OP03.08: Imaging Characteristics of Unicornuate Uterus: an 11‐year Retrospective Study

To determine the clinical features, and management of women presenting with differing subtypes of unicornuate uterus at a London tertiary centre. Retrospective audit of patients diagnosed with unicornuate uterus between 2010 and 2021. Data including demographic, clinical symptoms, MRI findings, management and obstetric history and outcomes were collected. 33 patients identified with a unicornuate uterus on MRI. 19/33 (57.6%) had a rudimentary horn and 14/33 (42.4%) had no rudimentary horn. Of the 14 cases with no rudimentary horn (median diagnosis age 30.5), all were incidental findings. 6/14 (46%) presented during fertility investigations and of those followed up, 7/10 (70%) had successful term pregnancies. Of the 19 cases with a rudimentary horn, 13/19 (68%) were non-functioning (median diagnosis age 31) and 6/19 (32%) were functioning (median diagnosis age 34.5). The largest group 6/19 (32%) had a stalk diameter of 6-10mm, the largest stalk was 35mm. Of the 13/19 cases with a non-functioning rudimentary horn, none had symptoms related to their anatomy. 5/8 of those followed up with a non-functioning rudimentary horn had term pregnancies. Of the 6/19 cases with a functioning rudimentary horn, 2 were communicating (incidental findings, median diagnosis age 51.5) and 4 were non-communicating (presenting with significant symptoms, median diagnosis age 29). The 2 cases requiring surgery both had non-communicating functioning rudimentary horns, the remaining 2 cases have been offered surgery. This retrospective study demonstrates the range of anatomical types of unicornuate uterus and that the specific classification type has an impact on symptoms, age of presentation and fertility. A unicornuate uterus with functional non-communicating rudimentary horn is most likely to present earlier due to pelvic pain/dysmenorrhoea and to require surgical or medical intervention.