Abstract
Background Identifying bicornuate uterus can be challenging especially as a cause of early pregnancy bleeding. On ultrasonographic examination, it is difficult to misdiagnose pregnancy in a bicornuate uterus as an ectopic pregnancy due to the continuity of the endometrium. A rudimentary horn of a bicornuate uterus in early pregnancy can occasionally be misdiagnosed for an ectopic pregnancy especially when compounded by severe abdominal pains and supportive sonographic evidence. Myometrial invasive grading of placenta may be necessary for emergency preparedness and consenting. Hemihysterectomy is lifesaving when percreta has caused severe postpartum haemorrhage. Case Presentation We present a 24-year-old primigravida who presented to the maternity department with severe abdominal pains at 35 weeks. She was pale on clinical examination and haemodynamically unstable. She underwent emergency caesarean section with a preoperative diagnosis of concealed abruptio placentae. Intraoperatively we encountered a bicornuate uterus, delivered a fresh stillbirth, and noted a placenta percreta. A hemihysterectomy was done and she recovered after transfusion without complications. Conclusion A gravid horn of a bicornuate uterus may present as an ectopic pregnancy; careful assessment at laparotomy or laparoscopy is required to prevent inadvertent surgical termination of pregnancy. Placental myometrial invasive assessment is important for delivery emergency preparedness.
Highlights
Identifying bicornuate uterus can be challenging especially as a cause of early pregnancy bleeding
We present a rare case of Mullerian dysgenesis of P.C., a 24-year-old primigravida who presented to the maternity emergency department with severe generalised abdominal pains at 35 weeks
Possible risks during surgical intervention may include inadvertent hemihysterectomy for a pregnancy that would otherwise have grown to viability [6]
Summary
Congenital Mullerian anomalies occur in ∼1.5% of females (0.1–3%) [1], with bicornuate uterus constituting 25% of Mullerian class 4 uterine anomalies [2]. Grimbizis et al reported a prevalence of 4.3% for the general population, about 3.5% in infertile women, and about 13% in women with recurrent pregnancy losses [3] The pathophysiology of this type of anomaly involves incomplete fusion of both uterine horns during embryogenesis; the bicornuate uterus is formed when the Mullerian ducts incompletely fuse at the level of the uterine fundus. In this anomaly, the lower uterus and cervix are completely fused, resulting in 2 separate but communicating endometrial cavities, a single-chamber cervix and vagina. Complete uterine septa that extend either to the internal or external os are known as bicornuate unicollis uterus and bicornuate bicollis uterus, respectively (Figure 1) [4]
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