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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 3  |  Issue : 4  |  Page : 217-219

Uterus bicornis unicollis; accidental discovery during an emergency cesarean section in a multiparous woman


Department of Obstetrics and Gynaecology, Faculty of Medicine, Kaduna State University, Kaduna, Nigeria

Date of Web Publication11-Jul-2017

Correspondence Address:
Matthew C Taingson
Department of Obstetrics and Gynaecology, Faculty of Medicine, Kaduna State University, Kaduna
Nigeria
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DOI: 10.4103/ssajm.ssajm_34_16

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  Abstract 

Uterine anomalies are usually incidental findings in our environment, because of the limited spread of noninvasive diagnostic procedures. We present a case of a 26-year-old G7P4+2 (none alive). She presented at 36 weeks of gestation with antepartum hemorrhage secondary to placenta previa. At surgery, she was delivered of a fresh still-born male baby that weighed 2.3 kg and found to have a bicornuate unicollis uterus.

Keywords: Antepartum hemorrhage, cesarean section, bicornuate unicollis uterus


How to cite this article:
Taingson MC, Adze JA, Bature SB, Amina DM, Caleb M, Amina A. Uterus bicornis unicollis; accidental discovery during an emergency cesarean section in a multiparous woman. Sub-Saharan Afr J Med 2016;3:217-9

How to cite this URL:
Taingson MC, Adze JA, Bature SB, Amina DM, Caleb M, Amina A. Uterus bicornis unicollis; accidental discovery during an emergency cesarean section in a multiparous woman. Sub-Saharan Afr J Med [serial online] 2016 [cited 2019 Sep 22];3:217-9. Available from: http://www.ssajm.org/text.asp?2016/3/4/217/210203


  Introduction Top


Congenital uterine anomalies result from the abnormal formation, fusion, or resorption of Müllerian ducts during fetal life[1] and are present in 5 to 30% of women with a history of miscarriage.[2],[3] Uterine structural anomalies are often discovered during pregnancy, at the time of abortion, or during evaluation for infertility.[4] Women with bicornuate uteri have a 62.5% chance of having a live birth and 25% risk of preterm birth and spontaneous abortion.[5] The most common symptomatic presentation is with early pregnancy loss and cervical incompetence.[6] We present a case of bicornuate uterus in a multipara discovered accidentally during cesarean delivery.


  Case Report Top


An unbooked 26-year-old G7P4+2 (none alive), presented on the July 21, 2016 at the Barau Dikko Teaching Hospital, Kaduna with a 5-h history of vaginal bleeding and labor pain, at a gestational age of 36 weeks. This was the first episode of vaginal bleeding. The patient received no antenatal care and had no obstetric ultrasound in this pregnancy. In 2010, she had a spontaneous miscarriage at an estimated gestational age of 20 weeks and another at 24-week gestation in 2011. Both were complete. In 2012, she delivered a macerated still birth female at 36 weeks. Between 2013 and 2015, she had three neonates that subsequently died at 3, 1, and 2 years of age, respectively.

On presentation, she was in painful distress, pale, anicteric, and had no pedal edema. Her pulse rate was 100 bpm and blood pressure was 100/70 mmHg. Abdominal examination revealed an enlarged uterus, symphysiofundal height 36 cm, and moderate uterine contractions were palpated. There was a singleton fetus in longitudinal lie presenting cephalad. Fetal heart sound was absent. Emergency ultrasound sound scan confirmed a singleton fetus, with absent cardiac activity and showed the placenta wholly in the lower segment. A diagnosis of major type placenta previa was made, and she was prepared for cesarean section. Investigation revealed a hemoglobin concentration of 8.5 g/dl, rhesus positive blood group B, AA hemoglobin genotype, hepatitis B surface antigen negative, nonreacting retroviral screening, and the urinalysis was within the normal. She had an emergency cesarean section. The intraoperative findings were: bicornuate uterus, the fetus was occupying the right horn, whereas the left horn was enlarged to the size of a 12-week gravid uterus and its cavity communicating with the right, a fresh still born male infant weighing 2.3 kg, type IV placenta previa, normal ovaries, and tubes on each horn of the bicornuate uterus. The appearance of the uterus is shown in [Figure 1]a–[Figure 1]d. Speculum examination performed on the 5th postoperative day confirmed a single cervix [Figure 2]. She had two units of blood transfused and an uneventful postoperative period. She was discharged home on the 7th postoperative day and counseled on contraception and to present as soon as she misses her menses.
Figure 1: (a) Horns of the bicornuate uterus. (b) Bicornuate uterus. (c) Bicornuate uterus posterior view. (d) Bicornuate uterus after repair.

