Presentation
Presented with recurrent early pregnancy loss.
Patient Data
The control film shows no obvious abnormality. On injection of contrast, there are two widely separated endometrial cavities with a smooth contour. The intercornual distance is greater than 4cm and the angle is greater than 105 degrees. Filling defects within the endometrial cavity suggest air bubbles pushed in during contrast administration.
Fallopian tubes show free intraperitoneal contrast spillage, at each end.
Case Discussion
Recurrent early pregnancy loss in a young, normally menstruating female raises suspicion of underlying Müllerian duct anomalies. A hysterosalpingogram (HSG) is routinely requested in nearly all cases presenting with primary and secondary infertility, as it can readily disclose any pathology involving the uterus and the Fallopian tube.
In the presented case, a bicornuate uterus is observed, demonstrating two widely separated endometrial cavities and a single cervix, without any evidence of tubal blockage. The intercornual distance measures greater than 4 cm, and the angle is more than 105 degrees.
This anatomical variation, characterized by the bicornuate uterus, may contribute to recurrent early pregnancy loss. The separation of the endometrial cavities could affect implantation and early fetal development, leading to pregnancy complications. The absence of tubal blockage suggests that the recurrent losses are likely related to uterine factors rather than tubal factors.
Management considerations for this case may involve further evaluation of the bicornuate uterus's impact on fertility and pregnancy outcomes.
Additional contributor: Dr Dijendra Nath Biswas
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