The following excerpt is from the article, written by Luigi Fedele M.D., Daniela Zamberletti M.D., Paolo Vercellini, M.D.,Milena Dorta,M.D., Giovanni B- Candiani M.D., 1st Department of Obstetrics and Gynecology University of Milan, Milan Italy, August 8,1986
This article has been used without permission and is for information purposes only. For reprints of this article contact Luigi Fedele, I Clinia Ostetrica e Ginecologica dell'Universita di Milano, Isituto "L.Mangiagalli," via Commenda 12. 20122 Milano, Italy.
Fertility is reduced in women who have a unicornuate uterus. However, in the reports in the literature either there is a lack of classification or the series is too small to assess the reproductive potential for this malformation. The purpose of this paper is to report a large series of 21 women who, had unicornuate uteri, the outcome or their pregnancies, and results of therapy.
MATERIALS AND METHODS
From 1975 to 1984, 21 women with unicornuate uterus were followed at the1st Department of Obstetrics and Gynecology, Milan University. The malformation was identified and classified according to Buttram and Gibbons' criteria 1 their classification the unicornuate uterus is subdivided into four subclasses, according to the presence or absence of a rudimentary horn an whether it is cavitary and communicating. For precise classification of the patients, hysterosa, pingography and Iaparoscopy or laparotomy were performed on each woman, with the following results: 1 in subclass A1a (With cavitary communicating rudimentary horn) 6 in subclass A1b (With Cavity noncommunicating rudimentary horn) 7 in subclass A2 (With noncavitary rudimentary horn) and 7 in subclass B (without rudimentary horn.) The contralateral adnexum was absent in ,case, all in subclass B. Intravenous urography was performed on 10 patients, and an associated unilateral renal malformation was seen in 7 (43.7%) (renal ptosis in cases. renal agenesis in 3, double renal pelvis in 10, and horseshoe kidney in 1) Two patients (of subclass A1a) were excluded from this study because of age: they were 14 and15 years old, respectively at the time of diagnosis. The previous obstetric history of the other 19 patients was evaluated retrospectively, and the evolution of fertility was followed prospectively for 2 to10 years.
RESULTS
Six patients had primary infertility of 2 to 16 years duration, and 13 women had had 25 pregnancies, 1 of these in a rudimentary horn (4%). Abortions occurred in 16 instances (64%). Premature live birth in 3 (12%), and a term delivery in 5 (20%), with a live birth rate of 32%. Endometriosis was detected in three women (1 at American Fertility Society (AFS) stage 1 and 2 at AFS stage 2) and ovulation defects in two other. Medical treatment with danaol was instituted in the women with endometriosis, and those with ovulation disorders were given cIomlphene citrate. Rudimentary horns were removed in five patients; in one the operation was indicated because of a pregnancy in the horn, and in the other four it was elective. Pregnancy was achieved in these four women; three of the pregnancies resulted in term live infants , and one aborted. Delivery was by cesarean birth in 9 of the 11 pregnancies (81%) because of breech presentation in 6, intrauterine growth retardation in 2, and a previous cesarean birth in 1.
DISCUSSION
Fertility in the patient with unicornuate uterus is impaired. Six women (31.%) in this series never conceived, and 17 of the 29 pregnancies (58%) in the other 13 ended in abortion. Results reported in other series also include a high percentage of abortions and premature births. Primary infertility of these patients could be attributed to the fact that pregnancy can only occur in the unicornuate uterus. The exception is the patient with a communicating horn, in whom the risk of pregnancy in the rudimentary horn is increased.
