Woman thirty-six years old; always healthy; had menstruated regu larly but profusely since her fifteenth year; for the first six years every pregnancy regularly ended in abortion at the third month; then followed a fully developed child; and then again there were two abortions, the last on December 30, 1877. Six weeks later her periods recommenced, and remained regular. Towards the end of March examination revealed a five months' pregnancy and the probable existence of a duplex uterus. In May the child was borit; and examination showed that the ovum had been implanted in the left half of the uterus. The chances are that whenever the right half became gravid, abortion ensued. Two years later the woman again bore a living child from the left half, whilst the right had emptied itself of its contents at two months, and liad gone on men struating.
Twin pregnancies are not uncommon, one fcetus being in each cornu, or both in the one. Triple pregnancy has also been seen. It is doubt ful if when there is complete partition up to the external genitals preg. nancy can occur simultaneously. A true super-fecundation would have to occur, It is improbable, though not impossible, that super-fcetation (development of a second ovum in one half, whilst the first had already been impregnated from a previous ovulation) can occur. Our literature is unluckily not extensive enough to decide the question. (See Uterus Didelphys, page 235.) The position of the Retus corresponds to the shape of the titertm When there is complete separation, uterus bicornis septus and uterus bicornis unicollis, the fcetus lies most commonly head downwards and vertical. If however there is a common uterine cavity, breech tions are more frequent; and where there is simply a broadening of the uterus,—uterus arcuatus unicorporeus, —transverse positions are common.
But the position of the fcetus does not always correspond to the spin dle shape of the uterus. We would expect that the curved back of the fretas would always be applied to the concave wall of the cornu, so that in the right uterine horn one only, and in the left horn two positions would occur. But experience disproves this assumption.
Polaillon has observed placenta prfevia with a number of these malfor mations, and attributes the condition to them. The relative width of the uterine cavity is supposed here, as in the simple uterus, to be the etiological factor in the condition.
Although pregnancy in general is normal in cages of uterus bicornis, labor is interfered with in a disproportionately large number of cases. Sometimes it is very tedious, and death of the lying-in woman from ex haustion has been recorded. Ruptures of the lower segment of the uterus have also been caused. The percentage of operative cases, and of deaths, is certainly above the average; and this applies not only to the uterus bicornis, but to malformations of the uterus in general (L. Grivow). This is due above all to the oblique position of the cornua, in consequence of which the longitudinal axis of the fcetus does not correspond with that of the pelvic entrance. There the presenting part may meet with
other obstacles; the other non-pregnant but enlarged cornu may be in the way, or the hcad may be detained by the stretched abnormal ligamen tam recto-vesical above mentioned. Sometimes these obstacles only result in delaying delivery, the uterus gradually straightening itself, and the non-impregnated cornu receding. But in other cases death occurs from exhaustion or from rupture of the stretched and contused lower segments of the uterus. The longitudinal vaginal septum also may interfere. There may be severe postpartum hemorrhage when the placenta is sit uated upon the septum. uteri, and the insufficient muscular power does not completely close the gaping vessels Childbed, save for accidental puerperal diseases, is normal in most cases; and involution occurs as rapidly as in the simple womb.
In cases where the cornua act independently, and of twins where one is extruded at a long interval of time from the other, the lochia and the milk may appear only after the second birth, or they may set in at once after the first, and stop after the second child.
It is remarkable that there is no case on record of pregnancy in the closed horn of a uterus bicornis, while it is not infrequent in the rudi mentary cornu. At all events, I have been able to find no such case in the more recent literature of the subject (see Uterus Bilocularis).
If hernatometra forms in the closed cornu the other half may be im pregnated in spite of it. But the pregnancy is very liable to be inter rupted.
The presence of a vaginal septum will always direct our attention to the anomaly we are considering, since they so frequently occur together. Strange to say, it is frequently overlooked, even when, as in labor and obstetric operations, the hand of the physician remains in the genitals for long periods of time. The reason is that the examining finger enters one canal, the septum is not noticed or distinguished from the wall of the vagina, and the second vagina is not seen at all as a separate channel. If the septum is incomplete, it is probably lax; it lies against the vaginal wall, and is overlooked. During birth the passage of the fcetal head still more fully obliterates the other canal. In the above-mentioned case of uterus unicornis with rudimentary cornu, I perforated without feel ing the membrane. This has happened even to the most experienced obstetricians. There is a well-known and curious case recorded of a con sultation between Mai and Fischer, two equally experienced obstetrician& The ease was apparently a simple one, but one physician found the os uteri well open, while the other found it closed. A violent dispute oo. curred, and when, to settle it, both made a re-examination, each found exactly the opposite of what he had before determined. The vagina was double, and the two cervices were in different conditions.