Successful deliveries in a case of spontaneous pregnancy in ‘uterus bicornis unicollis’ with dicavitory twin gestation: a rare case report

Congenital anomalies of the uterus cervix and vagina are caused by alterations in development or fusion of the Mullerian ducts and are associated with multiple obstetric problems. A 32-year-old primigravida presented with spontaneous conception of dichorionic diamniotic twin with one twin in the right horn and another in the left horn of a bicornuate uterus. At 31.4 weeks of gestation the patient presented with preterm premature rupture of membranes followed by preterm labour, and progressed to deliver vaginally, resulting in the successful delivery of a live twin male and female baby. Spontaneous twin pregnancies in case of uterus bicornis unicollis are reported rarely. Here we discuss an extremely rare occurrence of spontaneous dicavitatory twin pregnancy in uterus bicornis unicollis and its outcome.

Significance of hysteroscopy in diagnosis and treatment of congenital uterine anomalies

Background/Aim. Hysteroscopy is one of the important methods in the endoscopic diagnosis and treatment of infertility, particularly at the examination of the morphology and function of the uterus. Uterine factor is present at 10% of infertile women, in which changes of the uterus can be congenital or acquired. The aim of this study was to estimate the significance of hysteroscopy in the diagnosis and treatment of congenital anomalies of the uterine cavity in patients in whom there was a reasonable suspicion for them based on prior clinical, ultrasound and hysterosalpingography (HSG) findings. The significance of hysteroscopy is considered in relation to the number of pregnancies achieved depending on the malformations in the 12 months period after the completion of the diagnostic or operational hysteroscopy. Methods. The study included 176 patients with congenital uterine anomalies, which had undergone hysteroscopy, diagnostic or operative, in the period from January 1, 2013 till January 1, 2016. Percentage of pregnancy was followed at all patients during the first 12 months after surgery. Patients were divided into two groups: the first group contained women who had pregnancy, and the second group included women who earlier were not pregnant. Their characteristics were compared, such as: age, duration of infertility, previous pregnancy and/or pregnancy loss, HSG and ultrasound findings, types of congenital anomalies, type of hysteroscopy, as well as the existence of associated pathology. Results. The mean age of patients tested in the study was 35 years. The group of patients with primary infertility had a total of 107 patients, while 69 patients were with secondary infertility. The average duration of infertility was 3 years in the studied patients. In the 12-months period, 39 of the examined women began pregnancy, which was completed with term delivery in 33 women. ?2 test showed a statistical significance difference (p < 0.05) between the groups of the patients with or without pregnancy after hysteroscopy in relation to infertility types as well as in relation to the number of previous miscarriages. Conclusion. Subseptus and septus uteri were the most common congenital uterine malformations in our patients. Very rare were uterus arquatus, uterus unicornis and uterus bicornis. In our study, 1/5 of examined women achieved pregnancy after hysteroscopy in the reporting period of 12 months, while the majority of these pregnancies ended with term delivery. The percentage of miscarriages in the examined women was reduced from 38% to 15% after hysteroscopy. In women who achieved pregnancy, uterine septum and subseptum were mostly diagnosed and in these patients hysteroscopic resection was successfully performed.

UTERUS BIKORNU

Background : Uterus bicornis subseptum is a deformity of the uterus such as the shape of the heart, the fundus appears to be curved inward, and has a barrier or wall inside to the uterine cavity. This abnormality occurs due to failure of the fusion of the left and right mullerian ducts. If pregnant, women who have this form of the uterus will usually experience a location abnormality, in which the fetus is often transverse or breech. However, women who have this disorder sometimes find it difficult to get pregnant so they experience infertility. In addition, there is usually a disturbance in the formation of the kidneys, but in this patient there was no abnormality in the urinary tract. In cases where the patient does not have children and a bicornu uterine abnormality is found, uterine repair is performed and it is hoped that with the uterine anatomy returning to normal, the patient can become pregnant.Objective : Discuss the management of cases of congenital abnormalities of the internal genital organs in patients with a bicornu uterus.Method : Case Report.Case : Reported a patient aged 25 years with primary infertility 4 years and a bicornu uterus. In patients, chromotubation was performed first, after chromotubation, the patient was performed metrosplasty to remove the bulkhead in the uterus and to repair the uterus. During the post-op follow-up at the hospital the patient did not show any signs of infection or acute abdomen, then the patient was discharged on day 5. The patient was advised to go to the OBGYN polyclinic regularly for further follow-up to the success of his uterine repair. Assessment can be done in several ways including transvaginal ultrasound to assess whether there is adhesions to the endometrium from the results of uterine repair, HSG, SIS or hysteroscopy can also be done in assessing the success of metroplasty in this patient.Conclusion : After metrosplasty in a patient with a bicornu uterus, further follow-up is required to determine the success of this procedure by performing a follow-up ultrasound.Keywords: Bicornu uterus, metroplasty

Successful vaginal delivery of spontaneously conceived twins in each horn of a bicornuate uterus with previous caesarean: a case report

Mullerian duct fusion anomalies resulting in uterine malformations have prevalence of 3-4%. Among this, bicornuate uterus has a rare incidence of 0.4%. Uterine malformations pose significant threat in terms of obstetric outcomes. We report an extremely rare case of spontaneous conception of twin pregnancy with the fetus occupying each horn of a bicornuate uterus (bicornis unicollis), in a woman with a history of previous caesarean section. She was booked at our hospital and the pregnancy remained uneventful. At 35 weeks she went into spontaneous labour and delivered vaginally without any maternal-fetal complications. The case is unique and the management is worth discussing as till date no protocols or guidelines have been proposed for the mode of delivery of bicornuate uterus with twins with previous cesarean. Only 12 cases of twins with bicornuate uterus have been reported till date. This is the first case in literature in which a successful VBAC has been conducted in a woman with bicornuate uterus with twins with previous caesarean.