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Bicornuate Uterus - Case 2

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Our next case is a 24-year-old patient

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who was reportedly six weeks pregnant and

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was definitely miscarrying clinically.

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IUP was never confirmed, so they got

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the ultrasound to make sure that she

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didn't have an ectopic pregnancy.

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Her HCG at this point was less than 100,

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so it would not be entirely unsurprising

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if we didn't see anything potentially.

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So this is a transverse cine clip

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of her uterus transvaginal imaging.

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As we scroll through here, we start to

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see two very widely disparate horns.

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And these are very, very widely spaced, right?

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Almost looks more like a didelphys in the

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sense that they are very widely spaced.

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But if you watch the endometrium, right,

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we're looking for how many cervixes are there.

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There is one here.

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So we have one cervix right here.

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So this is just another

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example of a bicornuate uterus.

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So other things to consider when you have a

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bicorneate uterus, you are at risk of IUGR

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because you have two horns that are smaller

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than usual, so they may not expand completely.

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And you're at risk of an early pregnancy

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loss, again, because the horn doesn't

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completely expand or a preterm labor.

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In a lot of ways, they are similar appearance

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to septate, and if it is similar, you have

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to differentiate by the final contour.

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In this case, it was pretty widely disparate,

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looked more like a didelphys uterus, except

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for the fact that there were not two cervices.

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There is one other special case

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that I'm not going to talk about.

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Here's a bicornuate bicalis, and that's where

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it does look like it has two different cervices.

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The differential there, or the distinction

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Between a didelphys and a bicornuate bicalis

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is that they will communicate somewhere,

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meaning that they did fuse somewhere,

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whereas a didelphys doesn't fuse at all.

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They will never meet.

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So, for example, this broke

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out into two cervices.

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It didn't meet right here.

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This would be a bicornea

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bicollis if you had two cervices.

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If you have a vaginal septum, however,

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it may be completely indistinguishable

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and it will be impossible for us

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to tell by imaging which one it is.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Uterus

Ultrasound

Gynecologic (GYN)

Body

Acquired/Developmental

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