Mullerian anomalies vary from 0.06% to 38% in normal population, while in women experienced recurrent pregnancy loss they reach up to 16.7%.
About 25% of cases having mullerian anomalies suffered from infertility, first trimester abortions, preterm labor, and fetal abnormal presentation. The pathophysiology of unicornuate uterus is explained by either complete or partial failure in the development of the Müllerian duct.The ESHRE\ESGE classified unicornuate uterus as (U4) or hemi-uterus where only unilateral uterine development takes place and the contralateral part could be either incompletely formed or absent.
Class U4 is further divided into:
- Class U4a or hemi-uterus with a rudimentary (functional) which has a communicating or non-communicating functional contralateral horn.
- Class U4b or hemi-uterus without rudimentary (functional) cavity characterized either by the presence of non-functional contralateral uterine horn or by aplasia of the contralateral part. Most of the complication if not all arise from presence of functional cavity in the contralateral part such as hemato-cavity or ectopic pregnancy in the rudimentary horn which may rupture into the peritoneal cavity causing internal hemorrhage jeopardizing the patient`s life. Proper diagnosis is essential for planning the management of the best outcome, it should be tailored to each patient and varies according to time of diagnosis and whether the case is emergency or elective. Different approaches may be used in such cases including laparotomy, laparoscopy, or any emerging technique such as imaging guided techniques.