Hysterosalpingography (HSG) is the first diagnostic test used for patients with suspected mllerian anomalies. HSG can detect a two-chambered uterus and allow assessment of the size and extent of a septum. Two-dimensional (2D) ultrasonography was previously done by the transabdominal route, but transvaginal ultrasonography (TVS) is superior to the transabdominal route and is now the standard imaging technique for the uterus. The main advantage of three-dimensional (3D) ultrasonography over 2D is the ability to image the three orthogonal planes of the uterus, of which the coronal view is the most important. Sonohysterography is an ultrasound-aided technique that entails injection of normal saline into the uterine cavity. Many magnetic resonance imaging (MRI) studies have shown a very high sensitivity of 100%, and more recently values of 95% have been reported in cases of mllerian anomalies. Uterine mllerian anomalies have a high frequency of adverse obstetric implications.

This chapter discusses the congenital uterine malformations and their reproductive implications. Patients with congenital absence of the vagina usually lack the uterus as well. Imperforate hymen and transverse vaginal septum are vertical fusion anomalies. Double uterus, septate uterus and unicornuate uterus are obstructive lateral fusion anomalies. In strassman procedure a transverse fundal incision is made in case of a bicornuate uterus and the two uterine cavities are unified. In Tompkins procedure for septate uteri a median bivalve is made and no tissue is excised. The two cavities are opened and unified. In Jones procedure which is usually reserved for the wide septum, a wedge resection of the septum is done and the uterine cavities are unified. In uterus didelphys, there is duplication of the uterus, cervix, and vagina. Fertility of women with didelphic uterus was comparatively good. Patients with congenital uterine malformations undergoing IVF have a good pregnancy rate.