Office Hysteroscopy in a Patient With Uterine Didelphys and Possible Retained Placental Tissue

INTRODUCTION: We present the case of a 32-year-old para 4 with a history of uterine didelphys and vaginal septum resection, as well as chronic endometritis, who was planning for a frozen embryo transfer. Prior to transfer, she underwent endometrial biopsies of bilateral uterine horns, with pathology in the right horn concerning for retained, degenerated placental tissue. In order to further evaluate and remove abnormal tissue from the uterine cavities prior to embryo transfer, office hysteroscopy was performed. OBJECTIVE: This video reviews uterine didelphys and the implications of this condition on pregnancy. We also demonstrate a case where establishing which uterine horn is being visualized can be difficult, and techniques for determining laterality. Finally, we review practices that can be used during office hysteroscopy to minimize vaginal instrumentation and improve patient comfort. METHODS: A 5-mm, 30 degree operative hysteroscope was used for this case. Sterile saline was the distension medium. The patient gave consent for video recording to be taken during the procedure; all patient identifiers were removed from the video prior to presentation. RESULTS: The total procedure time was 28 minutes. There were no complications. Pathology from the right horn demonstrated inactive endometrium, no evidence of chorionic villi or other products of conception. Pathology from the left horn showed inactive endometrium, no evidence of chorionic villi or other products of conception. The patient did not require any pain medication or sedation during the procedure. CONCLUSIONS: Hysteroscopy can be challenging in patients with müllerian unification defects, but with the use of techniques such as digital exam and taking time to visualize the duplicate cervices, adequate visualization of both uterine horns can be assured. Office hysteroscopy can be comfortable for patients, improve patient satisfaction, and improve provider productivity when compared with procedures in the operating room.