World Library  
Flag as Inappropriate
Email this Article

Unicornuate uterus

Article Id: WHEBN0005946724
Reproduction Date:

Title: Unicornuate uterus  
Author: World Heritage Encyclopedia
Language: English
Subject: Uterine malformation, Aphallia, Vaginal septum, Arcuate uterus, Bicornuate uterus
Collection: Anatomical Pathology, Congenital Disorders of Female Genital Organs
Publisher: World Heritage Encyclopedia
Publication
Date:
 

Unicornuate uterus

Unicornuate uterus
A unicornuate uterus as seen on a hysterosalpingogram
Classification and external resources
ICD-10 Q51.4
ICD-9-CM 752.3

A unicornuate uterus represents a uterine malformation where the uterus is formed from one only of the paired Müllerian ducts while the other Müllerian duct does not develop or only in a rudimentary fashion. The sometimes called hemi-uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

Contents

  • Etiology 1
  • Presentation 2
  • Rudimentary horn 3
  • Diagnosis 4
  • Management 5
  • References 6
  • External links 7

Etiology

The uterus is normally formed during embryogenesis by the fusion of the two Müllerian ducts. If one of the ducts does not develop, only one Müllerian duct contributes to the uterine development. This uterus may or may not be connected to Müllerian structure on the opposite site if the Müllerian duct on that site undergoes some development. A unicornuate uterus has a single cervix and vagina. Associated defects may affect the renal system, and less common, the skeleton.

The condition is much less common than these other uterine malformations: arcuate uterus, septate uterus, and bicornuate uterus. While the uterus didelphys is estimated to occur in 1/3,000 women,[1] the unicornuate uterus appears to be even more infrequent with an estimated occurrence of about 1/4,000.[2]

Presentation

Women with the condition may be asymptomatic and unaware of having a uniconuate uterus; normal pregnancy may occur. In a review of the literature Reichman et al. analyzed the data on pregnancy outcome of 290 women with a unicornuate uterus. 175 women had conceived for a total of 468 pregnancies. They found that about 50% of patients delivered a live baby. The rates for ectopic pregnancy was 2.7%, for miscarriage 34%, and for preterm delivery 20%, while the intrauterine demise rate was 10%.[2] Thus patients with a unicornuate uterus are at a higher risk for pregnancy loss and obstetrical complications.

Rudimentary horn

A unicornuate uterus may be associated with a rudimentary horn on the opposite site. This horn may be communicating with the uterus, and linked to the ispilateral tube. Occasionally a pregnancy may implant into such a horn setting up a dangerous situation as such pregnancy can lead to a potentially fatal uterine rupture. Surgical resection of the horn is indicated.[3]

Diagnosis

A pelvic examination will typically reveal a single vagina and a single cervix. Investigations are usually prompted on the basis of reproductive problems.

Helpful techniques to investigate the uterine structure are transvaginal ultrasonography and sonohysterography, hysterosalpingography, MRI, and hysteroscopy. More recently 3-D ultrasonography has been advocated as an excellent non-invasive method to evaluate uterine malformations.[4]

Management

Patients with a unicornuate uterus may need special attention during pregnancy as pregnancy loss, fetal demise, premature birth, and malpresentation are more common.[2] It is unproven that cerclage procedures are helpful. A pregnancy in a rudimentary horn cannot be saved and needs to be removed with the horn to prevent a potentially fatal rupture of the horn and uterus.[5]

Although it is unclear whether interventions before conception or early in pregnancy such as resection of the rudimentary horn and prophylactic cervical cerclage decidedly improve obstetrical outcomes, current practice suggests that such interventions may be helpful.

References

  1. ^ Grimbizis, G. F.; Camus, M; Tarlatzis, BC; Bontis, JN; Devroey, P (2001). "Clinical implications of uterine malformations and hysteroscopic treatment results". Human Reproduction Update 7 (2): 161–74.  
  2. ^ a b c Reichman, David; Laufer, Marc R.; Robinson, Barrett K. (2009). "Pregnancy outcomes in unicornuate uteri: A review". Fertility and Sterility 91 (5): 1886–94.  
  3. ^ Dhar, H (2008). "Rupture of non-communicating rudimentary uterine horn pregnancy". Journal of the College of Physicians and Surgeons 18 (1): 53–4.  
  4. ^ Woelfer, B (2001). "Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening". Obstetrics & Gynecology 98 (6): 1099–103.  
  5. ^ Reichman, David; Laufer, Marc R.; Robinson, Barrett K. (2009). "Pregnancy outcomes in unicornuate uteri: a review". Fertility and Sterility 91 (5): 1886–94.  

External links

  • Image gallery
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.
 



Copyright © World Library Foundation. All rights reserved. eBooks from Hawaii eBook Library are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.