THE ONE-HORNED UTERUS.
But it has not infrequently bee-n observed as the only deformity in otherwise well-built adults.
The uterus unicornis is elongated, and lies bent and obliquely in the pelvis. From its apex springs a tube, an ovarian ligament with an ovary, and a round ligament. Its volume in the virgin is less than normal; and a deficient development reminding one of a fcetal uterus not infre qnently accompanies the condition. The cervix is small, and the virgin vagina narrow.
On the convex side the second cornu may be entirely absent, or it may be present in an atrophied condition. If it is absent the corresponding tube ovary and round ligament are absent or atrophied (Bussmaul). In a case which Puech has described, the right ovary, oviduct, and ligament were entirely unconnected with the uterus, lay in the right lumbar region, received their blood supply from the aorta, and emptied it int,o the inferior cava.
The combination of congenital anomalies of the kidneys with uterus unicornis, as with uterine deformities in general, is very interesting. Absence of the kidney at the side where the uterine cornu was wanting, congenital hydronephrosis, etc., have been observed. The rudiments of both organg lie close together, and the same cause that interferes with the development of the one might hinder that of the other. Stoltz has demonstrated in the case of several new-born infants, an implication of the corresponding ureter and lateral half of the bladder in the same in stances, being the highest grade of the deformity, which thus affects one entire half of the genito-urinary apparatus.
The uterus unieornis is undoubtedly only the product of one Mill lerian duct. If at the autopsy there is no trace of the other horn, the other Miillerian duct was probably never formed; if traces of it are found, the organ has been destroyed in early fcetal life.
Physiologically, the uterus unicornis behaves very much like the sim ple, well-formed womb. We must not forget that very probably a con siderable number of these cases have been classed as CfV3e8 of under development or hypoplasia uteri.
Puberty, menstruation, conception, even twin pregnancy, may occur normally in these cases. The pregnancy is not interrupted, nor does the deficient muscular development seem to tend to cause rupture dur ing gravidity. But sometimes at birth the muscular structures are dis placed by the dilated placental vessels; the resistance of the uterine wall is lessened, and, as occurred in Moldenhauer's case, rupture may occur under the influence of the pains.
In a primipara, twenty-nine years old, delivery occurred spontaneonsly at the end of the ninth month; the fo3tus was macerated, and only one piece of the placenta could be removed. Death occurred with peritonitic symptoms after four days. The uterus.was found to be slender, slightly
inclined t,o the left. The muscular tissue was very thin, and at one point was a rupture half an inch in diameter. In the rela ed uterine cavity were portions of the placenta.
Left tube and ovary were normal; the right ovary, with a solid rudi ment of the right cornu, lay deep down in the true pelvis.
On account of the shape of the womb, the fcetus is always placed ver tically. The obliquity of the organ might press the presenting part against the pelvic wall, but this obstacle should be easily remediable when we consider the great mobility of the organ in these cases.
The puerperium also is normal. The fact that many successive births may be entirely normal in these cases, seems to show that the hypertrophy of the first pregnancy increases the size and the resisting power of the fundus.
There are no symptoms from the deformity in the post-puerperal period, save when the womb is rudimentary also.
The non-gravid uterus unicornis will be difficult to distinguish from other uterine deformities, as uterus fcetalis and infantilis.
The smallness of the vaginal portion, the shortness of the cavum, and the thinness of its walls, may enable us to diagnosticate deficient uterine development If now the various causes of lateral displacement of the uterus, as pen- and parametritic inflammatory exudations, tumors, etc., are absent, and the sound shows a strong deflection of the organ to one or other pelvic wall, the fundus is probably funnel-shaped. But as v. Hoist has shown, only conjoined manipulation through rectum and uterus (sound) will enable us to diagnostie,ate the anomaly with certainty.
One would suppose that in pregnancy the condition could be more easily recognized. But lateral deflection is not uncommon at that period with the normal womb; and the condition causes so much thickening and broadening of the fundus, that the peculiar character of the uterus unicorn's is quite lost. Cases are, however, known, in which the fundus does retain its form during pregnancy.
The treatment of uterus unicornis is the same as that of uterus in fantilis. In either case it is questionable whether we can by therapeutic measures cause increase in the development of the organ, and so render it fit for gestation. If pregnancy is present, and the uterine walls are very thin, Moldenhauer's experience may cause us t9 consider the pro priety of an early interruption of the pregnancy. At birth itself all the customary precautions when rupture is threatened are in order, especially early artificial delivery. Hemorrhage after delivery, from the thinness of the walls of the organ, should also be looked out for.