Presentation
Recurrent first trimester abortion.
Patient Data
The uterine cavity is divided into two by an inverted cone-shaped constant intrauterine filling defect until the level of the internal os with an acute angle between both uterine cavities measures 30° (<75°). There is one cervical canal seen during the examination. Normal opacification of the two cavities is noted. There is a narrow distance between two uterine cavities; the intercornual distance measures 3.7 cm (< 4 cm).
Otherwise, the uterine cavities show smooth margins observed. No constant intrauterine filling defects were visualized. Normal cervical canal and internal os.
Normal opacification of both tubes down to their fimbrial ends, with adequate peritoneal smearing detected in the delayed film, denotes bilateral tubal patency.
Case Discussion
The patient came for an assessment of the uterus as she was seeking pregnancy. She has a history of two previous abortions, the last one being one year ago at 14 weeks. She has had one complete pregnancy (P1) in three years, delivered by CS.
A complementary ultrasound was done that showed the normal shape of the uterus with two nearly parallel uterine cavities. The uterine fundus is minimally concave with no fundal cleft. The fundus measured 8 mm in thickness above the intercornual line in coronal view.
Features suggest a complete septate uterus. It is a class V Müllerian duct anomaly and the commonest one, accounting for about 45% of cases. The differentiation between septate and bicornuate uterus is crucial, as in septate uterus management can be done by hysteroscopic resection of the uterine septum without uterine perforation, which could happen in a wrongly diagnosed bicornuate uterus.
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