Re: Bicornuate uterus versus septate uterus
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Sep 4 21:05:58 2007
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
