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Unicornuate uterus
Classification and external resources

A unicornuate uterus as seen on a hysterosalpingogram
ICD-10 Q51.4.
ICD-9 752.3

A unicornuate uterus represents a uterine malformation where the uterus is formed from one only of the paired mullerian ducts while the other mullerian duct does not develop or only in a rudimentary fashion. The sometimes called hemi-uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

Contents

Etiology

The uterus is normally formed during embryogenesis by the fusion of the two mullerian ducts. If one of the ducts does not develop, only one mullerian duct contributes to the uterine development. This uterus may or may not be connected to mullerian structure on the opposite site if the mullerian duct on that site undergoes some development. A unicornuate uterus has a single cervix and vagina. Associated defects may affect the renal system, and less common, the skeleton.

The condition is much less common than these other uterine malformations: arcuate uterus, septate uterus, and bicornuate uterus. While the uterus didelphys is estimated to occur in 1/3,000 women,[1] the unicornuate uterus appears to be even more infrequent with an estimated occurrence of about 1/4,000.[2]

Presentation

Women with the condition may be asymptomatic and unaware of having a uniconuate uterus; normal pregnancy may occur. In a review of the literature Reichman et al. analyzed the data on pregnancy outcome of 290 women with a unicornuate uterus. 175 women had conceived for a total of 468 pregnancies. They found that about 50 % of patients delivered a live baby. The rates for ectopic pregnancy was 2.7%, for miscarriage 34 %, and for preterm delivery 20 %, while the intrauterine demise rate was 10 %.[2] Thus patients with a unicornuate uterus are at a higher risk for pregnancy loss and obstetrical complications.

Rudimentary horn

A unicornuate uterus may be associated with a rudimentary horn on the opposite site. This horn may be communicating with the uterus, and linked to the ispilateral tube. Occasionally a pregnancy may implant into such a horn setting up a dangerous situation as such pregnancy can lead to a potentially fatal uterine rupture. Surgical resection of the horn is indicated.[3]

Diagnosis

A pelvic examination will typically reveal a single vagina and a single cervix. Investigations are usually prompted on the basis of reproductive problems.

Helpful techniques to investigate the uterine structure are transvaginal ultrasonography and sonohysterography, hysterosalpingography, MRI, and hysteroscopy. More recently 3-D ultrasonography has been advocated as an excellent non-invasive method to evaluate uterine malformations.[4]

Management

Patients with a unicornuate uterus may need special attention during pregnancy as pregnancy loss, fetal demise, premature birth, and malpresentation are more common.[2] It is unproven that cerclage procedures are helpful. A pregnancy in a rudimentary horn cannot be saved and needs to be removed with the horn to prevent a potentially fatal rupture of the horn and uterus.

References

  1. ^ G.F. Grimbizis, M.Camus, B.C.Tarlatzis, J.N. Bontis, P.Dervoey. "Clinical implications of uterine malformation and hysterscopic treatment results.". Human Reproduction update, vol 7,no 2,pp 161-174,2001..  PMID 11284660
  2. ^ a b c Reichman D, Laufer MR, Robinson BK.. "Pregnancy outcomes in unicornuate uteri: a review.". Fertil Steril. 2008 Apr 24.. PMID 18439594
  3. ^ Dhar H.. "Rupture of non-communicating rudimentary uterine horn pregnancy.". J Coll Physicians Surg Pak. 2008 Jan;18(1):53-4.. PMID 18452672
  4. ^ Woelfer B, Salim R, Banerjee S, Elson J, Regan L, Jurkovic D (December 2001). "Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening" ( – Scholar search). Obstet Gynecol 98 (6): 1099–103. doi:10.1016/S0029-7844(01)01599-X. PMID 11755560. http://www.greenjournal.org/cgi/pmidlookup?view=long&pmid=11755560. 

External links

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