The Two-Horned Uterus

I am currently in full-on Step2CK/Boards study mode. I'm averaging 10 hours a day at the moment, trying to increase it to 11, and I take the exam in less than 4 weeks. I'm surprised at how different studying is this year as compared to last year's studies for Step1. I was in England, and I was absolutely spoiled; the only thing I had to do was study. No bills to pay, no laundry to do, no food to make, no dishes to clean, not one single obligation outside of studying (Mike's parents are absolutely amazing and I cannot thank them enough for their support!). I'm also taking my science-based clerkship right now (pathology), which takes up a little bit of my time. This year is so much more difficult. Mike is busy studying in between loads of coaching sessions and summer camps...which means the housework is falling on me, miss needs-to-study-all-day-every-day. And it's pretty hard to balance, actually, as one may notice by how absolutely messy the apartment is!

Anyway, enough complaining! I do love what I do, and I wouldn't trade it for the world. I'm performing better on my exams than I had for Step1, which is a really promising sign. I have a goal score for my Step2 and I am absolutely going to achieve it (even if it means everything else in my life is put on hold for the next month!).

As I have been studying, I am constantly reminded of interesting patients I have seen in the past year. It's funny, the whole first year of clinical work everything seems amazing and everything seems rare because everything is brand new to you. It's not until I've reached the end of my third year that I realized just how amazing some of the patient's stories actually are! So, as they come up, I would like to share them with you. I have nothing else to blog about anyway, unless you want to hear about how I sit at my desk for days at a time, taking breaks only to go to case studies, eat, shower, walk the dog, and run! (didn't think so....)

Story #1:

While I was on the OB service, I was able to scrub in on every delivery that occurred during my shifts. My very first experience with a C-section was something I'll never forget. Gowned up (with high boots and all), I watched as the OB and her senior resident cut open a gorgeous woman's abdomen and pull out a beautiful baby. After the baby, the resident laid a strangely heart-shaped organ onto the mom's abdomen - the woman's uterus - so that he could suture the uterus closed. That's when the resident decided to pimp me -
Resident: "what's significant about this patient?"
Me: (Hm....quite an open-ended question, but) "her uterus appears to be misshapen."
Resident: "Yeah, it's called a bicornate uterus, meaning two horns. It's an anomaly which occurs in about 1 in 1500 women. This is the first time I've ever seen one before. Aren't you lucky to have scrubbed in today?...Since she has this malformation, what other things should we be concerned about in this patient?..."
Me: (oh my god I have no idea, but that was one of the most disgusting procedures I have ever seen in my life; I feel a bit light-headed...) "... ... ..."
Resident: "Which organs are related to the same embryological origin as the uterus? It's the kidneys. The malformation is due to the failed fusion of the Mullerian ducts. We need to make sure there are no anomalies in this patient's kidneys, as about 1/3 of patient's with a bicornate uterus also have renal abnormalities."

That was pretty cool. Thinking back on the patient, she was an older woman and this was her first delivery. I thought it kind of strange that she was so old (only like 35), old for a first time mom. But looking back, this makes sense. Women with a bicornate uterus have difficult conceiving, as the egg finds it difficult to implant. Moreover, second-trimester miscarriages occur due to defective implantation of the placenta. Other complications of pregnant women with a bicornate uterus include: fetal anomalies, prolonged labor, malpresentation of the fetus (such as breech and transverse lie), and increased bleeding.

Bicornate Uterus literally means "two-horned uterus". Animals which carry multiple offspring during pregnancy often have this type of uterus (such as dogs), but its occurrence in humans is 1:1000-2000 women. It consists of a double uterine cavity with one cervix and one vagina.

For more information regarding embryogenesis of the uterus and kidneys, click here. That stuff is more Step1 material than Step2 so (thank God) I don't have to memorize that junk again! ;)