Re: Bicornuate uterus versus septate uterus
From: R. Daniel Braun (rd.braun@gmail.com)
Tue Sep 4 15:46:14 2007
Remember that sometimes the vaginal septum can very closely resemble a
normal lateral vaginal wall and there may only be a very small opening near
the hymeneal ring which you may easily overlook. If you do, then you never
see or Pap the second cervix.
The other complication of duplications as pointed out in my 1970 article is
in the patient with perimenopausal or post menopausal bleeding. BOTH
cavities need to be evaluated. At that time there were 35 cases of uterus
didelphys with Endometrial CA reported and half of them had delay in
diagnosis because the wrong cavity had been curetted.
BTW, Uterus Didelphys means complete duplication of uterus, cervix, &
vagina.
Dan
On 9/4/07, Garry E. Siegel, M.D. <garrys@mindspring.com> wrote:
>
> Thanks, and my plan is to do a careful physical examination when she's
> in postpartum, and order an IVP.
>
> I doubt that she'll need more, given the fine comments that all have
> contributed.
>
> Garry
>
> At Tue, 4 Sep 2007, Mark Jutras wrote:
> >
> >After 21 years as an REI, I have only had one patient with a bicornuate
> >uterus who I did unification on and now I probably would not do the
> >procedure on the same patient. I have had a couple of other recurrent
> >aborters who had a more complex situation with both a partial bicornuate
> and
> >a septum. In those cases you assume it is the septum and only take the
> >septum down. The point is that these women were having problems and
> your's
> >was not. No problem = no surgery.
> >
> >Most women with a true septum do not have pregnancy problems. If you
> happen
> >to find it "by accident" leave it alone. If you are doing a hysteroscopy
> >for other reasons later, I would probably incise (excise not necessary
> and
> >possibly harmful) since the greatest risk of the procedure is probably
> >anesthesia (of course you want it on your permit).
> >
> >As far as imaging - it has been true for a long time that anything more
> than
> >ultrasound is rarely needed. I have noticed that even the "never give a
> >straight answer" radiologists are actually starting to call the septums
> >rather than saying can't rule out etc. You can always differentiate a
> >septum from a bicornuate uterus with ultrasound alone. There are more
> >complex anomalies were an MRI may be needed. Haven't ordered one in 21
> >years but come close a couple of times. This has usually been in a case
> >were fibroids were also present and I was trying to figure out what was
> >what. Additionally, the books and ASRM classification sheets do not
> contain
> >all possibilities of Mullerian anomaly.
> >
> >As far as the double cervix, its just a question of PAPing
> everything. The
> >double barreled cervix with two ostia in one body is not important. You
> >only cut them if you need to to clarify the surgery while taking down the
> >septum. They almost always reform, while the septum in the uterus never
> >does. The cervical part of the septum is of no consequence.
> >
> >--
> >Mark Jutras, MD, HCLD
> >Huntersville, NC
> >
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
