non-communicating rudimentary horn under hysteroscopic assistance

Non-communicating accessory uterine horns with an endometrial cavity are the most common and clinically significant unicornuate subtype of Müllerian duct abnormality. They are generally associated with symptoms of dysmenorrhea, dyspareunia, infertility, endometriosis, adhesions, and life-threatening cornual pregnancy. Treatment options include surgical resection of the rudimentary horn, hysteroscopic recanalization, and endometrial ablation. Currently, laparoscopic resection is the recommended treatment choice. Dissection of the rudimentary horn from the unicornuate uterus is the most challenging part of this procedure and may compromise the remaining unicornuate uterus wall. Here we describe a case of laparoscopic coring-type resection of a non-communicating functional rudimentary horn firmly attached to the unicornuate uterus, by using hysteroscopic assistance. The use of hysteroscopy, adjunct to laparoscopy, facilitates the coring-type resection and may strengthen the remaining myometrial scar.

English

A 15-year-old girl presented with acute abdomen. On exploratory laparotomy she was found to have a right functional rudimentary horn of the uterus. We report a case of unicornuate uterus with functioning rudimentary horn. We here in highlight that mullerian duct anomalies should be considered in the differential diagnosis of acute abdomen even in normally menstruating girls. Unicornuate uterus with a rudimentary horn is susceptible to many gynecologic and obstetric complications. Hematometra, chronic pelvic pain, endometriosis, infertility are some of the complaints in women with unicornuate uterus.

Müllerian duct anomalies diagnosed by saline contrast sonohysterography: prevalence in a general population

To estimate the prevalence of uterine müllerian duct anomalies in a general population. Cross-sectional study. University hospital in collaboration with the Danish Civil Registry. A total of 1,654 women randomly recruited from a general population; 686 women were eligible and accepted inclusion (429 pre- and 257 postmenopausal). Saline contrast sonohysterography (SCSH) was finally performed in 622 women (aged 20-74 years) (the procedure was impossible owing to cervical stenosis in 58, contraindicated in 2, other patient-related factors in 4). The shape of the uterus was dynamically evaluated in the transversal and longitudinal planes during SCSH and classified in accordance with American Fertility Society as normal, arcuate, septate (partial, complete), bicorn (partial, complete), or unicorn. History of previous miscarriage and menstrual cycle was obtained by a questionnaire. Prevalence of müllerian anomalies, miscarriage, and oligomenorrhea. The overall prevalence of müllerian anomalies was 9.8% (61 of 622) (95% confidence interval [CI] 7.5-12.1). The majority had arcuate uteri (n=42, 6.8%), 17 partial septate (2.7%), 1 complete septate (1.6%), and 1 unicorn uterus (1.6%). Müllerian anomalies were significantly more frequently diagnosed in nulliparous (20% [26 of 128]) compared with parous women (7% [35 of 494]). Müllerian anomalies were more frequent in women with oligomenorrhea compared with women with normal menstrual periods (19% [15 of 79] vs. 10% [34 of 339]). One first-trimester miscarriage or multiple miscarriages (more than one) were not significantly more frequent in premenopausal women with müllerian anomalies compared with women with normal-shaped uteri (24% [6 of 25] vs. 22% [57 of 265]). In a general population examined by SCSH the prevalence of Müllerian anomalies is estimated at 9.8%. Müllerian anomalies were more frequent in nulliparous women. Both impaired fertility and a pregnancy-associated modulation of the uterine corpus are among explanations. Müllerian anomalies were associated with oligomenorrhea in premenopausal women. In this general population there was no association between miscarriage and müllerian anomalies; however, the number of cases was limited.

English

Most of the adolescent girls complain of pain during periods. The incidence of dysmenorrhea is 25%. A 17 year old girl came with right sided pain which was mistaken for appendicitis and had laparoscopic appendicectomy. She was referred to gynecology outpatient department since the pain on the right side was not relieved even on medical treatment. Repeatedly she took leave from her school. At one stage patient was thought to be malingering and was referred for psychotherapy. MRI showed class IV bicornuate unicollis uterus, with partially underdeveloped rudimentary horn with functional endometrium. The provisional diagnosis prior to laparotomy was bicornuate uterus but on surgery it was found to be a unicornuate uterus with non-communicating rudimentary horn on the right side with functioning Endometrium. There was no associated renal abnormality and endometriosis. The functioning unicornuate horn was attached to the uterus by a fibrous band which was excised easily. The patient was relieved of dysmenorrhea. In unilateral dysmenorrhea the probability of congenital malformation should be thought of. Early diagnosis and management will help to prevent a lot of complications like endometriosis, infertility, ectopic pregnancy and rupture of underdeveloped pregnant horn.

