More Vibha*, Himangi Warke**,(* Assistant Professor, ** Associate Professor, *** Professor. Department of Obstetrics and Gynecology, Seth GS
Mali Kimaya*, ***. Satia MN
We report a case of pregnancy with silent rupture at 32 weeks of gestation in a left horn of bicornuate uterus which continued till 35 weeks, followed by delivery of a live fetus. The diagnosis of bicornuate uterus was missed in early weeks of gestation on ultrasonography (USG) and later was misdiagnosed as abdominal pregnancy. Preoperative diagnosis with USG and magnetic resonance imaging (MRI at our institute confirmed the diagnosis of pregnancy in the left horn of uterus. A live fetus was delivered by cesarean section followed by excision of the left uterine horn.
Congenital malformation of uterus is due to abnormal fusion of mullerian ducts or failure of absorption of the septum. Mullerian duct anomalies are estimated to occur in 0.4%. They can be diagnosed at different stages of life. Abortion, preterm delivery, malpresentation, fetal growth restriction are more commonly seen in women who have bicornuate uterus. Non invasive imaging modalities like USG and MRI helps in diagnosis of bicornuate uterus in early weeks of gestation.
Figure 2. Left rudimentary horn after delivery of baby (black arrow) with omental adhesions (green arrow), right horn (yellow arrow).
Figure 3. right horn after excision of rudimentary horn.
Figure 4. Excised left horn.
Uterus during embryogenesis is formed by fusion of two mullerian ducts. Failure of fusion of the two mullerian ducts results in separate uterine horns (bicornuate uterus). Bicornuate uetrus can be bicornis bicollis or uterus bicornis unicollis. The two uterine horns in uterus bicornis unicollis may be equal but rudimentary, or equal and well developed, or one horn may be less developed than the other. Bicornuate uterus accounts for 25% of all müllerian anomalies. Bicornuate uterus is type four according to the American Fertility Society classification of müllerian anomalies. In majority, bicornuate uterus is undiagnosed. In others, it may be accidentally diagnosed during investigation of infertility or repeated abortion or during dilatation and curettage or cesarean section. Abortion, preterm delivery, malpresentations, IUGR are more commonly seen in women who have bicornuate uterus. There is increased incidence of cesarean delivery (82% as reported by Heinonen). Diagnosis of uterine anomalies on two dimensional USG is difficult. Three dimensional USG is an excellent method to evaluate these malformations. MRI delineates duct anomalies and their extent and its accuracy reported is 100%.[5,6] Rupture in such cases is due to inability of malformed uterus to expand. There is also increased risk of postpartum hemorrhage in cases with uterine anomalies as seen in our case, which required excision of the horn.
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More V, Warke H,
Mali K, .
Silent Rupture of Gravid Rudimentary Horn and Fetal Survival. JPGO 2014 Volume
1 Number 9 Available from: http://www.jpgo.org/2014/09/silent-rupture-of-gravid-rudimentary.html Satia MN