Impaired reproductive performance of the unicornuate uterus: Intrauterine growth retardation, infertility, and recurrent abortion in five cases

Very seldom has unicornuate uterus been reported, and the few reports provide no basis for assessment of the reproductive capability of such an organ. In this article, the authors address the gap by analyzing six pregnancies in five patients. Case 1. In 1971, at age 23 and after 3 years of infertility, the patient underwent hysterosalpingography which disclosed a unicornuate uterus with a single patent left tube. Laparoscopic examination in 1972 showed the absence of the right tube and ovary and an apparently unimpaired left tube and ovary. The patient suffered a spontaneous missed abortion at 12 weeks in 1975. Endometrial biopsy showed a luteal phase deficiency. Progesterone vaginal suppositories were begun on the 16th day of the cycle, and the patient conceived on the second cycle. At the 35th week, she was delivered of a 2-pound stillborn male infant. The placenta weight 260 g. Fetal movements had ceased 24 hours earlier. Autopsy revealed no gross or microscopic abnormalities. The patient became pregnant once more in 1978, again using progesterone suppositories. Uterine volume was low and continued to fall behind expected rates of growth. Labor was induced in the 35th week of pregnancy, and a male infant (1880 g) with hypospadias was delivered. Case 2. The 27-year-old patient became pregnant after 3 years of infertility. On the expected date of confinement, labor began spontaneously and dilatation progressed normally to 4 cm. Meconium was noted and severe late decelerations began. A male infant weighing 3 pounds and 13 ounces, and covered with meconium, was delivered. At cesarean section, the uterus was seen to be entirely asymmetrical on the left; the right ovary and tubal remnant were attached to the right lower uterus. The hysterosalpingogram later showed a unicornuate uterus extending to the left. Case 3. The patient, 34 years old, had three consecutive first-trimester abortions in 2 years. After the last of these abortions, the hysterosalpingogram showed a cornuate uterus on the left, with a single tube open. Subsequent hysteroscopy and laparoscopy showed a normal intrauterine cavity to the left, a normal left tube and ovary, a right ovary and terminal portion of the tube high in the pelvis, essentially no broad ligament, and a 3-cm protuberance from the back of the cervix that proved to be a myoma and was later removed. During a subsequent cycle in which the patient used vaginal progesterone suppositories, beginning on day 17, she conceived and had a totally normal pregnancy. The infant was delivered normally at term. Case 4. The 25-year-old patient had three consecutive spontaneous abortions, after which the hysterosalpingogram showed a unicornuate uterus on the left. The right ovary was removed, together with the fibrous band that represented the vestigial right horn of the uterus. The patient became pregnant 2 months later, and the infant was delivered at term by cesarean section. The prenatal course was entirely normal except for breech presentation. Case 5. At the age of 29, the patient had been infertile for 5.5 years when the hysterosalpingogram disclosed a unicornuate uterus. The right ovary, uterine anlage, and rudimentary tube were removed. Two months later the patient became pregnant and had an uncomplicated pregnancy and delivery.