Clinical Spectrum of Unicornuate Uterus with Noncommunicating Rudimentary Horn: Five-Year Analysis at a Tertiary Care Center

Abstract Objective: The aim of this study was to analyze gynecologic and obstetrical morbidities associated with unicornuate uterus with rudimentary horn and to plan future management strategies for patients with this condition. Materials and Methods: This was a retrospective study of 38 patients with unicornuate uterus with rudimentary horn found on laparotomy. The research was carried out at the Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India, from April 2007 to March 2012. The patients' clinical details were reviewed and management of the cases was analyzed. Results: Of 38 patients, 4 were adolescents who presented with dysmenorrhea and had hematometra in a noncommunicating rudimentary horn on laparotomy. Eighteen patients had rudimentary horn pregnancy and 17 presented in the second trimester. All patients underwent laparotomy, 12 for hemoperitoneum and 5 for failed induction. Preoperative diagnosis was suspected clinically in 13/18 cases. Sixteen patients had pregnancy in the sem...

Endometrial Tuberculosis in a Unicornuate Uterus with a Rudimentary Horn

Endometrial Tuberculosis in a Unicornuate Uterus with a Rudimentary Horn

Pregnancy in the Rudimentary Uterine Horn Case Report of an Unusual Presentation = عرض لحالة نادرة لحمل في قرن رحم غير مكتمل النمو

A unicornuate uterus with a rudimentary horn is a uterine anomaly resulting from the incomplete development of one of the Müllerian ducts and an incomplete fusion with the contralateral side. Pregnancy in a rudimentary horn of the uterus is a rare clinical condition with a reported incidence of 1 in 100,000 to 140,000 pregnancies. Usually the diagnosis is missed and may present as an emergency with haemoperitoneum. The standard treatment is the surgical excision of the horn. A gravida 2, para 1 patient presented at 23 weeks' gestation with fetal demise. Repeated failed attempts at induction of labour raised the suspicion of an abnormally located pregnancy which was confirmed by magnetic resonance imaging. She underwent a laparotomy with right rudimentary horn excision. The final diagnosis of a non-communicating rudimentary horn pregnancy was made intraoperatively and was confirmed by histopathology. This case highlights the importance of an early ultrasound in detecting uterine anomalies and the need for high clinical suspicion.

Acute abdomen in a patient with rudimentary horn

<p style="margin-bottom: 0in;"><span style="font-family: Times New Roman,serif;"><span style="font-size: x-small;"><span style="color: #231f20;">Unicornuate uterus with a rudimentary horn is a rare condition. These patients present with dysmenorrhoea and chronic pelvic pain and infertility. We present an interesting case of hematometra with non-communicating rudimentary horn with unicornuate uterus. Strong suspicion to this condition helps in early diagnosis and treatment.</span></span></span> <p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="font-weight: normal;">DOI: <a href="http://dx.doi.org/10.4038/sljog.v35i3.6340">http://dx.doi.org/10.4038/sljog.v35i3.6340</a></span></span></span></span> <p style="margin-bottom: 0in;"><em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2013; 35: 90-91

Diagnostic and Laparoscopic Management of Unicornuate Uterus with Rudimentary Horn

We describe here a case report of a female patient with a unicornuate uterus with noncommunicating left rudimentary horn. The patient presented herself to us due to persistent lower abdominal pains, primarily dysmenorrhea and suspected internal genital endometriosis. Further to additional diagnosis and imaging by vaginal and abdominal ultrasound and abdominal MRI, a suspected rare congenital malformation of the genital tract was established. A normal vagina with cervical system without pathological findings was presented during the operation. The diagnostic hysteroscopy and laparoscopy indicated an intact right unicornuate uterus with a regular tube and ovary. A left rudimentary horn, noncommunicating with cervix and vagina was also presented, also together with a regular tube and ovary. The chromopertubation carried out proved the patency of the right tube. The decision was taken intraoperatively to remove the left rudimentary horn with ipsilateral tube. The surgery could be carried out without complications. We are reporting a patient with persistent lower abdominal pain, who desires to have children, to conceive with a unicornuate uterus and left rudimentary horn with retrograde menstruation and proliferative endometrium. Surgical minimal invasive treatment by laparoscopically removing of the left rudimentary horn and tube took place.

