TITLE:
Bicornuate Uterus: Infertility Treatment and Pregnancy Continuation without Cerclage: An Unusual Case
AUTHORS:
Meenal Parmar, Surabhi Tomar
KEYWORDS:
Bicornuate Uterus, Paramesonephric, Mullerian Duct
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.15,
November
24,
2014
ABSTRACT: Introduction: Uterine
malformation in general population is around 7% - 8%. Abnormal fusion of the
para-mesonephric duct (mullerian duct) during embryonic life results in a
variety of congenital uterine malformations, such as uterus didelphys, uterus
bicornis bicollis, uterus bicornis unicollis, uterus subseptae, uterus
arcuatus, uterus unicornis. The bicornuate uterus accounts for approximately
10% of the mullerian anomalies. Women with bicornuate uterus have no extra
uterine infertility issues. The uterine malformations are known to be
associated with spontaneous miscarriages, intrauterine growth restriction,
preterm deliveries, preterm prelabour rupture of membranes, breech presentation
and increased rate of caesarean delivery. The rates of spontaneous abortion and
premature delivery have been reported to reflect the degree of non fusion of
the horns. The common complications and adverse reproductive outcomes
associated with bicornuate uterus are recurrent pregnancy loss (25%), preterm
birth (15% - 25%) and cervical insufficiency (38%). We reported a case of
bicornuate unicollis pregnancy which was infertility treated and carried till
38 weeks and had a good outcome. Case Report: A 32-year-old nullipara presented
to Infertility OPD at NIMS Medical College and Hospital with the chief
complaint of inability to conceive in spite of having regular sexual
intercourse for 12 years without using any contraception. Patient was then
investigated, bicornuate uterus identified. Infertility treatment was done by
Intrauterine Insemination (IUI). Patient conceived and pregnancy continued till
term uneventfully. Discussion: The prevalence of uterine anomalies is 7% - 8%.
And now because of better availability of diagnostic modalities, better
detection of such anomalies is possible. Bicornuate uterus is a congenital
uterine anomaly that results from defective lateral fusion of the
paramesonephric ducts at about the tenth week of intrauterine life around the
fundus. A bicornuate uterus consists of two symmetric cornua that are fused
caudad, with communication of the endometrial cavities—most often at the level
of the uterine isthmus. In a partial bicornuate unicollis uterus the
intervening cleft is of variable length. Bicornuate uterus has been reported to
have the highest prevalence of cervical incompetence among mullerian anomalies.
Prophylactic placement of cervical cerclage in selected patients has been
reported to increase fetal survival rates.