Re: Bicornuate uterus versus septate uterus
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Sep 4 14:21:09 2007
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
