Cervical Cerclage for Complete Septate Uterus with Double Cervix and Double Vagina: A Case Report and Literature Review

doi:10.12280/gjfckx.20211105

Abstract

Abstract:

The incidence of congenital uterine malformation combined with uterine cervical incompetence can be as high as 30%. Septate uterus is one of congenital uterine anomalies with a prevalence of 0.2%~2.3% in women of childbearing age. It has a high risk of infertility, miscarriage and premature birth. Now we report a case of complete septate uterus with double cervix and double vagina. Hysteroscopic hysterectomy was performed before pregnancy, and bilateral cervical cerclage was performed via vagina at 14 weeks of gestation. At 23⁺⁶ weeks of gestation, the cervix was dilated and conservative treatment was performed, and the suture was removed at 30⁺¹ weeks of gestation when was about to give birth, and the patient gave birth naturally and brought the baby home. The current research of the diagnosis and treatment for septate uterus in pregnancy at home and abroad in recent years is reviewed.

Key words: Pregnancy, Mullerian ducts, Uterine cervical incompetence, Cerclage, cervical, Prenatal care, Case reports, Hypomelia mullerian duct anomalies, Septate uterus

XU Chong-bin, LI Ying-tao, ZHOU Meng-yang, XIAO Xiao-mei, WEN Jing-feng, HUANG Ying-min, WANG Yan. Cervical Cerclage for Complete Septate Uterus with Double Cervix and Double Vagina: A Case Report and Literature Review[J]. Journal of International Obstetrics and Gynecology, 2022, 49(4): 443-448.

