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Re: Bicornuate uterus versus septate uterusFrom: Mark Jutras (mjutras@gate.net)Tue Sep 4 12:37:19 2007
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
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