The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum.
OBJECTIVE
This study was undertaken to evaluate the diagnostic management and the reproductive outcome after surgical repair of a rare reproductive malformation.


METHODS
Sixteen women with a complete septate uterus, double cervix, and a longitudinal vaginal septum were referred for evaluation. Presenting complaints were chiefly pregnancy loss in parous women (n=9) and dyspareunia in nulligravid women (n=7). The combination of hysterosalpingography, ultrasonography, and/or magnetic resonance imaging was used to correctly identify the anomaly in 15 of the 16 cases. Both hysteroscopic (n=11) and transabdominal (n=5) surgical techniques were used to repair the uterine septum.


RESULTS
In no case was the correct diagnosis made before referral; the uterus didelphys was the most common misdiagnosis. The preoperative pregnancy loss was 81%. Postoperatively, 12 women conceived for a total of 17 pregnancies; there were 14 term live births or ongoing pregnancies in the third trimester (82%), with a first trimester spontaneous abortion rate of 18%. In 9 women who conceived after hysteroscopic surgery, term live births occurred in 9 of 12 (75%) conceptions. A modified Tompkins metroplasty was performed in 5 women with subsequent term live births or ongoing third trimester pregnancies in 5 of 5 (100%) patients.


CONCLUSIONS
The identification of a duplicated cervix and a vaginal septum is consistent with several uterine malformations, which leads to frequent misdiagnosis and errors in management. Significant pregnancy wastage, obstetric complications, and dyspareunia are common, and surgical treatment is therefore advisable. Making the best choice between hysteroscopic or transabdominal metroplasty depends on the anatomic features of the cervix and the uterine cavity, but optimal patient management requires familiarity with both techniques.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, USA.
Phillip E
PE
Patton
Miles J
MJ
Novy
David M
DM
Lee
Lee R
LR
Hickok
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000002:abnormalities* / Q000601:surgery; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods; D015907:Hysteroscopy / Q000379:methods*; D007247:Infertility, Female / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D011247:Pregnancy / Q000706:statistics & numerical data*; D017584:Reproductive History; D018570:Risk Assessment; D014599:Uterus / Q000002:abnormalities* / Q000601:surgery; D014621:Vagina / Q000002:abnormalities* / Q000601:surgery