Usefulness of three dimensional transvaginal ultrasonography and hysterosalpingography in diagnosing uterine anomalies.

Uterine anomalies may lead to infertility recurrent miscarriage, preterm labour intrauterine growth restriction and post-partum haemorrhage. Infertility and recurrent miscarriage are relatively common problems in the female population. Diagnostic algorithms in such cases include the evaluation of uterine anatomy Magnetic resonance imaging (MRI) is the most accurate technique for visualizing the female genitourinary tract anatomy but as it is expensive and not readily available, it is not useful in everyday practice. Hysterosalpingography (HSG) is a frequently performed procedure that plays an important role in evaluating the uterus and fallopian tubes. The most typical indication for HSG is infertility and recurrent miscarriage, which are common problems in the female population. However this procedure is invasive, exposes the patient to ionizing radiation, carries a risk of complications and does not show the external contour of the uterus, which is essential for differentiating uterine anomalies. Three dimensional transvaginal ultrasound (3D TV USG) is a noninvasive and quick, imaging method that may be used in diagnosing uterine anomalies. This method allows evaluate the external contours of the uterus, making it comparable to MRI. In this study we discuss the advantages and disadvantages of HSG and 3D TV USG in diagnosing uterine anomalies. Additionally we present the results of HSG and 3D TV USG of 155 patients referred to our Department because of infertility and/or suspected uterine anomalies. After performing HSG, in the studied group 118 patients were diagnosed with a normal uterus, 4 with unicornuate (including 1 patient with an unicornuate uterus, with rudimentary horn), and 6 with didelphys uterus. In 22 cases, due to the lack of evaluation of external contour of the uterus, we could not differentiate arcuate, septate and bicornuate uterus. After performing 3D TV USG we confirmed the HSG diagnosis and precise differentiated 22 disputable cases. 8 with arcuate, 11 with septate (2 complete and 9 partial) and 3 with complete bicornuate uterus. In 5 patients, severe pain and lack of cooperation during HSG made the acquisition of diagnostic X-ray images impossible. In these cases 3D TV USG allowed the anatomic assessment of the uterus, a normal uterus was found in all of them. All uterine anomalies were then confirmed by hysteroscopy and/or laparoscopy Basing on a review of the literature and our results, we conclude that HSG is not the optimal method for diagnosing uterine anomalies, while 3D TV USG can accurately show the uterus anomalies and may become an alternative method to MRI.

Rupture of Non-communicating Rudimentary Horn at 28 Weeks of Pregnancy in Previously Scarred Uterus: A Diagnosis in Disguise

Pregnancy in non-communicating rudimentary horn of unicornuate uterus is an uncommon form of ectopic pregnancy usually resulting in rupture during second trimester with grave consequences for the mother and fetus. We report a case of ruptured non-communicating rudimentary horn at 28 weeks of gestation in woman with previous Caesarean section in unicornuate uterus. She presented to emergency with pain abdomen since four days. Laparotomy was done and the rudimentary horn excised. Post-operative recovery was uneventful. High index of suspicion of uterine anomaly and its early diagnosis in cases of second trimester rupture is required to save this catastrophic event.

Live birth following a term pregnancy in a non-communicating rudimentary horn of a unicornuate uterus

A case report of a live birth following a term pregnancy located in a non-communicating rudimentary horn of a unicornuate uterus in a rural hospital in Nigeria is presented. A 32-year-old primiparous woman registered for antenatal care at a rural missionary hospital at 28 weeks gestation. She had intermittent unexplained vaginal bleeding prior to booking and multiple ultrasound scans in different centers affirmed a viable intrauterine pregnancy. She had an elective cesarean section at 38 weeks gestational age on account of a persistent oblique breech presentation and “low lying placenta.” Intra-operatively, the pregnancy was found in a non-communicating pouch continuous with the left fallopian tube and separate from the uterine cavity. A female baby weighing 2.2 kg with no gross deformity was delivered. Resection of the rudimentary horn and repair were done. The possibility of a uterine anomaly should be considered by clinicians and sonographers in unexplained intermittent early pregnancy bleeding.

