Abstract
SEPTATE UTERUS WITH DOUBLE CERVIX AND VAGINA: RETHINKING THE DEVELOPMENT OF MULLERIAN ANOMALIES

Dr. Ramya Shankar*, DGO, DNB, Dr. Umashankar K Mallappiah, MS, Dr. Ramesh G, MS, Dr. Narendranath Kudva, MD, Mohana Sai Roopa

ABSTRACT

Objective: To report a rare case of septate uterus with cervical duplication and a complete longitudinal vaginal septum which is not included in the common classification systems of Mullerian anomalies and its reproductive difficulties. Design: Case report. Settings: University Hospital Patient: A 29 year old lady with bad obstetric history; gravid 4, Para 3, living 0 at 31 weeks of gestation with a rare mullerian anomaly and eclampsia. Interventions: Clinical, intraoperative and postpartum evaluation of the anomaly. Main Outcome measure(s): Adaptability of present anomaly to Classical theory of embryological development of mullerian ducts and the alternative theories studied. New ESHRE /ESGE consensus on the classification of female genital tract congenital anomalies reviewed. Health and Reproductive consequence of this rare uterine anomaly studied in literature search. Result(S): The reproductive outcome of present case and similar anomalies in the literature studied and its management suggested. Conclusion: This rare mullerian anomaly is inconsistent with the classical embryological theory of caudal to cranial mullerian duct fusion but supports the alternative embryological hypothesis suggested by Muller et al, according to which fusion and absorption begins at the isthmus and proceeds simultaneously in both the cranial and caudal directions. Though the obstetrics outcome associated with this anomaly is not well known, in our case it seems to be similar to the very high reproductive failure associated with septate uterus.

Keywords: Mullerian anomaly, Septate uterus, Duplicate cervix, Complete Longitudinal Vaginal Septum, Recurrent Pregnancy Loss (RPL), American Fertility Society (AFS) classification.


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