Spectrum of congenital uterine malformations

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  20% unicornuate : Single uterine horn ± rudimentary horns

  
  
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  5% uterus didelphys : 2 separate horns, 2 cervices

  
  
  
  
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    Often associated with vaginal septum (75%)

  
  
  
  
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  10% bicornuate : 2 horns with variable degree of fusion

  
  
  
  
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    Concave or heart-shaped external fundal contour

    
    
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    May have 1 cervix (bicornis unicollis) or 2 cervices (bicornis bicollis)

  
  
  
  
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  55% septate : Normal, convex external fundal contour

  
  
  
  
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    Septum length variable: When complete it extends to external os

  
  

Use 3D ultrasound

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  Volume acquisition allows reconstruction of true coronal plane to show fundal contour

  
  
  
  
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    Septate uterus: Fundus mildly convex to mildly concave

    
    
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    Bicornuate: Concave or heart-shaped external fundal contour

  
  

Look for associated renal anomalies

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  Occur in ~ 30% of patients with müllerian duct anomalies

  
  
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  Unilateral renal agenesis in majority but crossed-fused ectopia, pelvic kidney, horseshoe kidney, renal duplication, and cystic dysplasia all reported

Look for obstructed component if pelvic pain

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  Hematometra: Blood-filled uterus (may involve single horn of duplicated system)

  
  
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  Hematometrocolpos: Blood-filled uterus and vagina

Pregnancy failure increased especially with septate uterus

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  Use ultrasound guidance for dilatation and evacuation/curettage to ensure appropriate part of cavity is reached