Friday, August 19, 2011

Single Uterus - Two cervixes

One pregnant woman came to our hospital in preterm labor. My Assistant Professor had seen her and admitted her for tocolysis and betamethasone therapy to hasten fetal lung maturation. "Sir, she has a longitudinal vaginal septum and two cervixes." "I will see her" I said. I checked her up, and indeed, she had a longitudinal septum in the upper part of the vagina. Sometimes it so happens that there is a single cervix, and the septum has its upper edge at some distance from the cervix. Hence the examining finger can pass from one side of the septum and feel the cervix, then pass on the other side of the septum over its upper edge and feel the same cervix. But one gets the impression that there are two cervixes, one on either side of the septum. In order to avoid this confusion, I put the right index finger on the left side of the septum, the right middle finger on the right side of the septum, and could pass each finger through one cervix each, 1 cm dilated. Fetal membranes and the fetus above them were felt by each finger. "There is a single uterine cavity with the fetus in it. There are two cervixes, each communicating with the uterine cavity. Treat her preterm labor. When the time comes, she will deliver through either of the cervixes. We may have to divide the septum during labor if it obstructs childbirth" I said. It was not to be. The fetus died inside the uterus the next day. No cause was found for the fetal death. We had to induce labor to deliver her. During labor, there was obstruction, and they had to divide the septum. Someone who had not understood the anomaly operated on her. I came to know all about it the next day. I wanted to see what had happened inside her. When I examined her, I found that they had divided not only the septum, but also the tissue between the dilated cervixes. So she had a single cervical opening, sort of a figure-of-eight rotated through 90 degrees. "We do not have to do anything for her right now. I would have preferred the cervixes were left intact. Give her contraception of her choice, and let her register early in her next pregnancy. She may need a cervical cerclage in that pregnancy." The patient went home happy that no surgery was required at that time. I am still worried what may happen to her if she goes to another hospital in her next pregnancy.

प्रशंसा करायचीय, नावे ठेवायचीयेत, काही विचारायचय, किंवा करायला आणखी चांगले काही सुचत नाहीये, तर क्लिक करा.

संपर्क