Flexible hysteroscopic exploration in surgical termination of pregnancy in a patient with uterine abnormality

Congenital uterine anomalies may cause various reproductive problems, including difficulty performing vaginal surgical termination of pregnancy (TOP). We report the case of a 35-year-old woman with a uterus bicornis bicollis (a double, partially fused uterus with two cervices and a vaginal septum), who was requesting termination of pregnancy following two failed attempts at vacuum aspiration. Flexible hysteroscopy, in combination with trans-abdominal ultrasound, was used to facilitate the correct passage of the dilators during a successful dilatation and evacuation (D&E) followed by insertion of intra-uterine progestogen-only contraceptive system (‘Mirena’). On review of the literature, we found no similar cases reported.