Re: Bicornuate uterus versus septate uterus
From: Ina May Gaskin (midwifeim@earthlink.net)
Wed Sep 5 09:50:53 2007
A friend of mine has a septum in her vagina, 2 uteri and 1 kidney.
She had been told that she could carry a pregnancy only in the larger
of the two, but she proceeded to become pregnant in the smaller and
had a normal labor and delivery. Had a frank breech with great ease
with one of them.
But she'll never donate a kidney to anyone.
Ina May
On Sep 4, 2007, at 7:12 PM, Garry E. Siegel, M.D. wrote:
> Dan:
>
> Thanks.
>
> Early in my career, I had a patient referred by her internist, a 19 YO
> P0 with a chief complaint that "tampons didn't work." Also, she had an
> LGSIL pap.
>
> Her vagina appeared to be a solo one, and her cervix was
> flush/non-visible.
>
> I had her come in during menstruation to see her cervix, which was a
> pinpoint opening at the top of the vagina buried in the normal vaginal
> rugae.
>
> I can't remember what her ultrasound showed, but I took her to the OR
> (this was 10+ years ago, give or take) and did a
> hysteroscopy/laparoscopy.
>
> The H-scope fluid squirted out of a second, tiny vaginal orifice in
> the
> exact area of a left Skene's gland. I put the scope down it and
> didn't
> see much, and I'm pretty sure she had a normal looking uterus, but I
> can't exactly remember (I'll look at the chart tomorrow).
>
> Anyway, 3 uneventful pregnancies and vaginal deliveries. With the
> first, the septum in the vagina was more "normal" and tore during her
> first delivery, and I repaired it. Now, she has a pretty much normal
> looking vagina AND cervix, and has had normal paps.
>
> Garry
>
> At Tue, 4 Sep 2007, R. Daniel Braun wrote:
>>
>> 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
>>
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
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