{"id":7808,"date":"2026-02-27T18:33:03","date_gmt":"2026-02-27T17:33:03","guid":{"rendered":"https:\/\/juanacrespo.com\/caso\/malformacion-uterina-compleja-cirugia-reconstructiva-y-embarazo-evolutivo\/"},"modified":"2026-04-30T16:36:11","modified_gmt":"2026-04-30T14:36:11","slug":"complex-uterine-malformation-reconstructive-surgery-and-a-successful-pregnancy","status":"publish","type":"caso","link":"https:\/\/juanacrespo.com\/en\/case\/complex-uterine-malformation-reconstructive-surgery-and-a-successful-pregnancy\/","title":{"rendered":"Complex uterine malformation, reconstructive surgery and a successful pregnancy"},"content":{"rendered":"

Extract:<\/h3>\n

A 33-year-old patient with a complex uterine malformation<\/b> requiring a comprehensive approach to achieve a safe pregnancy. The case presents an added complication due to previous surgery, which has altered the anatomy and clinical presentation.<\/p>\n

History:<\/h3>\n

A 33-year-old woman with primary infertility for one year. Regular periods, not heavy, not painful. Only one functional ovary. As a teenager, she had regular, painful and debilitating periods that led her to A&E on several occasions. She has been taking contraceptive pills for one year.<\/p>\n

No previous treatments have been undertaken<\/p>\n

Diagnosis:<\/h3>\n

A new comprehensive assessment was carried out using<\/p>\n

    \n
  • High-resolution gynaecological ultrasound.<\/li>\n
  • Pelvic MRI.<\/li>\n
  • Diagnostic hysteroscopy.<\/li>\n<\/ul>\n

    All of this concludes that the patient presents with: a congenital malformation called unicornuate uterus<\/b>, with a left uterine remnant that had no outlet to the cervix. Each month, menstrual blood became trapped in this closed cavity, causing:<\/p>\n

      \n
    • Intense pain.<\/li>\n
    • Progressive inflammation.<\/li>\n
    • Development of secondary adenomyosis.<\/li>\n<\/ul>\n

      Treatment plan:<\/strong><\/h3>\n

      A treatment plan is designed to meet two objectives:<\/b><\/p>\n

        \n
      1. To definitively resolve the anatomical problem and the pain<\/li>\n
      2. To preserve and optimise future reproductive capacity<\/li>\n<\/ol>\n

        For this reason, we structured the treatment into three phases.<\/p>\n

        Phase 1: Embryo preservation prior to surgery<\/strong><\/p>\n

        The strategy was based on achieving a good embryo yield; 13 oocytes were retrieved, resulting in 3 chromosomally normal embryos analysed by PGTA and 1 low-grade mosaic.<\/b><\/p>\n

        This allowed us to have healthy embryos before performing surgery on the uterus, increasing safety and reducing subsequent risks.<\/p>\n

        Phase 2: Highly complex reconstructive surgery<\/strong><\/p>\n

        Advanced laparoscopic surgery was performed.<\/p>\n

          \n
        • Complete resection of the left rudimentary horn (left hemihysterectomy).<\/li>\n
        • Right salpingectomy.<\/li>\n
        • Left ovarian fixation.<\/li>\n<\/ul>\n

          Why was this surgery necessary?<\/strong><\/p>\n

            \n
          • To remove the cavity where blood was accumulating.<\/li>\n
          • To halt the progression of adenomyosis.<\/li>\n
          • To leave a uterus that is anatomically safe for pregnancy.<\/li>\n<\/ul>\n

            Phase 3: Hysteroscopic optimisation<\/strong><\/p>\n

            Months later, we performed a surgical hysteroscopy, a guided uterine repair microsurgery to:<\/p>\n

              \n
            • Slightly enlarge the cavity of the unicornuate uterus to improve uterine distensibility and functionality<\/li>\n<\/ul>\n

              This step is essential in complex cases: it is not enough to remove the malformation; it is necessary to prepare the uterus to receive an embryo.<\/p>\n

              Phase 4: Endometrial preparation with embryo transfer<\/strong><\/p>\n

              Following six months of surgical recovery and highly personalised endometrial preparation:<\/p>\n

                \n
              • We transferred a single chromosomally normal embryo.<\/li>\n
              • Implantation was achieved.<\/li>\n
              • The pregnancy progressed normally.<\/li>\n
              • Discharge from obstetric care.<\/li>\n<\/ul>\n

                Conclusion<\/strong><\/h3>\n

                At Equipo Juana Crespo<\/b>, we treat complex infertility from a holistic perspective:<\/p>\n

                  \n
                • Advanced anatomical diagnosis.<\/li>\n
                • Specialised reconstructive gynaecological surgery.<\/li>\n
                • Transfer at the optimal time.<\/li>\n<\/ul>\n

                  This case demonstrates that, even in the face of severe uterine malformation with secondary adenomyosis, it is possible to achieve a successful pregnancy when treatment is correctly sequenced and personalised.<\/p>\n","protected":false},"featured_media":1810,"template":"","meta":{"_acf_changed":false,"content-type":"","inline_featured_image":false},"categoria-de-caso":[374,384],"class_list":["post-7808","caso","type-caso","status-publish","has-post-thumbnail","hentry","categoria-de-caso-surgeries","categoria-de-caso-uteruses"],"acf":[],"_links":{"self":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/caso\/7808","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/caso"}],"about":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/types\/caso"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/media\/1810"}],"wp:attachment":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/media?parent=7808"}],"wp:term":[{"taxonomy":"categoria-de-caso","embeddable":true,"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/categoria-de-caso?post=7808"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}