MyPACS.net: Radiology Teaching Files > Case 38615807

Last visited 04-20-2010 TWINS IN BICORNUATE UTERUS
Contributed by: Sharon Pozniak, Triton College, Illinois, USA.
Patient: 30 year old female
History:

Female age 30. G2 P0 A2

EDD: 7/2/2010

A past history of twins in a single horn of a bircornuate uterus.  Fetal demise of those twins occurred at 22 weeks. Patient is now considered a high risk patient.

Images:[small]larger

Fig. 1: 3 D image in 1st trimester

Fig. 2: Transverse view at 18 wks.

Fig. 3: Transverse view of both horns at 18 weeks

Fig. 4: Transverse view of abdomen at 20 weeks

Fig. 5: Doppler image of the septum of uterus

Fig. 6
Findings:

2 singletons in a complete bircornuate uterus.  There is a single fetus in each horn and each is a boy. Fetus A, in the left horn, is breech with a HR of 136 BPM.  Fetus B, in the right horn of the bicornuate uterus, is cephalic with a HR of 133 BPM. Twins show no variation in abdominal circumference, BPD, HC, and FL. Cervical length is 4.9 cm and shows no apprarent signs of cervical incompetence.  This detailed ultrasound examination showed no abnormalities and no remarkable findings which lowers the risk of T21, but does not rule it out.

The cervical length is 4.9 cm

Diagnosis: Due to previous history, this is considered a high risk pregnancy. The AFI is normal and the growth pattern of the twins is in between the 50th and 75th percentile. There are no remarkable findings. Fetuses are both healthy and thriving.  No cervical stenosis seen. Still need to follow up with additional ultrasounds.
Discussion:

A bicornuate uterus is a duplication of the uterus having one or two cervices, with only one vagina.  There are two uteri and two endometrial cavities.  There is a deep notch in the fundus causing it to look heart shaped.  This is caused from partial fusion of the mullerian ducts during embryologic development.

It is the most common congenital anomaly and has an increased risk of infertility.  There is a 60% success rate in delivering a child, but a higher risk of cervical incompetence. It is also associated with a higher risk of spontaneous abortions, but it has a lower statistic than a septated uterus. There is an increased risk for premature labor, breech presentation and possible retained products of conception. 

Surgical reconstruction is an option for patients having recurrent miscarriages.

References:

Hagen-Ansert, Sandra L. Diagnostic Ultrasonography Volume 2. Missouri, Mosby 2006

Henningsen, Charlotte. . Clinical Guide to Ultrasonography. Missouri, Mosby 2004

Ovel, Susanna. Comprehensive Review for General Sonography Examinations. Missouri, Mosby 2009

www.MedScape.com and www.BabyMed.com

Images provided by Dr. Sabbagha

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Additional Details:

Case Number: 38615807Last Updated: 04-20-2010
Anatomy: Other   Pathology: Normal/Variants
Modality: USAccess Level: Readable by all users

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