Live Birth Following a Term Pregnancy in a Non-communicating Rudimentary Horn of a Unicornuate Uterus
Mrs. J.O. was a 32-year old secondigravida who had one previous vaginal delivery of a set of twins. She booked for antenatal care in the index pregnancy at a Catholic Mission Hospital in Cross River State Nigeria at a gestational age of 28+2 weeks. Prior to booking however, the pregnancy had been complicated by intermittent vaginal bleeding, abdominal pain and anemia for which she received care in several private hospitals from the 10th week of gestation to about the 24th week of gestation when the bleeding ceased spontaneously. Ultrasound scans performed in the course of her evaluation for the bleeding revealed different findings from the absence of intra-uterine gestational sac to single intrauterine gestation of compatible gestational age. One scan suggested hemoperitoneum and the possibility of a heterotopic pregnancy. All scans were performed outside the mission hospital.\nAt booking, she had no complaints. General physical examination was normal and the uterine fundal height was compatible with her gestational age with an indeterminate fetal lie. Fetal heart tones were normal. Her packed cell volume was 30.9 L/L and other routine investigations were normal. During her antenatal care subsequently, she only complained of occasional non-specific generalized abdominal discomfort.\nShe had an elective cesarean section at 37 weeks gestation for a persistent oblique breech presentation and a “low lying placenta.” The abdominal cavity was entered through a Pfannenstiel incision. The baby was delivered through a low transverse uterine incision. Difficulty with delivery of the placenta resulted in heavy bleeding and prompted exteriorization of the uterus with the placenta. This revealed a morbidly adherent placenta in a non-communicating compartment in the left uterine cornu. The compartment was continuous with the left fallopian [Figures and ]. Further hemorrhage was controlled by the application of a size 18 G Foley's catheter as a tourniquet at the level of the uterine isthmus such that both uterine arteries and the right infundibulopelvic ligament were compressed. Following this, the rudimentary horn, placenta and membranes were resected en-bloc with the left fallopian tube while preserving the left ovary. The uterine wall was repaired in two layers with No. 1 chromicised catgut. Two units of cross-matched and screened whole blood were transfused intra-operatively. The baby was female and weighed 2.2 kg. She had no obvious anomaly. Post-operative packed cell volume was 30.3 L/L. Mother and baby were discharged on the 6th post-operative day. Post-natal clinic visit at 6 weeks was unremarkable. Histology of the excised tissue showed “oedematous thin smooth muscle layer enclosing dense eosinophilic areas containing a mixture of blood clots, decidual cells and few chorionic villi. Tubal epithelium also appeared oedematous.”