Background: A bicornuate uterus is a relatively common and often asymptomatic
congenital uterine malformation. Objective: The aim of this work is to
highlight the diagnostic difficulty in this case, as well as its therapeutic
and prognostic aspects. We report here the case of a young girl carrying a
pregnancy on an undiagnosed unicollis bicornuate uterus, which was initially
diagnosed as an unruptured ectopic pregnancy. Conclusion: The bicornuate
uterus still poses diagnostic difficulties, especially in disadvantaged populations
due to the poor accessibility of diagnostic means.
References
[1]
Saravelos, S.H., Cocksedge, K.A. and Li, T.C. (2008) Prevalence and Diagnosis of Congenital Uterine Anomalies in Women with Reproductive Failure: A Critical Appraisal. Human Reproduction Update, 14, 415-429.
https://doi.org/10.1093/humupd/dmn018
[2]
Troiano, R.N. and McCarthy, S.M. (2004) Mullerian Duct Anomalies: Imaging and Clinical Issues. Radiology, 233, 19-34. https://doi.org/10.1148/radiol.2331020777
[3]
Musset, R. and Belaich, J. (1964) Nécessité d’une classification globale des malformations utérines. In: XXIIes Assises Françaises de Gynécologie, Masson, Paris.
[4]
Buttram, V. and Gibbons, W. (1979) Mullerian Anomalies: A Proposed Classification: An Analysis of 144 Cases. Fertility and Sterility, 32, 40-46.
https://doi.org/10.1016/S0015-0282(16)44114-2
[5]
(1988) The American Fertility Society Classifications of Adnexal Adhesions, Distal Tubal Occlusion, Tubal Occlusion Secondary to Tubal Ligation, Tubal Pregnancies, Müllerian Anomalies and Intrauterine Adhesions. Fertility and Sterility, 49, 944-955. https://doi.org/10.1016/S0015-0282(16)59942-7
[6]
Acien, P. and Acien, M.I. (2011) The History of Female Genital Tract Malformation Classifications and Proposal of an Updated System. Human Reproduction Update, 17, 693-705. https://doi.org/10.1093/humupd/dmr021
[7]
Grimbizis, G.F., Gordts, S., Di Spiezio Sardo, A., et al. (2013) The ESHRE-ESGE Consensus on the Classification of Female Genital Tract Congenital Anomalies. Gynecological Surgery, 10, 199-212. https://doi.org/10.1007/s10397-013-0800-x
[8]
Grimbizis, G.F., Di Spiezio Sardo, A., Saravelos, S.H., et al. (2016) The Thessaloniki ESHRE/ESGE Consensus on Diagnosis of Female Genital Anomalies. Gynecological Surgery, 13, 1-16. https://doi.org/10.1007/s10397-015-0909-1
[9]
Reuter, K.L., Daly, D.C. and Cohen, S.M. (1989) Septate versus Bicornuate Uteri: Errors in Imaging Diagnosis. Radiology, 172, 749-752.
https://doi.org/10.1148/radiology.172.3.2528160
[10]
Ludwin, A., Pityński, K., Ludwin, I., et al. (2013) Two- and Three-Dimensional Ultrasonography and Sonohysterography versus Hysteroscopy with Laparoscopy in the Differential Diagnosis of Septate, Bicornuate, and Arcuate Uteri. Journal of Minimally Invasive Gynecology, 20, 90-99. https://doi.org/10.1016/j.jmig.2012.09.011
[11]
Abo Dewan, K.A., Hefeda, M.M. and ElKholy, D.G. (2014) Septate or Bicornuate Uterus: Accuracy of Three-Dimensional Trans-Vaginal Ultrasonography and Pelvic Magnetic Resonance Imaging. The Egyptian Journal of Radiology and Nuclear Medicine, 45, 987-995. https://doi.org/10.1016/j.ejrnm.2014.04.001
[12]
Faivre, E., Fernandez, H., Deffieux, X., et al. (2012) Accuracy of Three-Dimensional Ultrasonography in Differential Diagnosis of Septate and Bicornuate Uterus Compared with Office Hysteroscopy and Pelvic Magnetic Resonance Imaging. Journal of Minimally Invasive Gynecology, 19, 101-106.
