Andrews and Jones

The following article is from the Department of Obstetrics and Gynecology, Eastern Medical School. This was originally presented at the forty-fourth Annual Meeting of The South Atlantic Association of Obstetricians and Gynecologists, New Orleans, Louisiana, January 31- February 3,1982.

This article is being used without permission and it is for information purposes only. The article does not appear in full. Reprint request can be had from Dr.Mason C.Andrews, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk Virginia 23501.

Impaired reproductive performance of the unicornuate uterus: Intrauterine growth retardation, infertility, and recurrent abortion in the following cases

MASON C. ANDREWS, M.D.
HOWARD W. JONES, JR., M.D.
Norfolk Virginia

Unicornuate Uterus has been reported very seldom and the few reports provide no basis for assessment of the reproductive capability of such organs. In this article,we address this gap by analyzing 6 pregnancies in five patients

The following cases represent our entire experience in infertility and obstetric practice at Norfolk General Hospital and Johns Hopkins Hospital between 1969 and 1981. Furthermore, a search of the records in these institutions revealed only three additional cases during this period, but one was ineligible for pregnancy, and follow up was inadequate in the other two.

Case Reports

Case 1. B.S. at age 23. in 1971, after 3 years of infertility, underwent hysterosalpingography which disclosed a unicornuate uterus with a single patent left tube. In 1972, laparoscopic examination showed the absence of the right tube and ovary and apparently unimpaired left tube and ovary. In 1975. the patient suffered a spontaneous missed abortion at 12 weeks. Endometrial biopsy showed a luteal phase deficiency. Progesterone, vaginal suppositories were begun on the sixteenth day of the cycle. and she conceived on the second such cycle. Fetal growth as determined by biparietal diameter was consistently below the expected curve. At the thirty-fifth week she was delivered of a 2 pound stillborn maIe infant The placenta weighed 260 gm, Fetal movements had ceased 24 hours earlier. Autopsy revealed no gross or microscopic abnormalities.

Case 3, D.D, 34 Years old, sought advice because of three consecutive first trimester abortions in 2 years. The last spontaneous abortion had occurred in spite of progesterone vaginal suppositories begun 3 days after ovulation and Delalutin continued until uterine growth ceased.The hysterosalpingogram then showed a unicornuate uterus on the left with a single tube open open During a subsequent cycle in which the patient used vaginal progesterone suppositories beginning on day 17. she conceived, had slight vaginal bleeding for 6 days from day 38, and had a totally normal pregnancy. The infant was delivered normally at term.

Case 4. 0. H. 25 years old. had had three consecutive spontaneous abortions, The hysterosalpingogram then showed a unicornuate uterus to the left. The right ovary was removed, along with the fibrous band that represented the vestigial right horn of the uterus. The patient became pregnant 2 months later. and the infant was delivered at term by cesarean section, The prenatal course was entirely normal except for breech presentation.

Case 5. M R, 29 years old, had been infertile for 31/2 years when hysterosalpingography disclosed that she had a unicornuate uterus. The right ovary uterine anlage, and rudimentary tube were removed Two months later she became pregnant and had an uncomplicated pregnancy.

Analysis of results

In two patients who had a unicornuate uterus,a prolonged history of infertility was followed by pregnancy in which there was severe intrauterine growth retardation and life-threatening intrauterine hypoxia In each of two other patients, three consecutive spontaneous abortions were followed by pregnancies which the fetal outcome was normal. Removal of a cervical myoma in one of these patients and removal of the opposite ovary and vestigial rudimentary uterine horn in the other patient were carried out between rapidly repetitive abortions and the normal pregnancies. In the fifth case, after 51/2 years of infertility, removal of the opposite ovary and rudimentary uterine horn was promptly followed by a normal pregnancy.

Comment

The severe intrauterine growth retardation which occurred in three pregnancies in two of these five patients who had unicornuate uteri suggests the prudence of suspecting this possibility whenever such malformation exists. A possible explanation of the apparently inadequate intrauterine nutrition in the growth-retarded pregnancies may involve the absent uterine artery and the absent utero-ovarian artery on the undeveloped side.

The possibility that the surgical interventions conduced the subsequently prompt, successful pregnancies in the three other cases is speculative but intriguing. The removal of the contranieral ovary should certainly have increased the frequency with which ovulation occurred on the more developed side and may even have improved its function.

The frequency with which unicornuate uterus occurs is unknown but must be rare. It is true that all of the cases reported came here to medical attention because of a problem. However, in view of the wide use of hysterosalpingograms in it patients whose infertility is due to other causes and the fact that these represent the only cases recognized in two large institutions in 12 years, it would appear that these cases may be somewhat representative of the reproductive performance of organs so formed.