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Mullerian dysgenesis




Uterus Didelphys

It is a condition where there is failure of fusion along the whole length of mullerian duct resulting in 2 vagina, 2 cervix, and 2 uterus

Bicornuate uterus


a. Uterus bicornis unicollis


b. Uterus bicornis bicollis


In this condition only the lower part of the ducts fuse leaving the cornua separate, so always there is a single vagina

Here vagina and cervix are fused, i.e. single vagina, single cervix but 2 uterus.


Here vagina is fused but cervix and uterus are not fused, i.e. single vagina, 2 cervix and 2 uterus.

Septate / Subseptate uterus

Here the uterus is outwardly normal but contains a complete or incomplete septum which reflects a failure in the breakdown of the walls between the 2 ducts.

Arcuate uterus

Here the fundal bulge of uterus does not develop after fusion of the ducts i.e. flat topped uterus.

Unicornuate uterus

It does not represent a defect in the fusion of the ducts, rather here one of Mullerian ducts is completely absent and so there is only 1 fallopian tube. Uterus, cervix, and vagina though appear to be normal are only half of the fully developed organ.


HSG: Hysterosalpingogram (HSG) is mainly preferred in uterine anomalies but it cannot distinguish between a septate and bicornuate uterus. This is because in order to distinguish between the two, uterine fundus should be visible.



In Bicornuate uterus the 2 halves of mullerian duct do not fuse and there is defect in fusion of fundus as well.


In septate uterus a septum passes down from the uterine fundus. The fundus is normal in appearance.

  • Transvaginal USG: It is the best method to distinguish between a septate and bicornuate uterus as it reveals the shape of the fundal contour. The septate uterus presents a single unified fundus that is after broader than normal while bicornuate uterus has 2 entirely separate fundi divided by a distinct midline cleft of varying depth. The diagnostic accuracy of sonography may be improved when coupled with HSG.
  • Hysteroscopy: It is both diagnostic and curative.
  • MRI: Expensive technique but provides the most accurate diagnosis.
  • Sonohysterography (involves transvaginal ultrasound during or after introduction of sterile saline). It can also distinguish between a septate and bicornuate uterus by revealing both the double uterine cavity and the shape of fundal contour.

Management of Bicornuate or Septate Uterus

Presence of uterine malformation per se is not an indication of surgical correction. Unification operation is indicated in otherwise unexplained cases of infertility or repeated pregnancy wastage.

Options Include

  • Abdominal metroplasty: Which could be done either by excising the septum (Strassman, Jones) or by incising the septum Tompkins). Incidence of live birth is 5-7% after abdominal metroplasty.
  • Hysteroscopic metroplasty: Nowadays being done.

Extra Edge: A patient who has undergone hysteroscopic resection can be permitted for vaginal delivery in subsequent pregnancy as compared to abdominal metroplasty where cesarean is mandatory.



Bicornuate uterus


Arcuate uterus


Incomplete septum


Uterus didelphys


Complete septum


Unicornuate uterus


Septate uterus


Bicornuate uterus


Arcuate uterus


Unicornuate uterus


Uterus didelphys


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