{
    "abstract": "To describe the clinical circumstances, surgical approach, intraoperative challenges, and outcomes of patients with two cervices undergoing uterine evacuation for spontaneous, incomplete, or induced abortion at our institution.\nWe used diagnostic and procedure codes related to uterine anomalies and uterine evacuation to identify patients with cervical duplication who underwent uterine evacuation at Penn Medicine from January 2008 to December 2020.\nWe identified 15 patients with cervical duplication in whom we performed uterine evacuations during 19 pregnancies. We describe in detail each patient's first pregnancy with uterine evacuation at our institution, of which providers performed 11 in the first trimester, and four in the second trimester. Ten patients had a known diagnosis of cervical duplication prior to pregnancy. Five patients did not have a diagnosis of cervical duplication prior to pregnancy and providers newly made this diagnosis intraoperatively either at our institution or referring clinics. Providers at outside institutions referred three patients to our institution for incomplete procedures. At our institution, one patient had a procedure notable for a major complication. Eight other cases were notable for surgical challenges including difficulty placing osmotic dilators, difficulty identifying the correct cervix for local anesthesia, and contralateral cervical and uterine horn instrumentation.\nThis case series suggests surgical abortion in patients with two cervices is rare, but generally safe. The majority of patients did not have major complications, despite presenting a variety of unique procedural challenges. Surgical providers were sometimes the first to make the diagnosis of a second cervix.\nUterine evacuation providers must be aware of the possibility of an undiagnosed cervical duplication, particularly when encountering surgical challenges in patients with congenital reproductive tract anomalies. Providers should consider procedures under ultrasound guidance regardless of gestational age for patients with any congenital reproductive tract anomaly or who had prior incomplete procedures.",
    "authors": [
        {
            "affiliation": "Perelman School of Medicine at the University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA, United States; Oregon Health and Science University, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Portland, OR, United States. Electronic address: rubine@ohsu.edu.",
            "firstname": "Elizabeth S",
            "initials": "ES",
            "lastname": "Rubin"
        },
        {
            "affiliation": "Perelman School of Medicine at the University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA, United States.",
            "firstname": "Alexandra",
            "initials": "A",
            "lastname": "Huttler"
        },
        {
            "affiliation": "Perelman School of Medicine at the University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA, United States.",
            "firstname": "Monica",
            "initials": "M",
            "lastname": "Mainigi"
        },
        {
            "affiliation": "Perelman School of Medicine at the University of Pennsylvania, Department of Obstetrics and Gynecology, Philadelphia, PA, United States.",
            "firstname": "Andrea H",
            "initials": "AH",
            "lastname": "Roe"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2022. Published by Elsevier Inc.",
    "doi": "10.1016/j.contraception.2022.01.001",
    "journal": "Contraception",
    "keywords": [
        "Abortion",
        "Bicollis",
        "Cervical duplication",
        "Double cervix",
        "Miscarriage",
        "M\u00fcllerian anomaly"
    ],
    "methods": null,
    "publication_date": "2022-01-16",
    "pubmed_id": "35031305",
    "results": "We identified 15 patients with cervical duplication in whom we performed uterine evacuations during 19 pregnancies. We describe in detail each patient's first pregnancy with uterine evacuation at our institution, of which providers performed 11 in the first trimester, and four in the second trimester. Ten patients had a known diagnosis of cervical duplication prior to pregnancy. Five patients did not have a diagnosis of cervical duplication prior to pregnancy and providers newly made this diagnosis intraoperatively either at our institution or referring clinics. Providers at outside institutions referred three patients to our institution for incomplete procedures. At our institution, one patient had a procedure notable for a major complication. Eight other cases were notable for surgical challenges including difficulty placing osmotic dilators, difficulty identifying the correct cervix for local anesthesia, and contralateral cervical and uterine horn instrumentation.",
    "title": "Surgical uterine evacuation in patients with two cervices: a case series.",
    "xml": "<Element 'PubmedArticle' at 0x78850522a840>"
}