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MedPulse - International Medical Journal, ISSN 2348-2516 E-ISSN: 2348-1897

Volume 1, Issue 2, February 2014 pp 77-79

Case Report

Pregnancy in non Communicating Horn of Uterus – A Case Report

Shreyaa Sriram¹, U. T. Bhosale², Ramchandra D. Shriwastav³

¹PG student 1^st year, ²HOD, ³Assistant Professor

Academic Editor : Dr. Bhanap P. L.

Abstract

The incidence of uterine malformations is estimated to be 3% - 5% in the general population. Abnormal fusion of the mesonephric duct (mullerian duct) during embryonic life results in a variety of congenital uterine malformations like bicornuate uterus, unicornuate uterus. A unicornuate uterus is a uterus that has a single horn and a banana shape. Approximately 65% of women with a unicornuate uterus also have a second smaller or rudimentary uterine horn. The rudimentary horn can be solid or it can have a small cavity with a functioning ndometrium. Sometimes the smaller horn connects to the uterus and vagina, but more often it is isolated or non-communicating. Pregnancy can also occur in a non-communicating arm. The situation is similar to an ectopic pregnancy and must be treated as an emergency. If pregnancy occurs in the non-communicating arm, uterine rupture occurs in approximately 89% of cases by the end of the second trimester. Because of this risk, surgical removal of the non-communicating arm is recommended. Removal of a solid non-functioning arm is not necessary. In this case it is presented as a 30 year old 3^nd Gravida with 1^st spontaneous abortion, 2^nd pregnancy she underwent LSCS for breech presentation delivered 3kgs male baby, living, came with H/O 4 months Amenorrhea and P V bleeding since 2 days admitted in Bharati Hospital, Sangli. Patient was investigated with complete ANC profile and USG Obstetrics. USG was suggestive of uterus an teverted and bulky, E/O pregnancy of 13 weeks and 4 days, E/O Acrania with Exomphalous, FL -12mm was noted, Placenta attached to the fund us of the uterus. Impression -IUD with anomalies in baby with Bicornuate Uterus having pregnancy in right horn of uterus. Under ultrasonography guidance Emcridyl instillation was tried but failed due to? non communication of right horn of uterus to cervix. Decision of exploratory laprotomy was taken to terminate the pregnancy, on opening abdomen it was found that uterus was having a right horn enlarged with pregnancy of 12 – 14 weeks. Left horn, tubes and ovaries normal. Right horn with pregnancy excised. Postoperative period was uneventful. In conclusion, it will be interesting to know, if history of previous caesarean sections for breech (as observed) might be a probable etiological factor for rudimentary horn pregnancies and it is suggested that earlier detection of the location of embryonic growth by sophisticated diagnostic tools will save any such catastrophic outcome. Aim: Bicornuate uterus, also commonly referred to as a "heart-shaped" uterus, is a type of uterine malformation where two "horns" form at the upper part of the uterus. A bicornuate uterus is formed during embryogenesis. The fusion process of the upper part of the Müllerian ducts is altered. As a result the caudal part of the uterus is normal while the cephalo part is bifurcated. In this case it is presented as a 30 year old 3^nd Gravida with 1^st spontaneous abortion, 2nd Prev LSCS for breech presentation delivered 3kgs male baby, living came with H/O 4 months Amenorrhea and P V bleeding since 2 days admitted in Bharati Hospital, Sangli. Patient was investigated with complete ANC profile and USG Obstetrics. USG was suggestive of uterus anteverted and bulky, E/O pregnancy of 13 weeks and 4 days, E/O Acrania with Exomphalous, FL -12mm was noted, Placenta attached to the fund us of the uterus. Impression -IUD with anomalies in baby with Bicornuate Uterus having pregnancy in right horn of uterus. Under ultrasonography guidance Emcridyl instillation was tried but failed due to? non communication of right horn of uterus to cervix. Results: Decision of exploratory laprotomy was taken to terminate the pregnancy, on opening abdomen it was found that uterus was bicornuate with right horn enlarged with pregnancy of 12 – 14 weeks. Left horn, tubes and ovaries normal. Right horn with pregnancy excised. Conclusion: This was a rare and challenging case for us. This corrective surgery does not impair fertility. Women with uterine anomalies have poorer reproductive outcomes and lower pregnancy rates compared with women who posses normal uterus.