A woman is diagnosed with a congenital uterine anomaly characterized by the presence of two uterine horns, one cervix, and one vagina. Which of the following is the most likely diagnosis?

1. A

   Unicornuate uterus

2. B

   Bicornuate uterus

3. C

   Uterus didelphys

4. D

   Septate uterus

Appeared in: JIPMER Pondicherry NO - 2022

Explanation

• A bicornuate uterus results from the partial or incomplete fusion of the two Müllerian ducts during fetal development.
• This partial fusion leads to a uterus with two distinct, often heart-shaped, horns.
• The most common variant, known as bicornuate unicollis, features a single cervix and a single vagina, which perfectly matches the clinical description provided in the question.
• This anomaly accounts for approximately 10-20% of all Müllerian anomalies.

Why Other Options Were Wrong

• Option A: A unicornuate uterus is characterized by the presence of only one uterine horn, not two. This occurs when one of the Müllerian ducts fails to develop.
• Option C: Uterus didelphys involves a complete duplication of the uterus, cervix, and often the vagina. The question specifies only one cervix and one vagina.
• Option D: A septate uterus has a normal external shape but is divided internally by a wall of tissue (septum). The question describes two distinct uterine horns, which implies an external division, not just an internal one.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Congenital Uterine Anomalies (Müllerian Duct Anomalies) to guide bedside assessment, documentation, and the next nursing action.
• Women with a bicornuate uterus have an increased risk of adverse pregnancy outcomes, including recurrent miscarriage, preterm labor and delivery, and fetal malpresentation (e.g., breech).
• Nurses play a crucial role in educating patients about these risks and providing support. Preconception counseling with a high-risk obstetric specialist is often recommended.
• It is important to differentiate a bicornuate uterus from a septate uterus, as a septate uterus can sometimes be surgically corrected with hysteroscopic resection, whereas surgery for a bicornuate uterus (metroplasty) is rarely performed.

How to Approach the Question

• First, identify the key anatomical features described in the question stem: two uterine horns, one cervix, and one vagina.
• Next, recall the definitions of the different types of congenital uterine (Müllerian) anomalies presented in the options.
• Systematically compare the features from the question to the definition of each option.
• Unicornuate uterus has one horn. Eliminate this option.
• Uterus didelphys has two horns, two cervices, and two vaginas. Eliminate this option.
• Septate uterus has one external uterine body with an internal septum. Eliminate this option.

Concept Tested & Keywords

• Concept Tested: Congenital Uterine Anomalies (Müllerian Duct Anomalies)
• Stem keywords: congenital uterine anomaly, two uterine horns, one cervix, one vagina
• Lead-in keywords: most likely diagnosis

Question ID

QmYyZ6_rlXUbyv98lbZb4_

Copy ID

Reference Book

E6 Obstetrics Williams p. 28-47

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1155-1157