article · International Medical Case Reports Journal
A bicornuate uterus is a rare congenital anomaly caused by incomplete fusion of the mullerian ducts, resulting in a single cervix and two distinct uterine horns. Pregnancy occurring within a non-communicating rudimentary uterine horn is exceptionally uncommon and frequently results in uterine rupture or fetal demise. In this report, a twenty-four-year-old woman at twenty-nine weeks of gestation presented with three days of abdominal pain alongside a history of dysmenorrhoea and a prior miscarriage. A laparotomy initially conducted for a suspected abdominal ectopic pregnancy revealed a bicornuate uterus with a gravid, non-communicating right rudimentary horn containing a deceased fetus. Surgeons successfully resected the non-communicating horn while preserving the right ovary. Uterine anomalies remain difficult to diagnose in low-resource settings, underscoring the critical need for clinical awareness and early antenatal ultrasonography to prevent severe obstetric complications.
Congenital uterine anomalies are difficult to identify, particularly in low-resource healthcare environments lacking advanced diagnostic imaging. Failing to detect a pregnancy developing within a rudimentary uterine horn can lead to fatal maternal outcomes, including uterine rupture, as well as fetal loss. Promoting clinical awareness and prioritising early antenatal ultrasound screening enables practitioners to recognise these anomalies and conduct timely surgical interventions before life-threatening emergencies occur.
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Background: Bicornuate uterus is a rare congenital uterine anomaly that occurs due to incomplete fusion of the mullerian ducts during fetal development, resulting in a single cervix and two uterine horns with partial to complete separation with or without communication between the cavities. Pregnancy in a rudimentary non-communicating uterine horn of a bicornuate uterus is an even rare occurrence, usually due to transperitoneal migration of sperms or zygote, and it is often associated with fetal demise and uterine rupture. We report a case of a bicornuate uterus unicollis with a third-trimester fetal demise in a non-communicating rudimentary uterine horn with focus on diagnosis, investigations and management in a low resource setting. Case Presentation: The patient was a 24-year-old Ugandan, gravida 2 para 0+1 at 29 weeks of gestation who presented with abdominal pain for 3 days. She had a history of dyspareunia, dysmenorrhea, and a first-trimester miscarriage four years ago. Laparotomy for an abdominal ectopic pregnancy revealed a bicornuate uterus with a gravid non-communicating rudimentary uterine horn containing a dead fetus. Resection of the right non-communicating uterine horn was done with preservation of the right ovary. Conclusion: Despite the rarity and difficulty in the diagnosis of uterine anomalies in low-resource settings, it is important for clinicians, especially obstetricians and gynecologists, to be aware of a bicornuate uterus with a non-communicating rudimentary horn pregnancy that can lead to fetal demise and uterine rupture. Early antenatal diagnosis by ultrasonography is crucial in prevention of future obstetric complications in low resource settings.
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DOI: 10.2147/imcrj.s621351
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