0:01

Our next case is a 24-year-old patient

0:04

who was reportedly six weeks pregnant and

0:06

was definitely miscarrying clinically.

0:09

IUP was never confirmed, so they got

0:11

the ultrasound to make sure that she

0:12

didn't have an ectopic pregnancy.

0:14

Her HCG at this point was less than 100,

0:16

so it would not be entirely unsurprising

0:18

if we didn't see anything potentially.

0:21

So this is a transverse cine clip

0:23

of her uterus transvaginal imaging.

0:26

As we scroll through here, we start to

0:29

see two very widely disparate horns.

0:33

And these are very, very widely spaced, right?

0:35

Almost looks more like a didelphys in the

0:38

sense that they are very widely spaced.

0:39

But if you watch the endometrium, right,

0:41

we're looking for how many cervixes are there.

0:43

There is one here.

0:45

So we have one cervix right here.

0:46

So this is just another

0:47

example of a bicornuate uterus.

0:51

So other things to consider when you have a

0:52

bicorneate uterus, you are at risk of IUGR

0:55

because you have two horns that are smaller

0:56

than usual, so they may not expand completely.

0:59

And you're at risk of an early pregnancy

1:01

loss, again, because the horn doesn't

1:03

completely expand or a preterm labor.

1:06

In a lot of ways, they are similar appearance

1:07

to septate, and if it is similar, you have

1:10

to differentiate by the final contour.

1:12

In this case, it was pretty widely disparate,

1:14

looked more like a didelphys uterus, except

1:16

for the fact that there were not two cervices.

1:20

There is one other special case

1:21

that I'm not going to talk about.

1:22

Here's a bicornuate bicalis, and that's where

1:25

it does look like it has two different cervices.

1:27

The differential there, or the distinction

1:29

Between a didelphys and a bicornuate bicalis

1:32

is that they will communicate somewhere,

1:34

meaning that they did fuse somewhere,

1:36

whereas a didelphys doesn't fuse at all.

1:38

They will never meet.

1:40

So, for example, this broke

1:41

out into two cervices.

1:43

It didn't meet right here.

1:44

This would be a bicornea

1:45

bicollis if you had two cervices.

1:47

If you have a vaginal septum, however,

1:49

it may be completely indistinguishable

1:51

and it will be impossible for us

1:53

to tell by imaging which one it is.