Complete uterine septum, cervical septum and longitudinal vaginal septum: a challenging differential diagnosis with double cervix.

Abstract

Background: The presence of complete uterine septum, cervical septum and longitudinal vaginal septum (class U2bC1V1 according European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy classification) is a rare congenital anomaly of the female genital tract. The diagnosis of this anomaly is very challenging, significantly influencing the type of treatment to be performed.

Objectives: We propose a one-stop diagnosis through the combined use of 2D-3D ultrasound (US) and hysteroscopy and the minimally invasive endoscopic treatment of this anomaly, emphasising the diagnostic and therapeutic differences compared to U2bC2V1 anomaly.

Participant: Stepwise demonstration with video footage of an integrated approach in the management of a patient with a class U2bC1V1 anomaly. The patient was 23 years old and presented with dyspareunia and a previous miscarriage. We performed a one-stop diagnosis through the combined use of diagnostic hysteroscopy and 2D-3D pelvic US and a minimally invasive endoscopic treatment with a 15Fr bipolar miniresectoscope.

Intervention: Hysteroscopic control performed 40 days after the procedure showed a regular vagina, a normal single cervix and a normal uterine cavity. No intra- or postoperative complications occurred. The patient was discharged 3 hours after the procedure. The total operation time was 24 minutes.

Conclusions: Making an accurate diagnosis of a single cervix with cervical septum and a double cervix is crucial in the management of patients with complex genital anomalies. An accurate diagnosis is possible when combining hysteroscopy and US. Minimally invasive endoscopic treatment of U2bC1V1 anomaly with a 15 Fr bipolar miniresectoscope is an effective and safe procedure, easier when compared to the treatment of U2bC2V1 anomaly.

What is new?: This video article describes the hysteroscopic criteria for the differential diagnosis between single cervix with cervical septum and double cervix.