VIABLE LIVE BIRTH IN A NON COMMUNICATING RUDIMENTARY HORN OF UTERUS”. A CASE REPORT

Pregnancy in non communicating rudimentary horn of uterus is an extremely rare event and is classified as an ectopic pregnancy[1]. Rupture of uterus is usually seen in first or second trimester of pregnancy[1]. We hereby report a case of such a pregnancy which not only continued to third trimester but also resulted in delivery of a live viable neonate. Case Report ??A 22-year-old gravida 2 para 1, with previous uneventful normal vaginal delivery, presented to the labor room at 37 weeks gestation. This was an unplanned pregnancy and she had taken oral abortifacients (mifepristone 200 mg followed by misoprostol 400 μg 48 hours later) twice for Medical Termination of Pregnancy (MTP) in first and second trimester of pregnancy. She was subsequently advised surgical evacuation of uterus which could not be done due to some domestic family dispute. She was lost to follow up due to domestic family dispute. Her antenatal period (otherwise) was uneventful. She reported in labor in third trimester (hence early diagnosis was not available). On examination the height of the uterus corresponded to 32 weeks gestation. She was in labor. The fetus was in breech presentation. On pelvic examination, cervix was deviated to left side. Cervical os was closed and minimally effaced. A firm, round mass around 8*8 cms was felt on right side. Ultrasound showed a fetus of 32 weeks gestation with an empty horn of uterus lying on right side. There was a single cervix. There was no history of severe dysmennorhoea or cryptomennorhoea. So a provisional diagnosis of mullerian anomaly of either bicornuate uterus (complete) or a unicornuate uterus (with a communicating horn) was suspected. After informed consent, emergency cesarean section was done in view of breech presentation with intra uterine growth restricted fetus. Infra umbilical midline vertical incision was given on anterior abdominal wall. Intra-operatively, the horrendous picture of abnormal vessels over the uterus was seen (Figure 1). There was a horn of uterus on right side and pregnancy was in left side horn of uterus. She delivered a healthy female neonate weighing 1900 grams. After delivery of the fetus it was found that there was no communication between the cervix and horn of uterus (which was having fetus). Hence a diagnosis of unicornuate uterus with non communicating horn with pregnancy in non communicating horn was confirmed. Additionally, there was abnormal morbid adherence of placenta. Rudimentary horn of uterus with placenta in situ was excised (Figure 2). Subsequently, she had an uneventful recovery. Ultrasound of kidneys revealed no congenital anomaly. Mother and neonate were discharged in healthy condition on day 7 post operatively. Histopathology examination of excised horn of uterus confirmed non communicating horn of uterus with morbid adherent placenta (placenta accreta) (Figure 3). Mother and baby were doing well at 6-week follow-up at the outpatient department.