THE DOUBLE-MOUTHED UTERUS.
(Uterus biforis.) By this we mean a uterus with single body and cervix, but with the external os divided into two parts by an antero-posterior partition. These openings may or may not be of equal size. In some cases the posi tion extends upwards a certain distance, so that we can speak of a uterus bicoll is.
This anomaly, which is normal in the ant-eaters, is to be regarded as the lowest grade of uterine duplexity; the partition at the os being the last remnant of the original genital septum. It is difficult to say why it sometimes persists just here.
It may cause trouble during delivery. The presenting part may dilate one opening, and push the septum aside, but sometimes the septum is torn through. Winckel had such a case, which he called uterus infra septus, in which the prematurely born fcetus tore through the partition. Mebus relates a case in a primipara, in which both openings were strongly dilated by the cervix, so that the large fontanelle was found at the one, and the small at the other opening. When torn, these bands may cause
considerable hemorrhage, and may form the starting-place for infective processes in puerperio.
Recognition of the anomaly is not difficult; simple vaginal examina tion will reveal it. But during delivery one os only may be dilated, and the other escape notice. If by finger or two sounds we can recognize that both orifices open into the same cervical cavity, the diagnosis is made. In uterus bilocularis the sounds would not meet until they reach the fundus; and in uterus bicornis the external form of the womb is dif ferent.
It is only of obstetric interest. It may be necessary to push the divid ing band to one side, or, if that cannot be done, to double ligature and cut them, exactly as is done with vaginal bands.