Mullerian anomalies were first classified in 1979 by Buttram and Gibbons and further revised by the American Society of Reproductive Medicine in 1988. Unicornuate uterus is a type 2 classification with unilateral hypoplasia or agenesis that can be further subclassified into communicating, noncommunicating, no cavity, and no horn. 1 The incidence of uterine congenital anomalies because of Mullerian defects in the normal fertile population is 3.2%. A unicornuate uterus accounts for 2.4%-13% of all Mullerian anomalies. 2 72-85% of the rudimentary horns are noncommunicating with the cavity. 3 Unicornuate uterus with rudimentary horn may be associated with gynaecological and obstetric complications like infertility, endometriosis, haematometra, urinary tract anomalies, abortions, and preterm deliveries. Rupture during pregnancy is the most dreaded complication which can be life threatening to the mother. We report a case of ruptured rudimentary horn pregnancy of 20 weeks gestation which was ultrasonographically diagnosed as intra-abdominal pregnancy and on laparotomy was managed by resection of the rudimentary horn. CASE REPORT A 21-year-old G2A1 with amenorrhoea of five months was referred from district head quater hospital with complains of pain abdomen for two days which gradually increased in intensity, was more in the lower abdomen and associated with vomiting and one episode of syncopal attack. She was married for 3 years and had a spontaneous first trimester abortion one year back. Her menstrual cycles were regular. On admission patient had mild pallor, no icterus, pulse rate was 96/min, blood pressure-100/60 mm of Hg and respiratory rate was 20/min. On abdominal examination there was generalised
Uterine rupture is the primary concern when a patient chooses a trial of labour after a caesarean section. Bladder rupture accompanied by uterine rupture should be taken into consideration if gross haematuria occurs. We report the case of a patient with uterine rupture during a trial of labour after cesarean delivery. Her course of labour went into obstructed labour and failed forceps delivery for which she was referred to our tertiary care hospital. Intra-operatively she was found to be a case of rupture uterus with rupture of bladder and full fetus lying in the bladder which was delivered by giving incision on the anterior bladder wall. Patient had subtotal hysterectomy with repair of bladder done with suprapubic cystostomy. Her postoperative recovery was uneventful. Bladder injury and uterine rupture can occur at any time during labour. Gross haematuria immediately after delivery is the most common presentation. The incidence of rupture uterus and associated bladder injury is on increase due to higher rates of caesarean section. But there are no case reports on full fetus inside the bladder, so it is justified to report this case.
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