Figures/Tables 7

References 22

[1]	Ludwin A, Martins WP, Bhagavath B, et al. Overdiagnosis, overdetection, and overdefinition of the septate uterus: reexamination of the ASRM and ESHRE-ESGE criteria is urgently needed[J]. Fertil Steril, 2019, 112(3):448-449. doi: 10.1016/j.fertnstert.2019.05.026. doi: S0015-0282(19)30483-2 pmid: 31371057
[2]	Acién P, Acién M. The presentation and management of complex female genital malformations[J]. Hum Reprod Update, 2016, 22(1):48-69. doi: 10.1093/humupd/dmv048. doi: 10.1093/humupd/dmv048
[3]	Ludwin A, Ludwin I, Coelho Neto MA, et al. Septate uterus according to ESHRE/ESGE, ASRM and CUME definitions: association with infertility and miscarriage, cost and warnings for women and healthcare systems[J]. Ultrasound Obstet Gynecol, 2019, 54(6):800-814. doi: 10.1002/uog.20291. doi: 10.1002/uog.20291 pmid: 30977223
[4]	Sugi MD, Penna R, Jha P, et al. Müllerian Duct Anomalies: Role in Fertility and Pregnancy[J]. Radiographics, 2021, 41(6):1857-1875. doi: 10.1148/rg.2021210022. doi: 10.1148/rg.2021210022
[5]	Chan YY, Jayaprakasan K, Tan A, et al. Reproductive outcomes in women with congenital uterine anomalies: a systematic review[J]. Ultrasound Obstet Gynecol, 2011, 38(4):371-382. doi: 10.1002/uog.10056. doi: 10.1002/uog.10056 pmid: 21830244
[6]	Panagiotopoulos M, Tseke P, Michala L. Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification: A Systematic Review and Meta-analysis[J]. Obstet Gynecol, 2022, 139(1):138-148. doi: 10.1097/AOG.0000000000004627. doi: 10.1097/AOG.0000000000004627
[7]	Kim MA, Kim HS, Kim YH. Reproductive, Obstetric and Neonatal Outcomes in Women with Congenital Uterine Anomalies: A Systematic Review and Meta-Analysis[J]. J Clin Med, 2021, 10(21):4797. doi: 10.3390/jcm10214797. doi: 10.3390/jcm10214797
[8]	Fox NS, Roman AS, Stern EM, et al. Type of congenital uterine anomaly and adverse pregnancy outcomes[J]. J Matern Fetal Neonatal Med, 2014, 27(9):949-953. doi: 10.3109/14767058.2013.847082. doi: 10.3109/14767058.2013.847082
[9]	Akhtar MA, Saravelos SH, Li TC, et al. Reproductive Implications and Management of Congenital Uterine Anomalies: Scientific Impact Paper No. 62 November 2019[J]. BJOG, 2020, 127(5):e1-e13. doi: 10.1111/1471-0528.15968. doi: 10.1111/1471-0528.15968
[10]	Letterie GS. Management of congenital uterine abnormalities[J]. Reprod Biomed Online, 2011, 23(1):40-52. doi: 10.1016/j.rbmo.2011.02.008. doi: 10.1016/j.rbmo.2011.02.008 pmid: 21652266
[11]	Rikken JF, Kowalik CR, Emanuel MH, et al. Septum resection for women of reproductive age with a septate uterus[J]. Cochrane Database Syst Rev, 2017, 1(1):CD008576. doi: 10.1002/14651858.CD008576.pub4. doi: 10.1002/14651858.CD008576.pub4
[12]	Venetis CA, Papadopoulos SP, Campo R, et al. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies[J]. Reprod Biomed Online, 2014, 29(6):665-683. doi: 10.1016/j.rbmo.2014.09.006. doi: 10.1016/j.rbmo.2014.09.006
[13]	Brown R, Gagnon R, Delisle MF. No. 373-Cervical Insufficiency and Cervical Cerclage[J]. J Obstet Gynaecol Can, 2019, 41(2):233-247. doi: 10.1016/j.jogc.2018.08.009. doi: 10.1016/j.jogc.2018.08.009
[14]	Golan A, Langer R, Wexler S, et al. Cervical cerclage--its role in the pregnant anomalous uterus[J]. Int J Fertil, 1990, 35(3):164-170. pmid: 1973922
[15]	Abramovici H, Faktor JH, Pascal B. Congenital uterine malformations as indication for cervical suture (cerclage) in habitual abortion and premature delivery[J]. Int J Fertil, 1983, 28(3):161-164. doi: 10.1016/0090-8258(83)90067-7. doi: 10.1016/0090-8258(83)90067-7 pmid: 6140235
[16]	Mastrolia SA, Baumfeld Y, Hershkovitz R, et al. Independent association between uterine malformations and cervical insufficiency: a retrospective population-based cohort study[J]. Arch Gynecol Obstet, 2018, 297(4):919-926. doi: 10.1007/s00404-018-4663-2. doi: 10.1007/s00404-018-4663-2
[17]	Seidman DS, Ben-Rafael Z, Bider D, et al. The role of cervical cerclage in the management of uterine anomalies[J]. Surg Gynecol Obstet, 1991, 173(5):384-386.
[18]	Chifan M, Tîrnovanu M, Grigore M, et al. Cervical incompetence associated with congenital uterine malformations[J]. Rev Med Chir Soc Med Nat Iasi, 2012, 116(4):1063-1068. pmid: 23700889
[19]	周巧云. 宫腹腔镜完全双角子宫成形术后宫颈环扎成功分娩一例[J]. 国际妇产科学杂志, 2016, 43(6):650-651. doi: 10.3969/j.issn.1674-1870.2016.06.013. doi: 10.3969/j.issn.1674-1870.2016.06.013
[20]	钟彩娟, 李映桃, 陈佳, 等. 单角子宫妊娠合并宫颈机能不全一例并文献复习[J]. 国际妇产科学杂志, 2020, 47(5):597-600. doi: 10.3969/j.issn.1674-1870.2020.05.026. doi: 10.3969/j.issn.1674-1870.2020.05.026
[21]	Lim K, Butt K, Crane JM. No. 257-Ultrasonographic Cervical Length Assessment in Predicting Preterm Birth in Singleton Pregnancies[J]. J Obstet Gynaecol Can, 2018, 40(2):e151-e164. doi: 10.1016/j.jogc.2017.11.016. doi: 10.1016/j.jogc.2017.11.016
[22]	Ono S, Kuwabara Y, Matsuda S, et al. Is hysteroscopic metroplasty using the incision method for septate uterus a risk factor for adverse obstetric outcomes?[J]. J Obstet Gynaecol Res, 2019, 45(3):634-639. doi: 10.1111/jog.13884. doi: 10.1111/jog.13884

时间（孕周）	宫颈剩余长度（左/右,mm）	宫颈形态（左/右）	宫颈内口宽度（左/右,mm）	宫颈内口深度（左/右,mm）
2020年9月22日（21⁺²周）	14/5	U/U	12/12	27/32
2020年9月28日（22⁺¹周）	12/5	U/U	13/10	27/31
2020年10月15日（24⁺⁴周）	10/0	U/全程扩张	23/-	25/-
2020年10月25日（26周）	15/0	Y/全程扩张	10/-	33/-
2020年11月3日（27⁺²周）	9/0	Y/全程扩张	20/-	28/-

时间（孕周）	宫颈剩余长度（左/右,mm）	宫颈形态（左/右）	宫颈内口宽度（左/右,mm）	宫颈内口深度（左/右,mm）
2020年9月22日（21⁺²周）	14/5	U/U	12/12	27/32
2020年9月28日（22⁺¹周）	12/5	U/U	13/10	27/31
2020年10月15日（24⁺⁴周）	10/0	U/全程扩张	23/-	25/-
2020年10月25日（26周）	15/0	Y/全程扩张	10/-	33/-
2020年11月3日（27⁺²周）	9/0	Y/全程扩张	20/-	28/-