Bicornuate Uterus with Pregnancy
Case Report
A 32 year old lady G3P2L2 with 20 weeks pregnancy came to the obstetrics department for her first antenatal check-up. Her first delivery was a normal vaginal delivery at term with growth restricted girl baby weighing 2 kg at birth and is now alive and healthy. Second was a caesarean section for breech, oligohydramnios and intrauterine growth restriction (IUGR). Third is present pregnancy. Pregnancy dating ultrasound scan done at 11 weeks showed uterus to be deviated to the right and a single live fetus of 10 weeks 3 days in abicornuate uterus with implantation in the left horn and an empty right horn. She had a pregnancy loss at 14 weeks gestation.
Discussion
Uterine abnormalities are the result of Mullerian or paramesonephric duct anomalies or disturbances at the time of fusion or development. Bicornuate uterus is a congenital uterine anomaly that results from defective lateral fusion of the paramesonephric ducts at about the 10th week of intrauterine life around the fundus
The incidence of uterine malformations in general population is estimated to be about 3-5% and 5-10% in women with poor reproductive outcome .Precise diagnosis requires diagnostic modalities like ultrasonography, magnetic resonance imaging, Hysterosalpingogram, hysteroscopy and laparoscopy. Pregnancy occurring in the malformed uterus is relatively rare, and many of them are asymptomatic, but should be suspected in patients with recurrent miscarriages and malpresentations. Bicornuate uterus is a unification defect of the Mullerian ducts, and is estimated to represent 10% of Mullerian duct anomalies . Bicornuate uterus may be asymptomatic and may remain undiagnosed until abdominal surgeries such as hysterectomy. One of the first diagnostic clues for the diagnosis of uterine anomalies is the occurrence of obstetrical complications. Women with bicornuate uterus may experience a successful pregnancy outcome, but are still at risk of obstetric complications such as malpresentations, preterm rupture of membranes in small for gestational age foetuses, recurrent pregnancy loss, preterm delivery and cervical incompetence.
Conclusion
Uterine abnormalities are accompanied with uneventful outcomes such as preterm labour, fetal malpresentations, and even perinatal mortality. However, these anomalies may not be suspected before the occurrence of abortion or its complications. In the present report, IUGR in the first pregnancy, the breech position in the second pregnancy and abortion in the third pregnancy might have possibly resulted from uterine abnormality associated with the Bicornuate uterus. Although women with complete bicornuate uteri might experience successful pregnancy, they are still at the risk of certain complications. Nevertheless, it seems necessary to raise the patients’ awareness towards the possible outcomes of this condition by physicians.
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