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Figure 2: Cervix

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  Discussion Top


Pregnancies of women with Müllerian anomalies have potential obstetric complications. However, pregnancies within bicornuate uteri have better obstetric outcome than other Müllerian fusion defects.[7]

Clinical diagnosis of uterus bicornis unicollis is difficult; therefore, most often the malformation goes undetected and is discovered incidentally during laparoscopy or during hysterosalpingography, ultrasound scan, (three dimensional), and resonance magnetic imaging.[8],[9],[10] The malformation may be discovered during laparotomy or during cesarean section, as in our case, and others reported.[11],[12],[13]

Complications of uterus bicornis include spontaneous miscarriages, which this patient had two times. Fortunately, they were all complete. Subsequent successive pregnancies are retained for longer periods in cases of uterine malformation;[14] this was the finding in our case that subsequently had three deliveries at term. Other workers have reported normal vaginal deliveries in cases of uterus bicornis unicolis.[15] Surprisingly, in some cases, the diagnosis may be missed at cesarean section.[16]

The treatment of uterus bicornis depends on the clinical presentation. It ranges from observation in asymptomatic women with normal obstetric outcomes to cervical dilatation and metroplasty.[17]


  Conclusion Top


Women with bicornuate uterus could have a successful reproductive carrier; attendance for antenatal will improve outcome rather than presenting as an emergency in labor.

Acknowledgements

The authors would like to express gratitude to Prof Lydia Airede, for her critical reading and comments on the case report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Moore KL, Persaud TVN, Torchia MG. The urogenital system. Before We Are Born: Essentials of Embryology and Birth Defects. 7th ed. Philadelphia, PA: Saunders/Elsevier; 2008. p. 162–89.  Back to cited text no. 1
    
2.
Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C, Pellicer A. Reproductive impact of congenital Mullerian anomalies. Hum Reprod 1997;12:2277-81.  Back to cited text no. 2
    
3.
Acien P. Reproductive performance of women with uterine malformations. Hum Reprod 1993;8:122-6.  Back to cited text no. 3
    
4.
Nwankwo NC, Maduforo CO. Mullerian duct anomaly in a Nigerian woman with recurrent pregnancy loss. Niger J Clin Pract 2011;14:109-11.  Back to cited text no. 4
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5.
Lin PC. Reproductive outcomes in women with uterine anomalies. J Womens Health (Larchmt) 2004;13:33-9.  Back to cited text no. 5
[PUBMED]    
6.
Nahum GG. Uterine anomalies. How common are they, and what is their distribution among subtypes?. J Reprod Med 1998;43:877-87.  Back to cited text no. 6
    
7.
Reichman DE, Laufer MR. Congenital uterine anomalies affecting reproduction. Best Pract Res Clin Obstet Gynaecol 2010;24:193-208.  Back to cited text no. 7
[PUBMED]    
8.
Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, Gordts S, Exacoustos C, Van Schoubroeck D et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 2016;31:2-7.  Back to cited text no. 8
    
9.
Braun P, Grau FV, Pons RM, Enguix DP. Is hysterosalpingography able to diagnose all uterine malformations correctly? A retrospective study. Eur J Radiol 2005;53:274-9.  Back to cited text no. 9
[PUBMED]    
10.
Marcal L, Nothaft MA, Coelho F, Volpato R, Iyer R. Mullerian duct anomalies: MR imaging. Abdom Imaging 2011;36:756-64. doi: 10.1007/s00261-010-9681-x  Back to cited text no. 10
[PUBMED]    
11.
Doruk A, Gozukara I, Burkaş G, Bilik E, Dilek TU. Spontaneous twin pregnancy in uterus bicornis unicollis. Case Rep Obstet Gynecol 2013;2013:834952.  Back to cited text no. 11
    
12.
Isango YI, Mukuku O, Ilunga PM, Kakisingi CN, Nsambi J, Kabamba C et al. Bicervical uterus bicornis permeable: accidental discovery during an emergency caesarean section in a multiparous woman in Lubumbashi. Pan Afr Med J 2013;15:75.  Back to cited text no. 12
    
13.
Nkwabong E, Nwadjie WD. Praevia barrier due to the non gravid horn of a bicornis unicollis uterus: case report. Health Sci Dis 2014;15:1-3.  Back to cited text no. 13
    
14.
Heinonen PK. Unicornuate uterus and rudimentary horn. Fertil Steril 1997;68:224-30.  Back to cited text no. 14
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15.
Jaslow CR, Kutteh WH. Effect of prior birth and miscarriage frequency on the prevalence of acquired and congenital uterine anomalies in women with recurrent miscarriage: a cross-sectional study. Fertil Steril 2013;99:1916-22.e1. doi: 10.1016/j.fertnstert.2013.01.152.  Back to cited text no. 15
    
16.
Morhason-Bello IO, Ojoko IE, Owonikoko KM, Olayemi O, Omigbodun AO. Uterus bicornis unicollis; occurrence of consecutive viable pregnancies in separate horns. Ann Ib Postgrad Med 2007;5:80-82.  Back to cited text no. 16
    
17.
Sinha R, Mahajan C, Hegde A, Shukla A. Laparoscopic metroplasty for bicornuate uterus. J Minim Invasive Gynecol 2006;13:70-3.  Back to cited text no. 17
[PUBMED]    


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