Unilateral Functional Uterine Horn with Non Functioning Rudimentary Horn and Cervico-Vaginal Agenesis: Case Report

Developmental anomalies involving Mullerian ducts are one of the most fascinating disorders in Gynaecology. The incidence rates vary widely and have been described between 0.1-3.5% in the general population. We report a case of a fifteen year old girl who presented with primary amenorrhea and lower abdomen pain, with history of instrumentation about two months back. She was found to have abdominal lump of sixteen weeks size uterus. On examination vagina was found to be represented as a small blind pouch measuring 2-3cms in length. A rectovaginal fistula (2x2 cms) was also observed. Ultrasonography of abdomen revealed bulky uterus (size 11.2x6 cm) with 150 millilitre of collection. Adiagnosis of hematometra with iatrogenic fistula was made. Vaginal drainage of hematometra was done which was followed by laparotomy. Peroperatively she was found to have a left side unicornuate uterus with right side small rudimentary horn. Left fallopian tube and ovary showed dense adhesions and multiple endometriotic implants. Both cervix and vagina were absent. Total abdominal hysterectomy was done and rectovaginal fistula repaired. The present case is reported due to its rarity as it involved both mullerian agenesis with cervical and vaginal agenesis along with disorder of lateral fusion. This is an asymmetric type of mullerian duct development in which arrest has occurred in different stages of development on two sides. DOI: http://dx.doi.org/10.3329/bjms.v13i1.17500 Bangladesh Journal of Medical Science Vol. 13 No. 01 January2014: 101-104

Rapid Recurrence of Unilateral Endometrioma in a Teenager with a Noncommunicating Rudimentary Horn and Unicornuate Uterus

A 17-year-old nulligravida woman presented to the emergency department complaining of a six months’ history of severe dysmenorrhea. The patient underwent a laparoscopic excision of a right ovarian endometrioma in another hospital one year ago, 24 months after menarche at 14 years of age. Transvaginal ultrasonography, magnetic resonance imaging, hysteroscopy as well as laparo- scopy revealed a unicornuate uterus with a noncommunicating right rudimentary horn, a dilated right fallopian tube and a novel 40 mm right ovarian endometrioma. An excision of the right fallopian tube, the rudimentary horn and the endometrioma was performed. Since endometriosis may be originated by retrograde menstruation, an obstructive müllerian malformation should be ruled out at the diagnosis of endometriosis, particularly in adolescents. It may lead clinicians to provide an initial definitive treatment for avoidingrapid recurrent endometriosis.

Two Cases of Unicornuate Uterus Treated by Transcervical Incision of Uterus Metroplasty Successfully Pregnancy and Literature Review

Two Cases of Unicornuate Uterus Treated by Transcervical Incision of Uterus Metroplasty Successfully Pregnancy and Literature Review

Transabdominal cerclage placement in patients with prior uterine incisions: Risk of scar disruption

The object of this study was to describe pregnancy outcomes in women who had a transabdominal cerclage (TAC) placed after a prior uterine incision due to caesarean section or hysterotomy. This is a retrospective observational study of 57 women referred to a maternal–fetal medicine specialist (JES) for TAC placement after a previous uterine incision from 1989–2012. Pregnancy outcomes post-TAC placement are reported, including gestational age at delivery, survival rate and complications directly related to labour and the previous uterine scar. Of 51 women who had a prior uterine incision and were pregnant at TAC, 49 (96.1%) delivered viable infants at a mean gestational age of 35.9 weeks. One patient had intrauterine fetal demise at 16 weeks for causes likely unrelated to TAC and another had uterine rupture associated with a unicornuate uterus and advancing labour at 31 weeks. This study includes women with low transverse incisions, classical uterine incisions and higher order multiples. It was concluded that in women with a prior uterine incision, placement of a TAC is associated with low risk (2%) of uterine rupture.