https://doi.org/10.1016/j.jmig.2011.08.724
[13]
Ludwin, A., Ludwin, I., Banas, T., et al. (2011) Diagnostic Accuracy of Sonohysterography, Hysterosalpingography and Diagnostic Hysteroscopy in Diagnosis of Arcuate, Septate and Bicornuate Uterus. Journal of Obstetrics and Gynaecology Research, 37, 178-186. https://doi.org/10.1111/j.1447-0756.2010.01304.x
[14]
Strassmann, E.O. (1952) Plastic Unification of Double Uterus; a Study of 123 Collected and Five Personal Cases. American Journal of Obstetrics and Gynecology, 64, 25-37. https://doi.org/10.1016/S0002-9378(16)38732-4
[15]
Alborzi, S., Asefjah, H., Amini, M., et al. (2015) Laparoscopic Metroplasty in Bicornuate and Didelphic Uteri: Feasibility and Outcome. Archives of Gynecology and Obstetrics, 291, 1167-1171. https://doi.org/10.1007/s00404-014-3520-1
[16]
Nishida, M., Otsubo, Y., Arai, Y., et al. (2016) Difference in Reproductive Performance between Two Subtypes of Bicornuate Uterus. Archives of Gynecology and Obstetrics, 293, 1335-1338. https://doi.org/10.1007/s00404-016-4047-4
[17]
Bhagavath, B., Behrman, E., Salari, B.W., et al. (2015) Metroplasty to Treat Chronic Pelvic Pain Resulting from Outflow Tract Mullerian Anomalies. American Journal of Obstetrics and Gynecology, 213, 871e1-3.
https://doi.org/10.1016/j.ajog.2015.09.007
[18]
Speroff, L. and Fritz, M. (2005) Clinical Gynecologic Endocrinology and Infertility. 7th Edition, Lippincott Williams & Wilkins, Philadelphia.
[19]
Rousset, P., Raudrant, D., Peyron, N., et al. (2013) Ultrasonography and MRI Features of the Mayer-Rokitansky-Küster-Hauser Syndrome. Clinical Radiology, 68, 945-952. https://doi.org/10.1016/j.crad.2013.04.005
[20]
Acien, P. (1992) Embryological Observations on the Female Genital Tract. Human Reproduction, 7, 437-445. https://doi.org/10.1093/oxfordjournals.humrep.a137666
[21]
Reichman, D., Laufer, M.R. and Robinson, B.K. (2009) Pregnancy Outcomes in Unicornuate Uteri: A Review. Fertility and Sterility, 91, 1886-1894.
https://doi.org/10.1016/j.fertnstert.2008.02.163
[22]
Rackow, B.W. and Arici, A. (2007) Reproductive Performance of Women with Müllerian Anomalies. Current Opinion in Obstetrics and Gynecology, 19, 229-237.
https://doi.org/10.1097/GCO.0b013e32814b0649
[23]
Zyla, M.M., Wilczynski, J., Nowakowska-Glab, A., et al. (2015) Pregnancy and Delivery in Women with Uterine Malformations. Advances in Clinical and Experimental Medicine, 24, 873-879. https://doi.org/10.17219/acem/23171
[24]
Chan, Y.Y., Jayaprakasan, K., Tan, A., et al. (2011) Reproductive Outcomes in Women with Congenital Uterine Anomalies: A Systematic Review. Ultrasound in Obstetrics & Gynecology, 38, 371-382. https://doi.org/10.1002/uog.10056
[25]
Venetis, C.A., Papadopoulos, S.P., Campo, R., et al. (2014) Clinical Implications of Congenital Uterine Anomalies: A Meta-Analysis of Comparative Studies. Reproductive BioMedicine Online, 29, 665-683.
https://doi.org/10.1016/j.rbmo.2014.09.006
[26]
Takami, M., Aoki, S., Kurasawa, K., et al. (2014) A Classification of Congenital Uterine Anomalies Predicting Pregnancy Outcomes. Acta Obstetricia et Gynecologica Scandinavica, 93, 691-697. https://doi.org/10.1111/aogs.12400
[27]
Papp, Z., Mezei, G., Gavai, M., et al. (2006) Reproductive Performance after Transabdominal Metroplasty: A Review of 157 Consecutive Cases. The Journal of Reproductive Medicine, 51, 544-552.
[28]
Rechberger, T., Monist, M. and Bartuzi, A. (2009) Clinical Effectiveness of Strassman Operation in the Treatment of Bicornuate Uterus. Ginekologia Polska, 80, 88-92.
[29]
Sugiura-Ogasawara, M., Ozaki, Y., Katano, K., et al. (2011) Uterine Anomaly and Recurrent Pregnancy Loss. Seminars in Reproductive Medicine, 29, 514-521.
https://doi.org/10.1055/s-0031-1293205
[30]
Yassaee, F. and Mostafaee, L. (2011) The Role of Cervical Cerclage in Pregnancy Outcome in Women with Uterine Anomaly. Journal of Reproduction & Infertility, 12, 277-279.
